Current research seems to indicate that autism can present very differently in girls than it does in boys. This could explain why the current rate of diagnosis for girls is so much lower than for boys – doctors are using the diagnostic criteria developed to detect ‘male autism’.
Throughout the history of research into ASD, it has been focussed on males. Diagnostic tools were developed according to male traits (Gould and Ashton-Smith, 2011). It is likely that the way in which autism and Asperger’s presents in girls has simply not been adequately researched. Indeed, it is only in the last 5-10 years that any attention has been focussed on girls and the female presentation of autism.
So how does this help?
Well, autism is characterised by speech delays, and also impairment in three main areas – Social Interaction, Communication and Imagination. These are the ‘triad of impairments’, as categorised by Wing and Gould in 1979.
(Holtman et al., 2007)
- The motivation to interact socially appears to be different in girls than boys. Boys tend not to be motivated to interact socially, whereas girls do – they just struggle to achieve and maintain friendships.
- Girls either gravitate towards older girls, or else prefer much younger children. The reasons for this are varied, but an older girl might provide a level of social protection as they ‘mother’ the younger girl. On the other hand, a much younger child would tend to allow the child with ASD to control the play more, providing more predictability and control. Similarly, girls with Aspergers might look for a less able peer (maybe with a learning difficulty themselves), who would allow them to dominate play in the same way.
- Girls with autism or Asperger’s can become overly dependent on their mother (or other primary carer). They tend to regard them as their best friend – a constant in a world that they can often find challenging and even frightening.
- Girls and boys each try to control the situation they find themselves in. Boys tend to display disruptive behaviour (which is why they are often noticed earlier), but girls tend to feign illness to achieve the same level of control.
- Boys often become disruptive in response to daily demands, whereas girls simply ignore them.
- Girls often have a better ability to concentrate than boys. Boys can often become distracted more easily and be disruptive.
- Maybe because girls are more socially motivated than boys on the spectrum, girls can pick up and learn social behaviours by observation and copying. This isn’t something that comes naturally to them, but they can often better disguise their lack of social skills.
- One of the most common beliefs about autism is that people with autism cannot ‘pretend play’. Again, this is a very male definition of autism. Girls with autism do play imaginatively, but it is often intensely focused on often very sterotypically female interests – dolls, animals, make-up, celebrities… Because these interests don’t stand out as being odd for a girl, it’s often not as obvious to identify. The difference between a girl on the spectrum and one not is often the intensity of these special interests.
It would appear that many girls on the spectrum are much less noticeable than boys, because they are less disruptive generally, and have an ability to mimic behaviours without understanding (Attwood, 2012). However, this is only surface deep – underneath they still lack social understanding, and often have no deep knowledge of language.
If we are more aware of the differences between girls and boys and how autism presents in them, we can help more girls to access the support they need to thrive earlier.