Autism Diagnoses in Girls

"Many parents of girls with autism spectrum disorders (ASD) report spending much of the early years on an emotional rollercoaster. On the one hand, they are excited and celebrate their daughter’s developmental milestones, yet, they become increasingly concerned and anxious over puzzling behaviours."
"Parents are faced with barriers from medical doctors and psychologists to explain these sometimes severe and unusual behaviours. “I have been told by my own physician that ‘there is nothing wrong with your daughter’, and you start believing it is all in your own head” (Walker, 2012).
Obtaining an ASD diagnosis for a female can be very challenging with scant research and available answers from professionals."
"Autism was first reported by Leo Kanner in 1943 and since that time there has been thousands of journal articles and wide-spread international attention. Yet, there is a paucity of scholarly research focused on females with ASD. Although there is some recent discussion regarding the exact ratio of males to females, the most widely reported male-to-female ratio for ASD is 4:1 (Halladay, 2014). Dr. Hans Asperger originally reported in his seminal research on a milder form of autism (1944) that:

In the autistic individual the male pattern is exaggerated to the extreme… It could be that autistic traits in the female only become evident after puberty. We just don’t know. (Frith, 1991, pg. 85)."

Dr Lori Ernsperger, PhD, BCBA-D, US expert on Autism Spectrum Disorder in girls and women.

Images by artist Rosanna Rosetti

Autism has long been considered to be an emotional dysfunction affecting boys, seldom girls. There were scientific studies attesting to the conclusion that boys overwhelmingly presented with autism as opposed to girls, at a four-to-one ratio. But now new research has developed to the point where a re-think of the assumption is required with the realization that it does not reflect reality. Girls too are assailed with Autism disorders, but their symptoms tend to be far more subtle and quite unalike those experienced by boys, hence the lag in understanding that the theory has little substance.

Autism represents a spectrum of characteristics that are as different in every individual, just as individuals are themselves unique in character development traits and personalities. It is a complex neurobiological condition. And diagnosis has been reliant on assessments of behaviours. No brain scans or blood tests can diagnose the presence of autism. And since boys have a tendency to exhibit obvious symptoms of atypical behaviour, they are easier to diagnose, leaving the impression that they monopolize the autism spectrum disorder.

Boys typically like being among others similar to themselves and boys tend to be noisy and active, curious and often given to stretching the boundaries of age-permissive, curiosity-driven activities. So when a boy withdraws from that type of typical interaction, preferring to be off on his own, fascinated with his own version of curiosity-driven, but solo action as opposed to group activities, alarm bells ring. Boys are simply easier to categorize in their actions.

When girls behave in a withdrawn manner, preferring to be on their own, reading, playing with their possessions, behaving in a  elf-contained manner in preference to joining other girls doing similar things together, it was typically viewed as ordinary behaviour for certain types of girls. Which is not to say that both boys and girls exhibiting extreme symptoms of disorder are not more readily identified and as such are both diagnosed in equal numbers.

It is girls who display less obvious mannerisms of unsociability and difficulty in responding normally who go undiagnosed and as such, untreated.

Girls on the less extreme of the spectrum of behaviours tend to be overlooked. While girls who exhibit similar behaviours to boys when both are at the extreme end of the spectrum, are diagnosed at rates equal to boys. Parents are often informed that despite their concern over their daughters' behaviours that appear out-of-the-ordinary, using the typical yardstick of expectations, their daughters cannot possibly be on the spectrum.

Instead, these girls who are obsessively neat, or withdrawn because they appear shy and their characterizing manners are to be quiet and focused on dolls or books, these behaviours are still considered to reflect normal behaviour for girls, as being typically female. Doctors instead tend to diagnose such girls with attention deficit hyperactive disorder (ADHD), or alternately obsessive compulsive disorder, because they have become so accustomed to recognizing male symptoms of autism.

So when these incorrect diagnoses occur, there is no move toward appropriate early childhood intervention whereas with a correct diagnosis what follows is a spectrum of social and educational support ranging from educational accommodation, to special social services reaching out to give aid. In response to the new reality, however, doctors are now designing different types of services appropriate to meet the needs of girls whose parents have been demanding recognition of their daughters' aid requirements to offset their autism.

New guidebooks informing how to react throughout puberty and helping girls to establish social relationships have resulted from new diagnostic tools identifying the presence of autism spectrum now being increasingly diagnosed in girls.

The general consensus is that females with ASD exhibit:

• Increased social imitation skills,
• A desire to interact directly with others,
• A tendency to be shy or passive,
• Better imagination,
• Better linguistic abilities developmentally, and
• Interests that focus on animals or people.

 (Lai, Lombardo, Auyeung, Chakrabarti, & Baron-Cohen, 2014).

Images by artist Rosanna Rosetti