Learn to recognize subtle symptoms of autism in girls
You may need to pay more attention to notice less ‘typical’ signs that are flying under the radar
We often associate autism with males. And while it’s true that more boys than girls are on the spectrum, parents, teachers and doctors have a harder time recognizing this condition in girls. That’s because autism symptoms can be different for girls — and because of stereotypes about autism and about gender.
It starts on the playground. A boy with autism may play by himself and favour games with structured rules.
Girls on the autism spectrum are more likely to be near other children and talking — but you’d have to be looking carefully to notice their social struggle.
Girls with autism can certainly have friends, but they may have trouble maintaining these relationships and are vulnerable to bullying, especially as teens.
Autism is marked by intense and narrow interests. For boys, this might mean an obsession with trains, dinosaurs or rock collecting. With girls, the singleminded focus might be more about people and animals, literature, fashion or comics. They may have a rich fantasy world that you know little about. All of these things make it harder to notice the signs of autism in girls.
In school, girls with autism may seem shy and quiet or anxious. Because we associate these traits more with females (and we may be wrong), adults may not see these signs as red flags — girls with autism tend to fly under the radar.
In contrast, boys with autism are more likely to be recognized, simply because our long-standing beliefs about the signs of autism are derived mostly from boys.
A very key aspect of autism is difficulty making eye contact or using gestures and appropriate facial expressions when communicating with people. But, perhaps because of the social pressure on girls to please and fit in, they may be able to teach and force themselves to use these skills — although it doesn’t come naturally.
In order to connect with peers, they imitate them and suppress their instinct to relieve anxiety with trademark signs of autism such as repetitive hand flapping. But this coping is exhausting and stressful.
Many autistic girls need lots of time to be alone and de-stress after coming back from school or other group activities because of sensory or social overload — they may even have frequent after-school meltdowns.
Signs of autism in females can be subtler. With girls, it’s important not just to focus on “typical” autism red-flags such as an absence of eye contact or friendship, but to ask how they experience and cope with the social world.
When evaluating possible autism characteristics, I often ask girls how they feel being with other kids. What do they enjoy doing with them? What do they struggle with? If it were up to them, what would they do in their daily lives? This gives me asense of how they feel about social interactions and their focused interests.
Parents often have a good sense of where their child’s anxiety comes from. Such observation can clarify whether any anxiety during social interaction comes from shyness, fear of judgment or — reflecting core characteristics of autism — difficulty figuring out what’s going on interpersonally and why others say or do something. It could also be a combination of these. When parents ask their daugh- ters why they don’t have more friends or why they prefer to stay alone, a girl on the spectrum might say she can only handle a small amount of social interaction or one-on-one activities.
I often find when girls are referred for assessment of autism spectrum, it’s because they have some other issues, such as inattentiveness, hyperactivity, anxiety or learning difficulties, that bring them to the attention of a school psychologist or doctor. They may be acting frustrated or irritable, for example.
In fact, studies show that when girls have other behavioural, emotional or cognitive challenges, their autism will then likely be picked up similarly to boys. When researchers screen for autism in the general population, they find more girls than when they look through hospital records (one girl is diagnosed for every 3.3 boys in random testing, versus one girl for every 4.6 boys brought for testing in a clinic).
Certainly, nobody should rush to slap a label on kids. But women who were diagnosed late tell us they’re relieved to finally understand why they felt different from other kids and teens since they were children. And for school-aged girls, the education system could offer better support and accommodation. There are provincial programs to teach social skills and emotional regulation, for example. It’s worth exploring available resources, including support groups. A timely and correct diagnosis will help parents and teachers better understand their children’s strengths and challenges. The most important support for girls on the autism spectrum is not only developing more skills, but creating a more friendly environment for them by embracing their differences and cherishing commonalities.
Fortunately, awareness about the differing signs of autism has grown in the past decade. Talk to your doctor if you are concerned that you or your child may be on the autism spectrum. Dr. Meng-Chuan Lai is an assistant professor in the department of psychiatry at U of T, and a psychiatrist and clinician scientist at the Centre for Addiction and Mental Health (CAMH) and the Hospital for Sick Children (Sick Kids). Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine. Email doctorsnotes@thestar.ca.