Are girls with Autism under-diagnosed?

Autism Daily Newscast continues our series on why boys are diagnosed far more often to be on the autism spectrum than girls. The statistics show a ratio of 4 to 1, although some experts are questioning whether this number is accurate.

Recent studies have shown that the early signs of autism may not be as apparent in girls, leading to fewer girls being diagnosed.

The National Autistic Society’s Lorna Wing Centre in the United Kingdom presented a paper in 2011 outlining some of the differences in how autism presents itself in girls. Their researchers found that girls were more likely than boys to follow social actions by delayed imitation. They were also more interested in social interaction, but tended to be followers rather than leaders. Many girls engaged in pretend play and even had elaborate fantasy lives and imaginary friends. Their obsessive interests tended to be in areas that other girls were interested in, such as princesses or ponies, making them less noticeable than the restricted interests demonstrated by boys on the autism spectrum.

While girls with autism were shown to be more socially aware than boys, they still rarely engaged in small talk or social “chit-chat,” and they often showed a lack of awareness of social hierarchy.

Girls with autism are also less likely to engage in the type of aggressive, problematic behavior that many boys with autism can exhibit. Many younger girls with autism are seen as shy. Renee Buskirk, special education specialist for Fort Wayne Community Schools in Indiana, says,

“Before middle school, a girl’s symptoms may be masked, in part, because of how girls are socialized in our society. We raise them to avoid outward behaviors like aggression. Instead, they’re quiet and polite. It’s only later that we notice it goes beyond shyness. That these girls are not picking up on teenage girl talk.That they’re becoming socially isolated.”

These differences make it less likely that girls will be diagnosed at an early age. It’s possible that the gender gap in autism is not as vast as it now appears to be.

Radha Kolthari, a research associate with University College London’s Institute of Child Health, says,

“If girls with ASD are developing strategies to compensate for ASD-like traits, then it is possible that they are less likely to be diagnosed. Much of the research conducted on autism, which goes on to define our idea of the disorder, is conducted on males rather than females. This creates a cyclical system, in which our understanding of ASD is mainly based upon presentation of it in males, which means that more males are likely to be diagnosed.”

If girls with autism are less likely to be diagnosed at an early age, then they are also less likely to receive early intervention, which can have a dramatic effect on long-term outcomes. While it certainly appears that autism is more likely to affect males, there is a need for further research to make sure that girls who are affected by the disorder are not being overlooked.