Less girls than boys are diagnosed with ASD, but is there also a difference in behavioural symptoms that could lead to under diagnosis?
The ratio of boys and girls with autism is 4:1. However, when it comes to high functioning autism like Aspergers, it goes up to 7:1 What exactly is going on here?
Having a brother with autism, I’ve actually never thought that there might be a difference between boys and girls with the condition. As I found out, there are quite a few disparities:
Girls with high functioning autism are actually quite good at hiding symptoms and mask it by emulating normal social behaviour. In our society, girls are expected to be more social than boys making it difficult for some to cope and they may end up getting into trouble. This could also mean they try harder to conform to this ideal, making it less obvious to pin-point symptoms- especially as anti-social behaviour is a well-known symptom of autism. They show intense interests in fiction and have a rich imagination, often delving into their own worlds. Girls with autism are also more likely to have other mental health problems caused by the masking process (Yaull-Smith, 2008). I remember reading somewhere about a woman who was finally diagnosed with Autism in her 30s while for her whole life she believed she was suffering from depression instead.
Paul Lipkin (2014) wrote that girls with Aspergers or Pervasive Developmental Disorder (PDD), were diagnosed later than boys. This is because boys demonstrate more obvious behavioural symptoms than girls such as hand flapping and repetition. As mentioned above, girls will appear more social due to the fact that neuro-typical girls the same age are more accommodating of their behaviour and include them more in their circles. Boys the same age don’t usually do this although. This may be one of the reasons leading to delayed diagnosis and sometimes are not noticed at all.
The diagnostic system for autism may well already be gender-biased because of how difficult it is to identify females with autism. Hans Asperger (1944), who first wrote about the symptoms of autism and the Extreme Male Brain Theory, said himself that ‘the autistic personality is an extreme variant of male intelligence.’ He mentioned that he had never met a girl with autism. Many studies following his theories have found that typically developing boys were better than girls at systemising, which is being analytical and the ability to predict behaviour of systems. Girls on the other hand are generally better at empathising.
Perhaps the ratio of girls to boys with high functioning autism is not as accurate as the ratio between girls and boys with severe forms of autism entirely because of the current diagnostic schedule. Judith Gould and Jacqui Ashton Smith (2011) argued that by only utilising narrowed definitions set by a checklist, a lot of diagnoses are missed out. As autism is purely a behavioural-based diagnosis, clinicians must take the time to collect information assess the patients profile directly.
One of the things we struggle with as a family is taking a peaceful holiday. We don’t struggle with taking a holiday. We struggle with trying to have a peaceful one. Chris has always loved hotels and every time I come back to Singapore to visit he will ask me, “can we go hotel now?”. And we oblige. Guy loves the high life! He definitely knows what he wants but he can’t always get it due to the communication issue. When we do take him on holidays and hotel trips he still runs into tantrums that come seemingly out of no where. Certain things in his head or in the environment suddenly set him off and he would start either hitting himself or swearing and talking in a more repetitive way. The reality is that we just can’t understand what he wants sometimes. At times he would ask for impossible things and throw a tantrum when we can’t give it to him. All we can do is try to pacify him. I myself, try to distract him with a game on my tablet or point him towards something interesting to look at and tell him encouraging things.
When we went to Tioman for a four day trip, he wasn’t in the best of moods and I think it’s because the hotel didn’t have an elevator to be honest! (every hotel with a lift is in danger of Chris, he just loves riding them!). Although he likes adventure, this time, he just wanted to get home as fast as possible . He was happy to go swimming and hiking but he got bored staying in the room very quickly. He’d get very irritable and start shouting in public, which causes stares from people. I really don’t mind the stares myself and just leave him to it until he gets over it if my distractions don’t work. Telling him to lower his voice makes it worse and is rather pointless. It’s difficult trying to figure out the best methods to calm him but It’s something we will constantly have to try and cope with.
Last summer, I was looking forward to having him come over to England to visit me with the rest of our family, but the rest of the family ended up leaving him in Singapore because he kept throwing tantrums before the start of the trip. Dad decided he would be too hard to handle if he came here, especially since everything would be completely out of his comfort zone.
What causes these tantrums and unreasonable behaviour? Could it be the pills? Or maybe he got over-excited and wanted to go then and there? Or maybe he really didn’t want to go, even though he tells me he wants to come over every time I Skype him? I wish I knew! I wish I could support him all the way and beat his imaginary demons with him! Until they invent some sort of brain communicator, we’ll still continue making the effort to understand him and take him on trips because it’ll always be a good learning experience. On the plus side, bringing people with Autism out more spreads awareness to the general public and will show that yes, there are people like this and we should all learn to accommodate, not point and laugh. Who are we to define what is normal as they are just as much a part of our society as you and I.