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Why are autistic girls harder to spot?

Updated: Dec 1, 2022

By DiverseMinds Research Team

Reading time 10 minutes ⏰

Autism affects around one in every 100 people and there are around 700,000 autistic adults and children in the UK, according to the National Autistic Society. However, men were significantly more likely than women to be diagnosed with autism (4:1) and diagnosed at an earlier age.


So why are there more males than females with autism?


This is a very controversial topic, public knowledge and academic circles hold different views and disputes on this, and more and more obvious.


There are several main ideas to explain the preponderance of male ASD. Such as: genetic protective effect, extreme masculine brain theory, sex differences in behavioral phenotypes, later diagnosis in women, female protective factor hypothesis, female underdiagnosis, imprinted brain hypothesis, etc.


There are even cultural differences in gender role expectations and gender bias in parental reporting. These theories and hypotheses are intertwined to make sex differences in ASD confusing.


A significant number of neuroscientists believe that the incidence and number of women with ASD may be significantly underestimated (Devlin,2018). As for the reasons of more male ASD, specific explanations are as follows.



01.

Genetics


From the point of view of modern biology, ASD is a hereditary disease.


Therefore, genetic factors leading to gender differences must play a guiding role, such as the role of androgen messenger signal in male development or X-linked mutation, which makes its related genetic effects more serious and prominent in men, so male ASD is more common.


02.

Extreme masculine brain theory


It is suggested that brain alienation in ASD leads to extreme magnification of male traits, such as increased coronal area and weaker network connectivity, which enhances systemic thinking (so-called straight or technical) but weakens empathy thinking or emotional intelligence (Baron-Cohen,2005).


03

Imprinted brain theory


Genomic imprinting is thought to predispose men to ASD, meaning that paternal traits are passed on to offspring more strongly than maternal ones. This corresponds to the inheritance of schizophrenia, and the inheritance of fineness is mainly maternal.


The variation of related genes leads to social cognitive impairment, and both have opposite genetic variation basis (Ciaramidaro,2015).


It is claimed that the maternal and paternal genomes may have opposing reproductive interests, with parents being genetically opposed to each other in competing for the benefits of their offspring. Since its inception, this hypothesis has been criticized but embraced.


04

Female protection mechanism


Girls need more extreme genetic mutations to develop ASD than boys do. A team at Harvard University has found that women diagnosed with ASD or other neurodevelopmental disorders carry more harmful genetic mutations throughout their genomes than men with the same disorder. In other words, female ASD requires more genetic variation to develop the disease (Jacquemont et al.,2015).


05

Women are strong cover-ups


In this view, women generally have better superficial social mimicability and generally higher emotional intelligence, and if they do have ASD, it's not more pronounced than boys, making them harder to diagnose. In other words, ASD symptoms are masked by women's behavior and are not easily detected.


n addition, it has been claimed that the behavioral phenotype of female ASD differs greatly from that of male, which results in the diagnostic criteria set based on male ASD characteristics not being applicable to female ASD diagnosis at all (Bargiela,2016).


Clinical observation did find that symptoms such as hyperactivity, impulsivity, problem behavior and stereotyping were less prominent in girls with ASD than in boys with ASD. Women can mask their ASD symptoms through socially oriented behavior.


Dr. Louis Kraus, a psychiatrist at Roch University Medical Center in Chicago, believes that the reason there are more boys with autism than girls is because girls tend to have less obvious symptoms and are better at hiding autism.


Socially, for example, girls are generally quieter and less confident than boys. A shy girl may be considered acceptable as "feminine", while a boy with the same behavior tends to attract attention from others.


At the university of California, Los Angeles, children and adult neural development outpatient Amanda, gus, clinical director of the rudd is committed to developing interventions for campus of autistic children, now part of the intervention measures is based on by researchers at the university of California, Los Angeles, early research, the study looked at the boys and girls in the school playground of autism interactions with partners.


While other boys played together on the playground, boys with autism tended to be isolated around and in corners of the group, or behind trees, Gusrud said. Girls with autism are not so obvious, they approach other girls as if they are connected to the group, but there is no real interaction.


Another example is compulsive behavior in autism, and there are differences between girls and boys in this respect. For example, a boy with autism might be obsessed with things like rocks, no matter how heavy they are or how they carry them in his backpack, and talk about them endlessly, whereas a girl with autism might collect shells, which people think is normal.


Here's a look at the signs of autistic girls:


① Rely on other children (usually girls) to guide and speak for them during their school years.


② Have "passion" and limited interests. For example, while many girls may be fans of a particular TV show, a girl with autism may gather information and talk endlessly about characters, locations, props or actors, but know little about the plot or genre of the show.


③ Unusually sensitive to various senses, such as noise, bright light or strong smells. (The condition is common in both boys and girls.) Sensory sensitivities are not unique to autism, but they are a symptom of autism.


The conversation was confined to the topics she was interested in. She may share her particular domain and limited charm, but has no interest in hearing the responses of others.


⑤ The level of depression is very low. When she feels depressed, it is difficult to lighten her mood. She may have an age-inappropriate "breakdown."


⑥ Having trouble making friends, she may appear "clueless" when it comes to nonverbal social cues (other people turning away, facial expressions, etc.). She may also struggle to emulate other girls' behaviors, fashion choices or hairstyles, although she may want to "fit in."


⑦ Epilepsy (found in one study to be more common in girls than boys with autism).


Social communication became more and more difficult as she entered adolescence. (Research suggests that girls with high-functioning autism may find ways to cope and mask difficulties in social interaction, often by allowing others to speak for them.)


Therefore, parents with little girls should pay close attention to their children's development and intervene as soon as possible once they find their children have developmental deficiencies.


Finally, what did one mother discover about the unique challenges of raising her daughter with autism?


It's been four years since my daughter Chloe was diagnosed with autism. It was a dreary March day that still feels like yesterday. We lived in California and had a psychologist come to our home for an evaluation.


The psychologist spent two hours with Chloe and another hour or so writing a report. He handed it to me and said, "You have a long way to go, but you'll be fine." I cried as I said goodbye, shook his hand and closed the door. This is the beginning of our autism journey.


01.The beginning of a new journey


It was the worst day of my life, and I don't want to experience that intensity again. But the psychologist was right about one thing: things did get better! I've done a lot of research, getting kids to intervene early and then go to school, and it's going pretty well.


There are no instructions for what to do when your child is diagnosed, but I quickly realized that having a daughter with autism brings additional challenges and difficulties. Many professionals are used to working with boys, perhaps because boys are four times more likely than girls to be diagnosed with ASD, or perhaps because girls are often overlooked because their symptoms manifest differently.


Whatever the reason, I found that there were a lot of clinical studies on boys with autism, and when I looked for specific literature on girls with autism, it became difficult. Of course, my findings don't help a newly diagnosed child.


But there are still some things I've learned over the past four years that I might have made my child's progress more efficient if I had known at the outset.


02. Use early intervention


Early intervention is crucial, but it is important to note that different children use different methods and copying is ineffective in most cases. We are fortunate to have an excellent language intervention teacher who comes to our home once a week. She explained that many of her boy students didn't like to play with the toys she brought, but Chloe did, so she followed Chloe's preference and used the toys to play with her.


Many interactive games are language-based, and what better way to learn new vocabulary than through games? I've learned that a lot of girls with autism are social, that they like to socialize with others, but that doesn't mean they're "less lonely," a trait that can make diagnosis difficult because they don't check social/emotional cues during testing.


03. Whether to intervene while going to school


My daughter started public school after her third birthday. The school district did their own evaluation, created her individual education plan, and then placed her in a special needs group.


Her speech intervention teacher was impressed because her daughter barely communicated during speech therapy at school. Again, girls seem to feel more pressure in groups, so I have to advocate continuing the language intervention and keeping track of the changes on a monthly basis if the child stagnates or regresses in school.


04. Be an advocate for your children


Chloe grew up, entered the first grade, and as the learning got harder and harder, she began to fall behind. I have to advocate extra help for children. But most schools will not provide such services voluntarily, parents must ask them. Communicate with school authorities through the child's diagnostic reports and other supporting data, and keep in touch with teachers to keep track of the child's progress.


05. Let her vent


Girls with autism can be experts in disguise. Pretence is a social phenomenon in which a child learns, practices, and displays certain behaviors to fit in with others in order to appear more social. But this can increase children's anxiety and make them exhausted.


Chloe often breaks down after school, and we realize that's because she spends her days in the unknown and in high tension, pretending all day. After leaving the group environment, she needed time to decompress, let her guard down and be her true self. Faking is often one of the reasons why girls are delayed or not diagnosed with autism.


06. Pay attention to your child's state


One of our biggest challenges today is emotional regulation. The moment Chloe wakes up, I can usually predict what kind of day we'll have based on her behavior. Sometimes she's calm and stable about what's going on around her. But sometimes, even the slightest setback or deviation from her routine can cause her to fall apart completely. Once she's completely broken, it's hard to communicate with her.


Regulating her emotions was a challenge, but as she got older, she matured and was able to regulate herself more effectively. Her room is her own personal space, and we need to make sure she feels safe and gives her time to vent. We told her in every way we knew how she might feel. Now, Chloe hardly breaks down on the outside.


07. About special hobbies


Gaze is essentially being completely absorbed in something and unable to engage in other activities. For many children with autism, immersion can be a movie, a show, a tablet game, or a recurring thought. These are random, and their attention can last for hours, days, or even weeks. Usually, my daughter watches the same movie over and over again, day after day. Other times, she'll find a game on a tablet that brings her joy, doesn't have to stop her child's special hobby if it doesn't affect her normal life and health, and sometimes it turns into a teaching opportunity.


We could go on for weeks without any problems and she would be calm and content to indulge her obsession. When she was at school she didn't pay too much attention to one thing, which was another way of pretending. She prefers to concentrate on her family life because it makes her feel secure.


08. help her feel confident


Building confidence and positive self-perception is one of our current goals. I tried to use Chloe's interests to teach her this skill. Every day when she was frustrated with her schoolwork, I reminded her that she was really smart. I always tell her that I am proud of her, no matter how small the task she accomplishes. Before school, I would remind her what a kind and good friend she was to others. I hope she sees these strengths and traits in herself that will help develop confidence and high self-esteem.


Girls with autism present many complexities that are often overlooked or understudied. As girls age and progress, help and services are scarce and not readily available. Girls' needs are unique, less discernible than boys', but equally important to future success and happiness. No matter what their age or stage, parents should give their children the right support and resources to help them become the best version of themselves.


Diverseminds. co Research Team suggests that we observe autistic children more and give them more professional companionship. Relying on high intensity, high density and high professional rehabilitation training, we pay attention to the cultivation of children's motivation, understanding and skills, and finally let children achieve the right time, the right place, with the right people, say the right thing, do the right thing. This is the core concept and ideal behind our original MUST integrated therapy for autism.


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