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Indications of the Gender Gap in Autism Diagnosis

By: Life Skills Autism Academy / 24 Mar 2021

Studies show that girls are diagnosed with Autism Spectrum Disorder (ASD) significantly less and later than boys. Several studies have tried to determine why this is, but it is important to know that treatment is available for girls at any stage of diagnosis.

There are many potential reasons why girls are "lost" when it comes to identifying and diagnosing ASD in females. It could be that girls with mild symptoms can be missed entirely or misattributed to other developmental disorders. Some have also pointed to a girl's ability to control or identify emotions and adapt to social changes better than boys.

In any case, parents of girls who could be on the spectrum can look for these signs and confirm them by clinical professionals in the behavior health field. If ASD is confirmed, a Board Certified Behavior Analyst (BCBA), can then individualize treatment using Applied Behavior Analysis (ABA) Therapy.

Symptoms can be masked by girls, make diagnosing harder

One study that looked into females in late adolescence or adulthood gave in-depth accounts of them "pretending to be normal" and how the female gender led various professionals to miss their autism spectrum conditions (ASC) and how those ASC differ with male and female identity roles. 

In social settings, girls potentially on the spectrum may react differently than a boy on the spectrum that masks their social challenges. For instance, at a young toddler stage, boys with high-functioning autism may be more reclusive in addition to having an impersonal conversational skill set. These traits of social isolationism have become commonly identified with autism because it is more often how boys with ASD converse in social settings. But girls may more likely speak in high-pitched, childlike voices, much like their neurotypical peers, seemingly playful but more likely the girls are playing "in parallel" or alongside, rather than with peers.

ABA therapy can be conducted in part in group settings to teach social skills children with ASD need to reach optimal outcomes in school and playgroups. 

Another common ASD symptom treated in ABA is behavioral meltdowns or tantrums that can lead to conflict with peers. In return, the more of these conflicts that arise, the more warning flags are raised to alert school authorities, medical staff, and/or parents to seek an ASD evaluation. But girls in the general population are often less aggressive than boys so girls with ASD are less likely than boys with ASD to encounter aggressive conflicts with neurotypical peers that could trigger their own negative behavior.  Less of such behaviors means there are fewer reasons to establish a history of concerning behaviors to refer a girl to a psychologist or psychiatrist for evaluation.

Parents can watch for particular clues from girls who may have autism

A growing number of studies suggest that girls with autism, particularly those who are high-functioning, may be hiding in plain sight for a while prior to an official diagnosis.

Studies estimate that boys are "four times more likely" to have a diagnosis than girls. If girls' symptoms are less severe, they may be better able to cover up for challenges in school and in social settings. But this may come at a price. Often this coverup could lead to depression or anxiety, which is often co-occurring with autism. The symptoms of these can increase if autism is not diagnosed or treated with behavioral therapy.

New studies show there may even be slight differences between the core features of autism. A study at Stanford University suggests there is less repetitive and less restrictive behavior in girls than boys. The study demonstrated differences in male and female patterns of brain matter in the regions responsible for the motor component of repetitive behaviors such as hand-flapping. Researchers were able to distinguish boys with autism from girls with autism from these patterns.

Like boys with autism, girls can demonstrate social interaction and communication deficiencies, but at different levels of severity so it is important to be mindful of common symptoms at the very earliest stages of development, such as:

  • not responding to their name by a year old
  • not following or even acknowledging instructions
  • not making direct eye contact with someone or something when asked
  • mastering certain verbal skills, but later no longer using them
  • having difficulty explaining wants or needs
  • misinterpreting others' emotional reactions

As girls develop into school-aged toddlers, key characteristics of behaviors are centered on rigidity to established routines and repeated actions. Examples include:

  • having difficulty adapting to changes in daily schedules
  • being unusually attached to particular objects or toys
  • rocking from side to side
  • flapping hands regularly
  • organizing items in particular ways
  • repeating certain words, phrases, or sounds
  • limited tolerance to certain smells, tastes, or sounds
For more information on services provided by Life Skills Autism Academy or if you are interested in your child receiving a clinical assessment for autism, please call 1-888-9-SKILLS or email for more information at [email protected].

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