Adolescence is a challenging time for every child, as they experience important developmental milestones and navigate an increasingly complex world. For girls with autism spectrum disorder, adolescence can create a window into their unique experiences with autism, often resulting in a first-time diagnosis.
Four boys are diagnosed with autism spectrum disorder for every girl. According to Erica Rouch, a researcher and psychologist with the University of Virginia’s Supporting Transformative Autism Research initiative, this gender difference has contributed to a number of challenges in diagnosing girls.
“Autism spectrum disorder is diagnosed by evaluating behavior,” said Rouch, an assistant research professor in UVA’s Curry School of Education and Human Development. “And, as its name suggests, it is also a spectrum, meaning some individuals with ASD face more challenges than others. Because we see ASD much more frequently in boys, we have a clearer picture of what symptoms look like in boys and how to determine if a diagnosis is appropriate.
“What we are finding now is that the strengths and challenges faced by girls with autism don’t always mirror those of boys.”
In the last decade or so, Rouch noted that there has been a rise in autism diagnoses for girls who have strong intelligence and fewer behavior challenges, but still present with social interaction difficulties, a key symptom of autism. And recent data about girls with ASD, although still limited, suggests that these diagnoses are often being made in early adolescence.
“The limited research we do have seems to suggest that girls are not diagnosed until adolescence because they may present with less pronounced symptoms in early childhood and they may have ability to ‘mask’ symptoms in middle childhood,” Rouch said. “It seems that girls with ASD are more likely to find strategies to compensate for some of the core challenges with basic social communication that we see in boys.”
For example, girls might teach themselves to look at someone between the eyes to mimic eye contact. This has been referred to as “camouflaging” symptoms – the idea that girls are able to look around, see what their peers are doing, and mimic that to some extent – but it may not be totally natural for them.
“Ultimately, however, adolescence brings higher demands for social interactions, particularly in group social situations, and it becomes more challenging for these work-around strategies to be successful,” Rouch said. “Girls’ increasing challenges in these situations can help clarify an autism diagnosis.”
According to Rouch, one recent observation study documented elementary school children on a playground, revealing the significant difference in behavior between boys and girls with autism and offering insights into the difficulties in diagnosing autism at this age.
“The researchers found that the boys with ASD on the playground were physically distanced from other children, clearly playing alone,” Rouch said. “The girls with autism were sticking with the group, seemingly involved in group play. Yet while they were physically present, they were much less involved than other girls in social chatting during play. You can see how it would be easy to miss the subtle way they were not truly connecting and forming relationships with their peers. And of course, these girls are also missing a foundational experience that would help prepare them for the complex social relationships of adolescence.”
Because of this, adolescence seems to be when their difficulties are first noticed. Interestingly, however, these problems might be first noticed and diagnosed as anxiety or depression that has developed as a result of the social challenges. Researchers do know that girls with ASD are more at risk than boys with ASD of also having co-occurring anxiety and depression.
