Are girls with autism being missed?
A growing body of evidence supports the hypotheses that autism spectrum disorder (ASD) is being underdiagnosed or misdiagnosed in girls. Why might that be? And how could that affect your child? We will delve into a few of these issues in this blog post.
First, an overview of autism spectrum disorder.
What is ASD?
ASD is a biologically based, neurodevelopmental disorder. Meaning, autism is a disorder present at birth that affects how the brain develops. Individuals with ASD often display behaviors that are repetitive in nature and have difficulties participating in social situations. Autism is characterized as a “spectrum disorder” because it presents differently in each individual, causing the symptoms to vary in type and intensity. The current prevalence of autism is 1 in 68 children. Autism is more prevalent in boys, presenting with a ratio of four boys to every one girl with autism spectrum disorder.
Potential signs of ASD that you might notice in your child are outlined below.
- Your child does not use gestures to communicate, such as pointing, clapping, or nodding their head
- Your child does not use a combination of eye contact, gestures, sounds, and words to communicate
- Your child has a delay in speech and language skills
- Your child does not imitate actions, sounds, or words that they overhear
- Your child does not respond when you say their name
- Your child has sensory differences, including over- or under-sensitivity to certain sounds, textures, smells, etc.
- Your child has unusual ways of moving their hands or bodies
- Your child has significant difficulty with transitions
- Your child does not play with, or similarly to, other children their own age
The red flags outlined above may indicate a difference in your child’s development. If your child exhibits one or more of the red flags mentioned above, it does not necessarily mean that they have autism spectrum disorder. For example, not responding to their name could be due to a potential hearing loss. It is recommended that you discuss any concerns regarding red flags with your child’s medical team, including their pediatrician and therapists.
Why are they being missed?
As mentioned above, professionals in the field have begun to discuss this issue of underdiagnosis or misdiagnosis of ASD in girls. One potential area of difficulty is that assessments commonly used to diagnose ASD are based on data collected from the general population of children with autism, which consists of more boys than girls. That means the tests are less sensitive to detecting girls with ASD. Girls with well-known or easily understood symptoms will likely not be missed, but those that present with less obvious red flags may be. As ASD is less common in girls it might not be the first diagnosis that comes to mind, especially if symptoms are less severe. Although girls may and do exhibit some of the red flags outlined above, it can present differently or less obviously in girls. It is also common that girls are intrinsically more socially motivated, so symptoms of social communication difficulties may be less obvious.
What does it look like?
A few more specific signs of ASD that you might notice in girls are outlined below.
- Your child has interests that are age-appropriate but very intense
- Your child plays with toys in a “pretend” but repetitive manner
- Your child displays sensory differences, but might begin to hide these as they get older
- Your child has extreme reactions to change or transitions
- Your child is exhausted after social interactions
- Your child has difficulty making or keeping friends
- Your child has difficulty with conversational skills, such as topic maintenance and turn taking
- Your child may internalize their emotions, resulting in anxiety
How does this affect your child?
The slight variation in type or intensity of red flags in girls may cause them to be diagnosed with something other than autism spectrum disorder, such as an anxiety disorder or a language disorder. The misdiagnosis results in recommendations that may be less appropriate or encompassing of symptoms and may result in your child missing out on early intervention strategies to support their development.
What can I do?
If your child is demonstrating the behaviors above, or any general red flags for autism spectrum disorder, consider following up with your child’s therapist or pediatrician. Although individual speech-language therapists cannot provide a diagnosis of autism spectrum disorder, they can make appropriate referrals for testing and possible diagnosis.
Questions or concerns?
If you have questions or concerns about your child’s development, please contact us at firstname.lastname@example.org or 773-332-9439.
Ana Thrall Burgoon, M.S., CCC – SLP
Bartley, Janine. “Autism Spectrum Disorder.” Grand Valley State University, 4 Dec. 2018, Grand Rapids. Lecture.
Rudy, L. (2018, December 4). Symptoms of Autism in Girls . In VeryWell Health .
Volkers, N. (2018, April). Invisible Girls. The ASHA Leader, 23(4), 48-55.
Photo Credit: Photo by Jens Johnsson on Unsplash