Statistics tell us that autism spectrum disorder is far more common in boys than in girls. However, recent research says otherwise. The more we learn about autism and how it affects boys vs. girls, two things become very apparent. 

The first is that, unfortunately, girls with autism are woefully underdiagnosed (about four boys for every one girl: 4:1) (frontiersin.org). In fact, cross-study reviews indicate that the actual difference may be closer to 2.3:1. The second is the reasons for this mis- or delayed diagnosis are directly related to a combination of cultural misunderstandings about ASD and the fact that autism can differ between boys and girls. 

Additionally, current, more comprehensive research indicates that early intervention with high-quality applied behavior analysis and whole-family education and training substantially supports whole-child well-being and development in children with ASD.

Common Ways Autism Spectrum Disorder (ASD) Is Different For Girls

In addition to some differences in how autism shows up in boys compared to girls, researchers have also demonstrated that there are physiological differences. For example, “A new study led by UC Davis researchers finds widespread differences in brain development between autistic boys and girls ages 2-13. The study, published recently in Molecular Psychiatry, found sex-specific changes in the thickness of the outer layer of the brain, called the cortex (ucdavis.edu). 

The more we assess physiological and biochemical differences between boys and girls, particularly between the ages of 0 - 13, after which those differences even out, the more it makes sense why girls are at higher risk of experiencing misdiagnosis or delayed diagnosis.

If you were to read a typical list of ASD signs or symptoms, it would read something like this:

• Limited eye contact (avoiding or not maintaining eye contact, even with close loved ones).
• Not recognizing typical social cues via words, facial expressions, tone, or body language.
• Trouble identifying emotions in self/others.
• Poor response to being called by name. 
• Delayed speech, which results in a noticeable delay in babbling, first words, or using gestures (many children with ASD remain non-verbal for much longer than their peers or indefinitely). 
• Not understanding the back-and-forth nature of conversations or of sharing feelings, which can lead to one-sided conversations. 
• Not understanding figurative language, humor, or sarcasm (taking things literally).
• Prone to repetitive movements (stimming) such as rocking, hand-flapping, or spinning.
• Obsessive about organization or the lining up/ordering of objects/toys/dinner place settings, etc.
• Unusual and fixated focus on particular subjects (commonly celestial, dinosaurs, mechanical things, a particular country/culture, etc.
• Upset by changes to daily routines.
• Overly- or underly-sensitive to sensory input such as sounds, lights, textures, smells, or physical sensations (while some children may meltdown if their socks aren’t aligned properly, others can be outside in freezing temps without a coat on).
• And so on.

This is a general overview of common signs and symptoms of ASD, all of which are evident in the first seven years of life. However, this list doesn’t necessarily apply to girls the same way it applies to boys.

How ASD symptoms can differ in girls

When we say that ASD is different for girls, it can be misleading because many of the neural differences, challenges, or co-occurring disorders may be very much the same. However, the biological differences - largely hormonal - between girls and boys can affect how they exhibit ASD, and this leads to the “differences” we talk about below.

While all of those symptoms can and do apply to girls, we’re learning that the biological and hormonal makeup of females can “override” some of those same indicators. 

When girls have ASD they are more likely to:

• Mimic those around them in order to fit in (camouflaging), without really understanding the social cues. This becomes exhausting.
• Repressing or hiding their stimming or hyper-reactivity to sensory overload/stimuli (this can make girls with ASD more prone to eating disorders or self-harm as a way to release their feelings and reclaim a sense of control).
• Avoiding or not seeking social interaction (which makes it harder to notice the social challenges or idiosyncrasies that may be more evident in males).
• More apt to keep their social distress or meltdowns in when they’re in public, but release them at home instead.
• Having intense empathy or emotional connection to others (contrary to popular ASD myth), but internalizing it so that it isn’t obvious or recognized by peers/adults from the outside.
• Having a limited number of close (almost obsessive or intense) social relationships (often overwhelmed by larger groups), but those relationships can be easily upset, fragile, or prone to falling apart as a result of the girl's struggles with understanding the social cues, mimicking them, or because they struggle with disruptions in routine.
• Intense interests that tend to center on art, culture, music, or animals as opposed to cars/planes, robots, Legos, dinosaurs, or the cosmos (more common to their male counterparts).
• Preparing speeches/conversation topics, jokes, or plans in advance so they feel they can participate in the group without as much anxiety, confusion, or embarrassing (or hurtful) misunderstandings.

Again, ASD is a neurodivergent diagnosis, and all of a person’s symptoms fall across a spectrum. Many of us are prone to some of these symptoms (and some may be experienced with greater intensity than others). 

If a child has ASD, it can be screened for by their pediatrician, school social worker/therapist, or a qualified, experienced behavioral therapist or child psychologist with expertise in ASD diagnosis, which can help establish an accurate diagnosis and ensure they receive the intervention and support they need.

Puberty can exacerbate ASD differences between girls and boys

There is still a tremendous amount of research to be done when it comes to understanding the differences between sex-assigned at birth and hormones (endocrine system), the nervous system - and how all of those affect the whole child and whole person. However, there is no doubt that puberty exacerbates some of the differences we see between boys and girls with ASD.

For example, girls with ASD tend to enter puberty earlier than boys with ASD, and girls with ASD also tend to have higher rates of gender “body incongruence” (dysphoria) than males (autism.org)

Red Flag: When a child has more than one co-occurring disorder

Take note if your daughter or son exhibits symptoms of more than one of the common, co-occurring disorders associated with ASD. It could be that they are on the autism spectrum and it hasn’t been tracked by their pediatrician, day care providers, or teachers. 

This is not uncommon - especially if your child is high-functioning or you have a daughter whose successful social camouflaging has allowed her ASD to fly under the radar. Examples of co-occurring disorders associated with ASD include.

• ADHDAttention-Deficit Hyperactivity Disorder).
• OCD (obsessive compulsive disorder).
• Sensory processing disorders (SPD)
• Extreme social anxiety.
• Gastrointestinal (GI) disorders or an eating disorder.
• Epilepsy
• Additional mental health disorders, such as depression, anxiety, bipolar disorder, etc.)

While all of these can be stand-alone, neurodivergent diagnoses, multiple co-occurrences are worth looking into to ensure your child - and your family - are getting the education, training, tools, and support they need to navigate daily life - and academic life - with greater ease and well-being.

Autism Response Team of North Texas is Closing The Gap in Gendered ASD Support

The Autism Response Team is dedicated to supporting individuals and their families navigate daily life with greater ease, self-awareness, and support - at home, in the classroom, and within the community. Do you suspect your daughter may be flying under the radar of an ASD diagnosis? Have you been misled by outdated information about ASD and how it differs between boys and girls?

We are here to help! Contact us to schedule a consultation to learn more about our services and resources. We can help you complete high-quality assessments that provide accurate diagnoses, answers to your questions, and a personalized plan for positive, actionable progress and growth.