Women and girls experience autism very differently to boys and men
It’s still more common for men and boys to receive a diagnosis of autism. Lorna Wing found in her paper on sex ratios in early childhood autism that among people with 'high-functioning autism' or Asperger syndrome, there were as many as 15 times more men and boys diagnosed as women and girls, and experts are only just starting to see that this has a lot more to do with the diagnostic process than with actual rates of autism amongst females...
It's increasingly believed that autistic women and girls may be better at masking their difficulties, possibly due to evolutionary biological tendencies and/or social 'rules' about 'fitting in' and pleasing others. The majority of historical research into autism and ASD has been undertaken with male subjects, and so a difference in how boys and girls present leads to autism being missed in females. The suggestion is that high functioning women and girls with autism are therefore even more likely to be have been underdiagnosed due to their ability to mask their symptoms, compared to men and boys.
Just because women and girls appear to be coping better with their autism, it doesn't mean that underneath they are. So its important to recognise the differences in how girls with autism present...
Signs of autism in girls
Some say that the diagnostic criteria for autism is biased towards boys. Diagnosis of ASD is usually based on the triad of impairments, identified by Wing and Gould in 1979, but there are key differences to look out for in girls, as we shall see below. With Asperger's syndrome, girls can present differently again to boys in each of these areas of impairment.
(Holtman et al., 2007)
- Boys with ASD tend not to appear motivated to be socially interactive, but girls on the spectrum do, whether due to biological or social differences in what they believe they 'should do'. However, girls have a history of failure in achieving and maintaining friendships.
- Girls may gravitate towards older girls, who tend to mother them and act as a form of social “protection”.
- Girls may equally be socially immature and have a preference to play with much younger children who are not challenging and would allow the child with ASD to dominate play, giving them the predictability and control children with autism crave.
- Girls with Asperger’s may “adopt” a less able peer, perhaps someone with a learning difficulty, who may themselves be marginalised so they are open to being dominated by the child with ASD.
- Girls with Asperger’s may be unnecessarily dependent on their mother (or other primary carer) whom they regard as their best friend and confidante in a social world which they find challenging and frightening.
- Boys engage in disruptive behaviours, whereas girls may be persistently “ill” to gain what they want or control their situation.
- Girls with ASD tend to act passively and ignore daily demands, while boys become disruptive in response.
- Girls appear more able to concentrate than boys, who become distracted more easily and can be disruptive.
- Girls tend to learn social behaviours by observation and copying, which can disguise their social deficits. But closer inspection can reveal that they don't truly understand why certain social behaviours are undertaken by the rest of the population.
- Girls may find the idea of social hierarchy difficult, so they can respond inappropriately to people in authority, such as teachers.
- Children with ASD of both sexes need to learn the rules of “small talk” which they often find incomprehensible as a pastime. Girls’ difficulties tend to be masked by their passive behaviours and ability to mimic without understanding.
A proper diagnosis and full assessment of needs requires more than a checklist. It is only by asking the right questions, taking a developmental history, and observing the person in different settings that it becomes clear that the individual has adopted a social role which is based on intellect rather than social intuition. An expert diagnosis from a medical professional is the only way to know for sure.
Helping girls with autism
Girls with autism still experience a lot of the same sensory difficulties as boys and can end up feeling overwhelmed when bombarded with too much sensory information (e.g. sounds, smells or crowds of people). In girls, particularly when they're not recognised as being on the spectrum, meltdowns carry all sorts of negative connotations and risk her being branded with any number of negative nicknames; "a right madam" being one of the more tame. This only goes to compound the difficulties she experiences and is why its so important to understand what she is feeling and to find ways to help her reduce any feelings of frustration rather than forcing her to 'fit in'.
Calming sensory equipment (sometimes referred to as snoezelen), can provide an ideal solution for helping anyone, whatever their abilities, to relax when things get too much. An appropriate sensory space provides the opportunity to step away from the overwhelming situation, and the calming lighting, relaxing sounds and peaceful surroundings can have a profound effect on autistic girls' well-being, state-of-mind and ability to continue their day.
All aspects of a girl with autism's experience are inextricably linked to her gender. On the 'lighter' end of the scale is the example of how people with autism may be more adverse to certain textures than their neurotypical peers. This can be more troublesome for girls than for their male counterparts because the styles and textures of girls clothing often tend to be designed more for looks than comfort. Your daughter may refuse to wear certain items of clothing because "they hurt". This feeling is very real for her, and removing labels or allowing her to wear the shoes or clothes she chooses can prevent the distraction and hinderance to her concentration that she needs in order to function, happily, in her daily life.
However, on the more dramatic end of the scale, due to the social difficulties that come with autistic spectrum disorders, girls with autism may find themselves more likely to become victims of eating disorders, they may face a harder time than the average woman navigating the social expectations on females, puberty, sex and relationships, and they will likely need more guidance than their neurotypical peers in how to stay safe from sexual predators. ¹
If undiagnosed, women and girls, or indeed anyone with autism, ASD or any other spectrum disorder may not realise that the way they perceive the world and attempt to navigate it feels any different for anyone else. A diagnosis can often provide a huge amount of relief for both them and their loved ones, by enabling them to get the help and support they need. Understanding her experience and working with it to help her feel relaxed and capable of navigating through a hugely complex world, can be live changing.