Autism in boys vs. girls
Autism is a neurodevelopmental difference that presents in a variety of ways, but did you know that there are also big differences in boys vs girls? Unfortunately due to a variety of factors, autism research of the past was predominantly completed with boys, leaving a large portion of the autism community out. This leads us to the classic “4:1” ratio we often see. But what if I told you that there are more autistic girls than previously believed? And what if I told you they don’t fall into the archetype that’s always described? Girls are often diagnosed at an older age than boys, but why? Research is beginning to show that it’s because, much like many other medical diagnoses, autism looks different in girls than it does boys. Here are 3 ways autism is different in girls than boys.
Social cues and “better” masking. Part of the diagnostic criteria for autism includes deficits in social communication. This is generally viewed as difficulty with understanding nonverbal communication, lessened eye contact, use of highly literal language, etc. While all of these can and do often occur with autism, there are many girls who don’t appear to have these social challenges. While they don’t appear to have them, what we’re learning is that girls are often better at masking. Masking is the intentional or unintentional suppression of what are deemed “autistic behaviors” to appear typical. This could mean forcing eye contact, observing others and mimicking their behavior, or reducing stimming behaviors. All of these things reduce the appearance of social communication deficits. The thing is- just because a person is suppressing things about themselves, it does not mean those things don’t exist. It just means that person might not be identified as autistic as early as their male peers. As more and more data comes out about girls with autism, we’re realizing just how many girls suffer in silence because they don’t “look” or “act” autistic. It’s always important to keep this in mind, especially if your child has other potential indicators of autism.
Special interests may be more “socially acceptable.” Girls and boys have different expectations in society, and this plays out with many children on the spectrum. One of the diagnostic criteria for autism is “restrictive and repetitive behaviors,” which often include toys, movies, games, etc. Imagine you have 2 kids, both 7, one girl and one boy. Both of these children LOVE horses and are constantly talking about, collecting, and playing with horses. Which one stands out to you more? Because of how we as a society view gender and its role in interests, one might notice the boys’ behavior over the girls’. The girl might be labeled as a “horse girl” and the boy might end up with a diagnosis. As a society, we often expect and allow girls to be more into things in an “obsessive” way. Think Taylor Swift, One Direction, etc. etc. Socially, boys are less likely to outwardly present as a “fan” of something. So when they do, especially in a more repetitive way, we notice it. Now this is not to say that every girl with an obsession, or every boy who likes Taylor Swift is autistic, but it’s just to show how as a society, we are far less concerned with a girl having “obsessions” than a boy. It is important to remember that if an interest is restrictive or repetitive (meaning it impacts daily functioning), no matter the gender, it could be an indicator of autism.
Internal echolalia and stimming. This is a big one in my opinion. One of the first things parents notice about their child that leads them to seek an evaluation is stimming or echolalia. Stimming, or self-stimulatory behavior, is a method used by autistic people to self-regulate. This can look like hand flapping, clapping, rocking, or repeating words and phrases (echolalia). Oftentimes, stimming is something you can see, and it is something that parents notice, leading them to the doctor’s office. But what happens when you can't see it? Well, that’s what often happens with girls. Many autistic women describe stimming and echolalia as occurring in their heads. Instead of repeating the same phrase over and over out loud, they replay it in their minds. Stimming behaviors, rather than flapping or rocking, present in a more “typical” way, such as nail biting or skin picking. This is largely attributed to girls’ tendency to pick up on social cues younger, learning to internalize their self-regulation as to appear “normal.” As I described earlier, girls tend to pick up on social norms, which in turn internalizes the majority of their struggles.
It is crucial that parents, clinicians, doctors, and everyone in between be aware of these differences in boys and girls with autism. So many girls end up not getting the help they need because they don't “look autistic.” This mindset is harmful, and recognizing the difference in presentation is the first step in ensuring everyone gets the help they need.