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.