A parent might confront few questions more troubling than this determination of if, and where, a loved one might place of the spectrum of autism disorders. And the answers do not come easily: the signs of autism in girls and women differ significantly from those in boys – a difficulty compounded by the fact that these signs, these indicators of a diagnosis, can be so often missed, overlooked, especially in cases of high-functioning autism.
Autism Under-diagnosis in girls
Only very young girls exhibiting overt, severe, obvious symptoms are, typically referred for evaluation. These behaviors include repeated and exaggerated self-stimulation (“stims,” as discussed in another Hughes review of chewable objects), major challenges with speech and language, little or no social communication, or significant learning disabilities and cognitive inabilities.
Diagnosis becomes much more uncertain, in some cases, impossible in young ladies whose symptoms present themselves with subtlety, with learned subterfuge. Girls with higher IQs may mask their symptoms, copying the behavior of peers, only to delay diagnosis to, at best, the pre-teen years.
Blame, in part, the culture.
Cultural assumptions, indeed some prevailing stereotypes, may further missed diagnoses in girls. For example, the politics of feminism notwithstanding, girls may be expected to be more reserved, quiet, far less assertive than boys. Femininity, to the popular mind, finds no quarrel with girls who seem shy and withdrawn, just that way little girls are. A boy showing forth the same characteristics – passivity, shyness, silence in social situation – will almost always, right now, be labeled atypical. In the same, a young girl who lives in a world of her own creation attracts little or no attention, even as a boy with the same behaviors will draw immediate scrutiny, much of it negative.
Some indications of autism in girls
The Hughes Brothers emphasize that a single, solitary symptom among the behaviors recounted below need suggest autism. On the other hand, some of these symptoms may become more visible, more easily recognized, as a little girl ages. In retrospect, parents may then be able to identify patterns of autistic behavior present since toddlerdom. Before you worry overmuch, the Brothers ask that you take concern only if one or more of these behaviors is interfering with events of daily life, with your loved little girl’s happiness and progress in school, at home, and in the usual social situations of being a kid. Not to worry, even if a couple of symptoms of autism appear, so long as the young woman seems to be enjoying life, demonstrates an ability to adapt to the situation of the moment and, particular, succeeds in school and in her other chosen endeavors.
Only when you notice the prevalence of these behaviors over the years, when they begin to interfere with functionality of any sort in the girl’s life, you might want to consider clinical evaluation. Time then for the experts to become involved, beginning – in our opinion – with your family doctor.
Not to rely too heavily on the Hughes Brothers, however, here are some scholarly references to give you detailed background on the behaviors of girls potentially somewhere on the autism spectrum. Remember, the more highly functioning your daughter or niece might be, the more difficult the diagnosis. A case in which her intelligence might be a bit of an obstacle to, at least, early indication of the disorder.
The bibliography, then.
DeWeerdt, S. Autism characteristics differ by gender, studies find. Simons Foundation, 27 March 2014.
Dworzynski K. et al. J. Am. Acad. Child Adolesc. Psychiatry 51, 788-797 (2012)
Nichols, Shana. A Girl’s-Eye View: Detecting and Understanding Autism Spectrum Disorders in Females. Interactive Autism Network at Kennedy Krieger Institute, December 2009.
Sarris, M. Not Just for Boys: When Autism Spectrum Disorders Affect Girls. Interactive Autism Network at Kennedy Krieger Institute, February 19, 2013.