I have recently been working with clients who are asking questions about Autism in girls. While girls have always comprised a smaller percentage of this population than boys, I am wondering if the recent Pandemic of COVID19 is helping us to notice this process of interaction in girls. Families are spending much more time together which naturally leads to more interactions and more opportunity to observe the micro-interactions that are so important in identifying Autism in girls.
The March 1, 2016 issue of Science magazine has an excellent article on girls with autism: “Autism: It is Different in Girls” by Maia Szalavitz. She unfolds the story of a leading expert on Autism who did not recognize the signs of this disorder in his own daughter even though he had an older son already diagnosed with the disorder. Clearly the signs are different and like most other research on the human condition, the studies have been focused on males and not females. Some day our society will have to answer this question: why do we choose to study and focus on males in most all aspects of research? But that is a topic for another piece.
Girls with Autism are more likely to be diagnosed with Obsessive-Compulsive Disorder, as they like to repeat or organize things or with Attention Deficit Hyperactivity Disorder as they seem to space out in class and social situations or with Anorexia as they may be focused on control and management of their bodies. The societal view of women may be a piece of misdiagnosis as we often think of women as controlling, ditsy or overly concerned with their looks. The presentation of Autism is different for girls and our responsibility as professionals is to know this and use that knowledge to accurately identify girls so that treatment intervention can take place early.
The differences show up clearly in brain imaging and functioning. Research into the brain mechanisms that are typical for boys shows that girls are different. These sexual differences can be seen on brain scans so that Autism becomes a more complex syndrome given that different parts of the brain are involved in behaviors given the sex of the person. For example, social cues are processed in different parts of the brain for boys and girls, yet the observable behavior may be identical.
Girls tend to be misdiagnosed because they can present behaviorally as social. They use energy to mimic the behaviors of those around them leading to more common social behaviors. However, this energy and the subsequent emotional cost of mimicking is exhausting. Girls tend to hyper-focus on copying the behaviors that they see around them in order to be accepted and to fit in. Girls are much more invested in having social lives and they work at it. Boys are less interested in the social world and as a result their awkwardness in social situations leads to an early concern and an earlier diagnosis. Girls can be “hiding” in plain sight.
Another factor is that the interests of girls are more socially aligned with their gender than the interests of boys. Boys may spend their time with video games and socialize only with an online partner to play the game. Girls are more interested in being seen as social and accepted by their peers. They have more of a group mentality and boys do not. Autistic girls tend to me more emotionally reactive making their presence in social groups problematic. Because women in general have more emotionality, the Autistic girl can go unnoticed for a significant time.
Raising awareness of this syndrome in girls is important and takes closer observation over time. Even though the COVID19 Pandemic is a tragedy, the side effects may be productive for earlier identification of Autism in girls.