Attempting to identify signs of ASD in children can be challenging, but it can be especially precarious for parents of girls. The crucial first step in identifying ASD in female children is acknowledging the fact that ASD symptoms present differently in females than males at all ages. The second step for parents is learning what those differences are and what behavior to be on the lookout for. To assist in this process, we’ve compiled information to help parents have a better understanding of Autism Spectrum Disorder, why girls often go undiagnosed, and the many ways in which ASD symptoms can present differently in girls.
What is ASD?
According to the CDC, Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder and is characterized by certain behaviors that fall into two groups:
- Deficits in communication and social skills
- Presence of restricted or repetitive behaviors
Cognitive abilities, language skills, and social behavior can vary widely from individual to individual, and children with ASD may exhibit some or all of the following indicators, and they may do so to varying degrees, hence the “spectrum” that is ASD.
Communication/Social Indicators:
- Failure to respond to their own name
- Aversion to displays of affection
- Preference for solitary play
- Difficulty having a back-and-forth conversation
- Lack of eye contact
- Difficulty reading body language and emotions in others, responding appropriately to social situations and understanding social relationships
Restricted/Repetitive Behaviors Indicators:
- Performing repetitive actions and rituals
- Becoming fixated on minute details and minor changes in daily routine to the point of disruption
- Lining, sorting, or organizing toys vs. playing with them
- Showing an obsessive interest in a specific subject or object
- Experiencing sensory sensitivities
Read more: Autism Inclusion in the Classroom Requires a Shift in Training and Approach.
Why do girls go undiagnosed?
For every four male children diagnosed with ASD, only one female is. Only recently are researchers finding that this difference has less to do with the number of girls who meet ASD criteria and more to do with ASD indicators being overlooked in girls. The reason for this lies squarely on the shoulders of us as a society, specifically our societal expectations of stereotyped gender roles. Children are socialized to behave in specific ways based on gender, and adults are then socialized to expect certain behaviors in children based on the same gender stereotypes.
Many girls whose symptoms are unmistakable do get diagnosed at an early age, but girls whose ASD symptoms are subtle can slip through the cracks. A core indicator of ASD is a reserved, withdrawn demeanor, but stereotypically girls are expected to behave in quieter ways that are precisely reserved and demure in comparison to boys. This means that a girl with ASD who presents as shy and withdrawn could be perceived as simply displaying typically “feminine” traits and labeled a “daydreamer” while a boy with similar withdrawn traits might be identified as presenting ASD symptoms much sooner because he lacks the boisterous and assertive traits stereotypically associated with “masculinity.”
Additionally, because females are socialized to be people-pleasers and are often expected to put politeness and the comfort of others first, girls even at a young age can become masters at hiding their symptoms in an effort to fit in with peers and avoid being bothersome to their family.
Also, it’s common for girls with ASD to appear socially competent at an early age because they are mentored by peers, an act that serves as a sort of protective umbrella buffering the girl from social and communicative trouble spots. But this protection does not last as peers move on to other friends and interests, leaving the girl with ASD vulnerable and likely undiagnosed and untreated.
A final reason that girls with ASD indicators are not diagnosed properly is that they’re often misdiagnosed altogether, with their ASD being mistaken by physicians for everything from ADHD to OCD to even Anorexia.
Girls vs. boys
A simple way to understand how signs of ASD in girls often present in subtle ways that can be overlooked is to compare the lesser-known indicators in girls to the more well-known signs in boys.
| Boys with ASD | Girls with ASD |
|---|---|
| Interests and areas of play are rigidly repetitive and limited | Interests and areas of play are more flexible and broad + less repetitive |
| Less likely to respond to non-verbal communication such as pointing or gaze following | More likely to respond to non-verbal communication such as pointing or gaze following + are more focused and less prone to distraction |
| Social communication issues are challenging very early | Social communication issues can be manageable at early ages but become less so as they enter adolescence |
| May tend to engage in disruptive behavior to gain possessions | May tend to engage in disruptive behavior to get attention |
| Less likely to suffer from anxiety or depression | More likely to suffer from anxiety or depression |
| Obsessive Interests: more likely to focus on things like scheduling, statistics, and transportation which are more easily recognizable as out of the ordinary | Obsessive Interests: More likely to focus on things like celebrities and pop culture which are less recognizable as out of the ordinary |
| More likely to behave aggressively vs. being passive or withdrawn | More likely to present as passive or withdrawn vs. behaving aggressively |
Conclusion
Simply by being aware of the subtle yet significant differences in the ways ASD presents in girls, parents with concerns about their child’s development will be armed with the necessary tools to ensure early diagnosis, timely and effective treatment, and the best health outcome for their child.
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