Are Girls with Autism Not Being Diagnosed?
Autism diagnostic tests
When a child is sent for diagnostic testing to determine an autism spectrum disorder (ASD), the tests, traditionally, are the same for both males and females. Depending on the age of the child being screened for ASD, markers will vary, but generally speaking, doctors test a child’s developmental and social skills as well as sensory processing abilities. The guidelines for these tests and possible subsequent diagnoses are ruled by the most up to date version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, a study published on January 4, 2018, in the Journal of Autism and Developmental Disorders recognizes the importance of adjusting diagnostic testing depending on the child’s sex.
Signs of autism in girls
This study, led by researchers at the Center for Autism Spectrum Disorders at the Children’s National Health System, “add to the growing evidence that girls with autism may show symptoms differently than boys and that some of the social difficulties experienced by females with autism may be masked during clinical assessments.” (Children’s National Health Systems) According to the study, diagnostic tests are more likely to recognize the typically male presentation of ASD symptoms, specifically social and communication deficits. Girls given the same test are less likely to show deficits due to what has been coined as “social camouflaging.”
“Specific evidence of women more effectively masking or camouflaging social and communication deficits is limited, but autistic self-advocates theorize that the unique social pressures and demands on girls at a young age may teach them to “blend in” and “get by,” including maintaining successful, brief social interactions.” (Children’s National Health Systems)
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These same girls showed greater difficulty with everyday tasks than their male counterparts, however, indicating that the effects of ASD are not lesser, rather more carefully disguised.
Another study, published in Sage Journals, asked autism specialists to compare symptoms in males and females, in which “Seventy percent of [the clinicians] reported clear gender differences in autism symptoms, with boys more likely to exhibit repetitive behaviors, fixated interests and being less likely to engage in social interactions,” while “girls tend to be more verbal and socially interactive, at least at younger ages,” Marisela Huerta, a study co-author, told National Public Radio. (NPR, 2017)
Girls will often still exhibit classic symptoms of autism including sensory processing difficulties, hypo or hypersensitivity to pain, delayed verbal skills, self-injurious behaviors, a low threshold for frustrating situations or extreme passiveness, and even co-occurring seizure disorders.
Girls often go misdiagnosed
As a result of the diagnostic tests used, many girls receive several diagnoses, and misdiagnoses, before being receiving an ASD diagnosis. These misdiagnoses often include obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, or possibly anorexia nervosa. While these diagnoses may co-occur with ASD, it is important to have the full picture of any and all conditions affecting girls to provide them with the most comprehensive care available.
Women with autism who were misdiagnosed as children have been increasingly vocal about their struggle to be correctly diagnosed. Blog posts, formal interviews, and even YouTube videos–including this one from the channel “invisible i”–are springing up as women seek to help the families of girls searching for answers.
Where to seek help for your daughter
If you suspect your daughter may have autism, speak with her pediatrician for a referral to a neurologist or psychologist, who can diagnose her. Be sure to share all your concerns with the diagnostic doctor, including any instances of social camouflaging you may have noticed. It may be helpful to keep a list of your daughter’s symptoms or nuanced social interactions that you notice in the weeks leading up to your appointment. Seeking a second opinion can be helpful if you suspect your daughter’s symptoms have been misinterpreted. The sooner a child is properly diagnosed with autism, the earlier families and specialists can work with the child using popular interventions and selected therapies.
Children’s National Health System. (2018, January 4). Girls’ social camouflage skills may delay or prevent autism diagnosis: Study adds evidence to growing belief that current clinical tools fail to capture unique autism presentations in females. ScienceDaily. Retrieved from http://www.sciencedaily.com/releases/2018/01/180104160813.htm
NPR, S. W. (2017, July 31). ‘Social camouflage’ may lead to underdiagnosis of autism in girls. Retrieved from https://www.mprnews.org/story/2017/07/31/npr-social-camouflage-may-lead-to-underdiagnosis-autism-girls