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Why Are Girls With Autism Different?

Why Are Girls With Autism Different?

By Mir Kamin

Got tweens/teens? We’re trying a new advice column here at Alpha Mom to address your questions for the older-kid crowd. We hope you enjoy! And if you have a question to submit, hit me up at alphamomteens[at]gmail[dot]com.

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“D” writes:

I have seen you mention several times that autism can present very differently in girls than in boys and is therefore harder to catch early on. I was wondering if you had any further clarification on that or any examples? I am on the fence about whether or not my daughter will have to address anything along those lines, and was just looking for some general guidance. We have set up a meeting with a speech therapist and evaluation with our state program, and the only hard marker she is presenting so far is a delay in speech at just over two years old. She is happy and healthy otherwise, but she has some personality quirks that I am not sure about, so I was just looking for a little input on the female side of possible autism.

This is a great question, and I’m going to start off with some disclaimers. First of all, I am not a medical professional, and anything I say here always comes with the standard “Consult a professional” caveat. Second, my favorite autism-land truism is that, “If you’ve met one person with autism, you’ve met one person with autism.” There’s a reason we call it the autism spectrum. There are tendencies and similarities, but every individual is, well, individual. Finally, I always believe that knowledge is power, and the more you know, the better you can equip yourself to make the best possible decisions, labels are not to be feared, etc., but just as I’ve previously said, one of the most important barometers of what matters is your child’s happiness. Whatever else is going on, hearing that your daughter is “happy and healthy otherwise” tells me you don’t need to be super worried.

All of that said, I am the mother of two children who have autism spectrum disorders, and my daughter was, as is very typical, diagnosed pretty late (not until her teens). We went back and forth for years because there were multiple things going on and a perpetual chicken-or-the-egg vibe, and she is pretty much a textbook case of “girls are harder to diagnose.” I think the best primer I’ve read recently on why this is and how it manifests comes from Emily Willingham writing for Forbes, and here’s the (for me) key takeaway: For whatever reason, autistic boys tend to act out, while autistic girls “implode emotionally.” And how many difficulties/disorders/regular-teenage-girls things can be filed under “implode emotionally,” do you suppose? Loads. There’s now quite a bit of research into the connection between eating disorders and autism, which now seems like a no-brainer to me, but is fairly recent development. (And while eating disorders are not a purely female thing, they do occur more often in girls, and more and more, it’s how some of these autistic girls end up being diagnosed. The anorexia turns out to be secondary, and a classic example of that internal implosion.)

Science and super-heavy stuff aside—and bearing in mind that we are speaking in generalities, here, so this is not an absolute—let me give you a very simple example which I’ve seen play out time and time again. If you tell a joke to an autistic boy, chances are excellent that you’ll be greeted with either a blank expression or a slightly puzzled, “I don’t get it” if he doesn’t understand. Tell that same joke to an autistic girl and she’ll probably laugh on cue—and here’s the thing—whether she understands it or not. For whatever reason (societal conditioning, brain differences, a combination thereof), autistic girls are much more likely to mimic appropriate social actions and “try to appear normal” than their male counterparts. (Again, these are generalities, not absolutes. Some autistic boys “fake it” to blend in. Some autistic girls don’t.) The depth and breadth of what was flying over my daughter’s head without anyone realizing it was staggering. And that’s a huge part of that emotional implosion that’s common: eventually, a lot of autistic girls reach a point where they feel exhausted and alone from the constant work of pretending to be something they’re not, and then things often get very bad, very quickly.

Another example: One of the hallmarks of autism is “narrow, sustained focus in an interest area.” When a little boy memorizes all of his Thomas trains and plays with and talks about them constantly, people think “autism spectrum disorder.” When a little girl has a “real dolly” with a whole persona and life and routine, though, or makes dozens of intricate friendship bracelets every day, people just think… that’s adorable. The kinds of interests little girls tend to latch onto are often viewed as less unusual/extreme, for whatever reason.

Now that I’ve made it all clear as mud, here’s another fun fact: autism spectrum disorders share a lot of features with other, non-ASD, things, like ADHD, generalized anxiety, etc. It takes a trained clinician (honestly, sometimes multiple trained clinicians) to make an accurate diagnosis. So that’s fun!

Hopefully this gives you a general answer to your question. Specific to your daughter: you’re already being proactive about what you’re concerned about, so you’re in a great place to address any issues, already. As you move forward, I would simply urge you to bear in mind the whole “Is she lagging developmentally/is she happy?” duo of questions, as well as the fact that diagnosis is a tool—a very good tool, sure—but not a be-all and end-all. You can address/treat issues without a diagnosis, if necessary, and you sound prepared to do that. Just know that, statistically speaking, if she does turn out to be on the autism spectrum, she may not be diagnosed for a number of years.

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Don’t forget that you can submit your own question to alphamomteens[at]gmail[dot]com.

Mir Kamin
About the Author

Mir Kamin

Mir Kamin began writing about her life online over a decade ago, back when she was a divorced mom trying to raise two regular little kids and figure out what she wanted to be when she grew up. Now ...

Mir Kamin began writing about her life online over a decade ago, back when she was a divorced mom trying to raise two regular little kids and figure out what she wanted to be when she grew up. Now her life looks very different than it did back then: Those little kids turned into anything-but-regular teenagers, she is remarried, and somehow she’s become one of those people who talks to her dogs in a high-pitched baby voice. Along the way she’s continued chronicling the everyday at Woulda Coulda Shoulda, plus she’s bringing you daily bargain therapy at Want Not. The good news is that Mir grew up and became a writer and she still really likes hanging out with her kids; the bad news is that her hair is a lot grayer than it used to be.

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Comments

  • S

    D
    An slp commenting here. You are doing the right thing. Early intervention for speech delays , communication disorders have the best outcomes. A comprehensive birth to three evaluation with speech and a cognitive evaluation helps to put the pieces together. You may get a p d d diagnosis. Pervasive developmental delay. Some providers or states don’t want to give young children an autism label because the kids are little and as they age, it becomes more clear what is the cause of speech, motor, social delays. However birth to three can provide services or next steps if you need to contact your school district at age three or other programs. Just think long term, therapy and maturation can change the picture. I have treated girls with asd and they were all different, individuals like all of us. With that said, we treated three year olds that had few skills and were doing great heading into kindergarten. Read books like the out of sinc child and yale child study research. 
    Your daughter will do awesome because you already are trying to do the best for her,. Talk to her, play with her, and read to her.
    Good luck.
    S

  • Pingback: In related news: girls are complicated | Woulda Coulda Shoulda()

  • Heather

    Oh my gosh, yes. My 9-y-o daughter was diagnosed a few months ago. She’s bright as all get out, but the emotional and social was .,.challenged.

    Now that we know we are dealing with HFA/ASD, it makes a world of difference on how to approach it.

  • NM

    Oh, poop. I thought I had decided against autism evaluation (developmental ped was on the fence) because my girl doesn’t have those male traits, but the female ones you describe? I am back on that fence. And beginning further research. Thanks for the prompt.

  • Kim

    Well, well, well. My youngest got an ADD/anxiety diagnosis from a neurologist this summer, but what you’re describing?  Sounds exactly like her.  So what kind of clinician do I take her to?

    • Well, that depends. Again, two questions: Is she happy? Is she lagging behind developmentally? There’s so much crossover between ADD/anxiety/ASD, it’s possible the current diagnosis is correct. It’s also possible it’s not, or—surprise!—she could have those things and an ASD. Unless she’s not getting services/support under the current diagnosis which you feel you’re missing, my general advice is to (if you haven’t already) find a child psychologist who works with kids on these sorts of issues and see if they can help figure out the right supports. If there’s a suspected “missed diagnosis,” a good therapist working with your child will figure that out. Good luck!

  • Amy Renee

    And for what it’s worth, as Mir pointed out, it’s called a spectrum disorder for a reason. I wasn’t diagnosed with ADHD until I was an adult, but looking back, I probably could have been diagnosed with an alphabet soup of conditions as a kid. Given that so many conditions are not black and white, have it or don’t, you may find out that even if your daughter doesn’t meet the full criteria to be diagnosed with ASD, ADHD or whatever, some of the interventions meant for kids iwth ASD or ADHD may help her – and if so, use them. I have read quite a few books on ADHD and ASD both for adults and children, aimed specifically at women/girls and for both men and women, and I have found a ton of advice that I’ve been able to incorporate into my daily life for myself, and as parenting strategies for my kids – because while they don’t fall on the severe end of the diagnosis, they definitely have traits that put them more toward ASD than not, and some of those strategies (like having to teach my oldest to look people in the eye when speaking to them, because he doesn’t do it naturally but doesn’t find it painful like some people on the ASD spectrum do) have helped their life skills tremendously.

    So my overall advice is to keep doing what you are doing, and only push for a formal diagnosis if you think it is necessary for your daughter to get any interventions she needs at school, etc – but feel free to cherry pick advice from the books on ADHD and ASD, because much of it is good advice for childrearing in general.