Understanding the Gender Gap in Autism Diagnoses: Differences in Diagnosing Autism in Girls and Boys

Autism spectrum disorder (ASD) affects people of all genders, but research shows that autistic boys are diagnosed at much higher rates than autistic girls. While the reasons behind this gender gap are complex, it mainly stems from differences in how autism symptoms manifest in boys versus girls.

This article will dive into the key differences between autistic boys and girls to shed light on why girls tend to be underdiagnosed. It will also provide guidance for parents who suspect their daughter may be on the spectrum.

Understanding the Gender Gap in Autism Diagnoses
Understanding the Gender Gap in Autism Diagnoses: Differences in Diagnosing Autism in Girls and Boys

Why are Boys More Often Diagnosed with Autism?

Autism diagnoses are around 4 times more common in boys than girls. Here are some of the leading theories that may explain this discrepancy:

Genetic and Biological Factors

  • Some research suggests there may be sex-linked genetic factors that protect girls from developing autism to some degree.
  • Studies also show that elevated fetal testosterone levels could play a role in autism risk. This hormone theory may help explain why more boys are diagnosed.

Diagnostic Biases

  • Many early autism studies focused predominantly on boys, which skewed the diagnostic criteria towards male traits.
  • Diagnostic tests also contain an inherent male bias, as they were standardized using data from autistic boys.
  • Clinicians may miss subtle symptoms in girls or misattribute them to other conditions due to biases.

Differences in Symptom Expression

  • Girls may exhibit less severe autism traits like intellectual disability. This allows them to better compensate for their challenges.
  • Girls tend to have stronger verbal and social communication skills than autistic boys. This masks symptoms during casual interactions.
  • Girls are often better at camouflaging autism mannerisms. They work harder to blend in socially.

While the boy-to-girl diagnosis ratio used to be around 4:1, newer research suggests the real ratio is closer to 3:1. This indicates that many girls on the spectrum are still missed.

Key Differences in How Girls Show Autism Traits

Recent studies evaluating common diagnostic tests like the ADI-R and ADOS reveal some consistent differences in how autistic girls present compared to boys:

Social Communication Style

  • Autistic girls tend to be more passive and reserved, while boys show more disruptive behaviors.
  • Girls rely more heavily on camouflaging techniques to mask social difficulties.
  • Girls have an easier time blending in with neurotypical peers, especially in childhood.
  • Boys show more obvious signs of social delays early on like lack of eye contact.

Restricted Interests

  • Boys exhibit more intense special interests like train schedules or sports stats.
  • Girls have restricted interests like TV shows or music artists, but these appear more neurotypical.

Emotional Regulation

  • Autistic girls are more prone to internalizing problems like anxiety or depression.
  • Boys tend to externalize, showing more confrontational behaviors when frustrated.

Play Style

  • Autistic girls integrate more easily into play with peers, while autistic boys tend to play alone.
  • Girls play often revolves around dolls or pretend play, allowing them to practice social skills.

Language Development

  • Many autistic girls have age-appropriate language or may even be precocious talkers.
  • Boys show more significant language delays and challenges with back-and-forth conversation.

Symptom Severity

  • Girls tend to have less intellectual disability and fewer behavior challenges than boys.
  • High-functioning autism is more common in girls but overlooked due to subtler symptoms.

Co-occurring Conditions

  • Autistic girls have a higher likelihood of epilepsy and seizure disorders.
  • Boys are more prone to conditions like ADHD which amplify autism traits.

Why Are Autism Diagnoses Often Missed in Girls?

Due to the more subtle presentation of autism in girls, many go undiagnosed until later in life. Here are some of the top reasons diagnoses are missed:

Appearance of Normal Social Skills

Girls’ ability to make eye contact, have back-and-forth conversation, and participate in pretend play allows them to fly under the radar in social settings. Their social challenges are less obvious.

Camouflaging Behaviors

Girls work extremely hard to mask social difficulties through strategies like mimicking neurotypical peers, scripting conversations, and preparing responses in advance. This disguise makes their autism nearly invisible.

Passive and Reserved Nature

Since autistic girls tend to be quieter, compliant, and passive compared to boys, their symptoms blend in. Disruptive behaviors that call attention to autism are less common.

Subtler Restricted Interests

Girls’ intense interests generally fit more easily into socially acceptable topics, allowing their fixations to go unnoticed. Their need for sameness is also less disruptive.

Stronger Language Abilities

On the surface, many autistic girls have solid language skills. This masks underlying challenges like literal thinking, grasping nuance, or holding reciprocal conversation.

High Intelligence

Bright girls are able to lean heavily on their intellectual strengths to compensate for social deficits. Their autism traits seem less disabling.

Emotional Issues Viewed as Separate

Internalizing problems like anxiety or depression may be chalked up to mental health issues rather than recognized as part of an autism profile.

Expectations Based on Male Profile

Since the expectations for autism are based predominantly around male traits, girls who don’t fit the stereotypical profile can be overlooked.

Signs to Look For in Girls

While every autistic girl has a unique profile, some red flags that should spark further evaluation include:

  • Extremely pedantic, literal, or black-and-white thinking and speaking style
  • Tendency to monologue or deliver speeches on favorite topics
  • Appearing highly articulate and mature but struggling with true reciprocal conversation
  • Difficulty making or keeping friends despite desire for connection
  • Preference for solitary activities or quiet observation during group play
  • Need for rigid routines, order, and schedules
  • Highly focused interests or collections
  • Unusual sensory sensitivities
  • Aversion to touch, textures, loud noises, or other sensory input
  • Heightened anxiety in social situations
  • Emotional regulation issues like meltdowns or shutdowns
  • Precocious reading skills as a toddler or hyperlexia
  • High intelligence but significant challenges with executive function
  • Clumsiness, gait abnormalities, or fine motor skill delays

If several of these traits are present, an autism evaluation is warranted. Don’t write them off as shyness, anxiety, or simply a quirky personality. Trust your instincts if you suspect autism.

Getting Your Daughter Properly Evaluated

Here are some tips to secure an accurate autism assessment for a girl:

  • Seek out a clinician like a developmental pediatrician who specializes in female autism presentation. Look for one experienced in assessing gifted girls.
  • Provide the clinician with documentation and examples of social and communication challenges witnessed at home and school.
  • Use an autism screening tool designed specifically for girls like the CAST or ASC-ASD to support your case.
  • Highlight how traits like anxiety, sensory issues, and resistance to change impact daily life. Don’t let the clinician dismiss them.
  • If you receive another diagnosis like ADHD or anxiety, request they still assess for autism, as co-occurrence is common.
  • Request they use autism diagnostic tests designed for females, like the ADOS-2.
  • Ask them to interpret test results while accounting for camouflaging skills. Look at history and observed behaviors too.
  • If you receive a negative diagnosis but disagree, seek a second opinion and share documentation.
  • Work with your daughter’s school to request a special education evaluation for autism services.

Persistence and advocacy are key, as autism is often a process of ruling out other conditions. If you think autism is a fit, keep pushing until the right clinician investigates it fully.

Benefits of Accurate Diagnosis and Support

There are many advantages to securing an autism diagnosis for girls:

  • Access to autism-specific therapies and interventions
  • Support services and accommodations at school
  • Explanation for social and communication challenges
  • Greater self-understanding and identity formation
  • Relief of self-blame and misconceptions
  • Targeted help developing coping strategies
  • Assistance with sensory, anxiety, and emotional regulation issues
  • Connection to the autism community
  • Platform for advocating for needs

Don’t give up on getting your daughter the autism recognition and support she deserves. It can change her life trajectory for the better.

Why Specialized Therapy Matters

While general autism therapies help both boys and girls, there are advantages to services tailored specifically to your daughter’s needs as an autistic girl.

Social Skills Groups for Girls

Social skills classes just for girls focus on topics like:

  • Friendship skills
  • Handling conflict, gossip, and exclusion
  • Understanding social cues
  • Perspective-taking
  • Turn-taking in conversation
  • Regulating emotions
  • Self-advocacy skills

This allows girls to learn among peers who share similar struggles in a judgement-free zone.

Targeting Camouflaging and Compensation

Therapists can help girls:

  • Recognize when they are camouflaging symptoms
  • Understand the toll of masking on mental health
  • Practice authentic social interaction
  • Self-advocate for needs rather than just blend in
  • Balance social expectations with self-care

Mentorship Programs

Older autistic girls and women act as mentors, providing:

  • A role model and example of success
  • Insight into navigating girlhood and womanhood
  • Support shifting away from camouflaging
  • Help embracing autistic identity with pride

Social Emotional Learning

SEL programs tailored to autistic girls teach:

  • Identifying emotions in self and others
  • Expressing feelings constructively
  • Managing challenges like bullying, exclusion, or arguments
  • Building self-confidence and resilience
  • Advocating needs without aggression

This directly targets core autism challenges with social-emotional skills.

Individualized Therapy

One-on-one therapy allows girls to work on:

  • Gender identity, puberty, sexuality
  • Making and keeping friends
  • Dating and relationships
  • Reducing anxiety in social situations
  • Handling transitions and life changes
  • Job interview practice and workplace social skills
  • Self-care, wellness, and living independently

The individualized approach ensures programs are designed around the interests and needs of each girl.

Signs Your Daughter Would Benefit from Specialized Therapy

Look for these indicators that therapy would help your daughter:

  • Challenges making and keeping female friends
  • Anxiety or dread around social situations
  • Frequent experiences of exclusion, bullying, or conflict
  • Overly compliant people-pleasing tendencies
  • Lack of assertiveness and self-advocacy skills
  • Poor understanding of social cues and boundaries
  • Difficulty relating to same-age peers
  • Extreme rigidity, inflexibility, and need for control
  • Intense fears of changes, transitions, or uncertainties
  • Inability to identify or express emotions constructively
  • Emotional dysregulation and meltdowns
  • Lack of self-confidence in social abilities
  • Desire for friendships without ability to initiate or maintain them
  • Isolation, loneliness, withdrawal, or depression

If you notice your daughter struggling in any of these areas, specialized therapy can make a big difference.

In-Home ABA Therapy Provides Life-Changing Support

Applied behavior analysis (ABA) therapy offers incredible benefits for autistic girls through its highly personalized and evidence-based approach.

How ABA Therapy Helps Girls Specifically

  • Targets core autism deficits like social skills, communication, and emotional regulation
  • Builds adaptive real-world abilities for school, friendships, and beyond
  • Provides play-based instruction ideal for childhood learning
  • Focuses on generalizing skills to multiple environments
  • Customizes teaching strategies to each girl’s strengths and needs
  • Incorporates special interests into activities to motivate and engage
  • Helps girls recognize camouflaging habits and practice direct communication
  • Teaches self-advocacy and leadership skills
  • Fosters greater self-awareness, confidence, and identity
  • Supports handling gender-specific issues like puberty, sexuality, and societal expectations
  • Reduces anxiety surrounding social situations and change
  • Improves family relationships and ability to articulate needs
  • Enhances school performance and friendships

Benefits of In-Home ABA Therapy

Choosing in-home ABA therapy offers many advantages:

Convenience

Therapy takes place after school right in the comfort of home. No commute to a clinic or office.

Flexibility

Session times can be adjusted based on your daughter’s needs and schedule each week.

Individualization

Therapy goals and activities are tailored specifically to your daughter and family.

Generalization

Skills are worked on in natural home and community settings to promote real-world use.

Intensity

More hours per week of therapy than outpatient programs offer.

Family Involvement

Parent training helps apply strategies across all environments.

Evidence-Based

ABA is backed by decades of research proving its effectiveness.

Continuity

The same therapists work consistently with your daughter for better rapport.

What Sets Jade ABA Therapy Apart?

Jade ABA Therapy in Maryland stands out through:

  • Passionate Clinicians: Our therapists are dedicated to empowering girls on the spectrum and have specialized training in female autism presentation.
  • Research-Driven Methods: We use the most effective evidence-based techniques shaped by the latest autism research.
  • Individualized Programming: Each girl’s therapy is carefully designed around her unique profile, challenges, interests, and goals.
  • Seamless Care: Our clinicians work collaboratively with your daughter’s school, doctors, and other providers for comprehensive care.
  • Ongoing Parent Training: We coach parents in ABA methods to help generalize skills faster.
  • Consistent Support: Your daughter works with the same therapist team long-term for greater comfort and trust.
  • Sensory-Friendly Setting: Our center offers a warm, welcoming environment tailored to the needs of autistic girls.
  • Community Connection: We help girls learn to apply their emerging skills confidently in community settings.
  • Flexible Scheduling: Therapy sessions are scheduled at times optimized to your daughter’s needs.
  • Dedicated Coordination: Our team handles all insurance paperwork, provider communication, and program evaluation.

Get Started Today!

Don’t let your daughter miss out on the support that could change her life. ABA therapy through Jade lays the foundation for a bright future. Get in touch today to schedule your free assessment!

Call (410) 616-0901

Email info@jadeaba.org

Our passionate clinicians can’t wait to help your daughter thrive through personalized, play-based ABA therapy in the comfort of home. Let’s get started on the path to success!

References

  1. Ochoa-Lubinoff, C., Makol, B. A., & Dillon, E. F. (2023). Autism in Women. Neurologic clinics, 41(2), 381–397. https://doi.org/10.1016/j.ncl.2022.10.006
  2. Ratto, A. B., Kenworthy, L., Yerys, B. E., Bascom, J., Wieckowski, A. T., White, S. W., Wallace, G. L., Pugliese, C., Schultz, R. T., Ollendick, T. H., Scarpa, A., Seese, S., Register-Brown, K., Martin, A., & Anthony, L. G. (2018). What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills. Journal of autism and developmental disorders, 48(5), 1698–1711. https://doi.org/10.1007/s10803-017-3413-9
  3. Tillmann, J., Ashwood, K., Absoud, M., Blöte, A., Bonnet-Brilhault, F., Buitelaar, J. K., Calderoni, S., Calvo, R., Canal-Bedia, R., Canitano, R., De Bildt, A., Gomot, M., Hoekstra, P. J., Kaale, A., McConachie, H., Murphy, D. G., Narzisi, A., Oosterling, I., Pejovic-Milovancevic, M., Persico, A. M., … Charman, T. (2018). Evaluating Sex and Age Differences in ADI-R and ADOS Scores in a Large European Multi-site Sample of Individuals with Autism Spectrum Disorder. Journal of autism and developmental disorders, 48(7), 2490–2505. https://doi.org/10.1007/s10803-018-3510-4
  4. Dean, M., Harwood, R., & Kasari, C. (2017). The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder. Autism : the international journal of research and practice, 21(6), 678–689. https://doi.org/10.1177/1362361316671845
  5. Autism Research Institute. (n.d.). Autism and Seizures. https://www.autism.org/autism-seizures/
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