Why is it harder for girls to be diagnosed with autism?
“Boys are four times more likely to be diagnosed with autism than girls.”
While this is a factual statistic reported by the CDC, the underlying critical problem is that autistic girls, especially those that possess the capability to “test out” better, are either overlooked, misdiagnosed, or diagnosed later in life.
On average, girls with mild symptoms of autism are diagnosed two years later than boys, however, girls often go undiagnosed into preteen and teenage years, as well as into adulthood.
Below we explore some common reasons why a diagnosis is missed in girls.
“But You Don’t Act Autistic!”
Let’s start with some insight from the real-life “lost girl” experiences and wisdom that Jude Clee, writer, teacher, and NeuroClastic blogger, shares with the world.
“If my parents had taken me to the doctor and said, ‘We think our daughter’s autistic,’ they would’ve been laughed out of the office…but here’s the thing: I was an autistic child.
I am an autistic adult.
And I’m not alone; there are many girls and women and non-binary people like me, who’s autistic traits go unrecognized because of their gender.
Because as it turns out, autistic girls often present differently than autistic boys, and even mental health professionals are not always aware of the signs.
Girls tend to be better at masking. Girls are often hyper-aware of social interactions, either because of biological differences or the way they were raised (personally, I think it’s more of the latter). They become mimics, masking so often that when they do come out as autistic, they get a lot of, ‘But you don’t act autistic!’
There are consequences for overlooking girls. The girls themselves are no less autistic just because they aren’t diagnosed. I always knew that I was different but didn’t know why. If someone told me, ‘Jude, you’re autistic, and that’s okay,’ it would’ve saved me years of painful questions.”
Diagnosis Criteria is Based on Boys
Screening criteria and autism diagnostic tools are based on data collected mainly from the studies of autistic boys, which hinders the correct diagnosis of girls.
Historically, the diagnosis of autism has been more common in boys than girls, so scientists have focused their research on boys.
The girls that were identified as autistic in these studies, however, had lower intelligence and more severe symptoms.
Girls that presented milder symptoms and fewer social difficulties were overlooked.
Presentation Differences Between Autistic Girls and Boys
Professionals are beginning to identify behavioral differences between similar-age autistic girls and boys.
Numerous studies have identified that autistic girls display less repetitive and less restrictive behavior than boys.
Difficulties with social skills and socialization are a large part of autism’s range of symptoms and are specifically included in most diagnostic guidelines. This presents a diagnostic disservice to autistic girls because girls typically score much higher than boys in social skills, autistic or not.
Autistic girls are more likely to possess the ability and desire to communicate and connect socially, compared to autistic boys, who historically have less intrinsic competency and skill to manage and participate in social situations.
Autistic girls also possess a much greater capability to camouflage social struggles, compared to boys.
Later in life, such as in the teenage years, the challenges escalate for autistic girls as social relationships become more complicated, and this increases the likelihood of developing mentally challenging offshoots such as depression, anxiety, and poor self-esteem.
When presented, professionals and clinicians often fail to dig deeper and identify social dysfunction caused by autism.
Girls Misdiagnosed with ADHD
Autistic girls are commonly misdiagnosed with ADHD (attention deficit hyperactivity disorder) due to the overlapping of symptoms, such as difficulty concentrating and impulsivity, and less often, lacking social skills, and repetitive behaviors.
Fixation is a common symptom of autism that looks different in boys than it does in girls.
An autistic boy, for example, can have restricted interests, and he may be fixated on single topics or objects, such as planes, but even more so, his entire focus might rest on schedules or flight numbers associated with planes.
Autistic girls, however, display fewer signs of restricted interests.
An autistic girl may, for example, be fixated on dolls, and she may want to dress all her dolls in the same colors, and she may not want anyone to disturb or play with her dolls, but she is not fixated on just one aspect of her dolls, and her focus on dolls (or other interests) appears appropriate for girls, neurodiverse or not.
She may also have a variety of other interests that mask fixations, compared to autistic boys who might center their attention around one fixation.
Fixated interest is a less common symptom of ADHD, and in most situations, if there is a hyper-focus on any object or topic, it is not long-lasting (as it is in autistic individuals), therefore, because fixation is less common in autistic girls, but more common in autistic boys, autistic girls are more likely to be misdiagnosed with ADHD.
It is more than frustrating for girls and women, to believe that they have autism and have been overlooked or misdiagnosed.
We understand, and we want you to know that you are not alone with this.
If you are a parent of an autistic child, are trying to navigate an autism diagnosis, or are suspecting a misdiagnosis, our online learning community is designed for parents to find connections and support, with access to the most current resources, and an open door to reach out for professional consultation if additional help is needed.
It is not just for boys or girls. It is not just for younger children. You are never too old for RDI. You are never too young for RDI. We have consultants that specialize in adults, teens, or children so it is never too late to start!
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