Contributor: Thomas Frazier, II, PhD
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When you think of “autism,” does a male child come to mind?
It’s understandable if you answer “yes.” Past estimates have suggested that for every female on the autism spectrum, there are three to four males. On the high-functioning end of the spectrum, estimates have been even higher — in the ream of nine males to one female.
But those estimates are changing as we learn more about girls and women with autism. Autism affects females, too. It just affects them differently. In some cases, symptoms are more severe, while in others, they’re less obvious.
Different gender, different symptoms
When we work to diagnose a child with autism, we look for certain signs. Restricted interests are one of the biggest.
Does a child fixate on Pokemon or trains at the exclusion of everything else? Is a toy dinosaur the center of a child’s universe, at the expense of social interaction with family and peers? Paired with issues with social skills, these signs can help us diagnose a child — and get that child the necessary services to improve.
“Nobody likes to recognize stereotypes, but in this case, focusing on stereotypical male behavior may actually be harming girls who need care.”
Thomas Frazier II, PhD
Director, Center for Pediatric Behavioral Health, Center for Autism
However, in a study that included more than 300 girls with autism, females showed less restricted interests than their male counterparts.
That makes getting the right diagnosis harder. It may even be a reason girls with autism are underidentified, or given a different diagnosis, such as social communication disorder.
But here’s what we don’t know: Do females with autism actually have less restricted interests, or are we just better at looking for traditionally male behavior?
Nobody likes to recognize stereotypes, but in this case, focusing on stereotypical male behavior may actually be harming girls who need care.
Other differences between males and females with autism depend on age and placement on the autism spectrum. For example, lower-functioning females tend to have poorer communication skills and lower cognitive levels than males in the same situation. Unfortunately, that means they might get labeled as developmentally delayed but lack an autism diagnosis.
Things change as girls age, too. For instance, adolescent girls tend to show more irritability than males. More troubling, they have a higher risk of behavior such as aggression or self-injury.
What these differences mean for parents and practitioners
For people at centers for autism who work with children, understanding the differences between males and females with autism matters.
Why? Because we have to tailor our approach to match a patient’s needs. And because we don’t want kids, teens or young adults to slip through the cracks and miss out on services that can give them a better life.
Research will continue, not only into these differences but also into the genetic factors that may help “protect” girls from autism. But the data we have now suggests it’s time to revisit how we diagnose females.
For parents and others caring for girls with autism, my message is to be proactive and protective. For example, lower-functioning girls with poor communication skills may benefit greatly from closely integrating speech and behavioral therapy. Treatment should focus both on improving communication and decreasing the impact of any compulsive or inflexible behaviors.
As for higher-functioning girls, remember what a vulnerable time adolescence can be. Then remember autism increases that vulnerability. Knowing that girls with autism have a higher risk for irritability and self-injury makes it that much more important to get them the behavioral help and support they need.