By Raising Children Network
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Autism spectrum disorder (ASD) in girls can be different from ASD in boys. It might also be diagnosed differently. And girls with ASD can face different challenges compared with boys with ASD.

How autism spectrum disorder is different in girls

Boys and girls with autism spectrum disorder (ASD) are similar in many ways. For example, they all have difficulties relating to and communicating with other people. They can repeat a particular behaviour over and over, or get fixated on a topic or special interest.

But some characteristics of ASD can look a bit different in girls. In general, compared with typically intelligent boys with ASD, typically intelligent girls with ASD might:

  • seem more passive
  • seem to have better social skills
  • have better communication skills.

Girls with ASD have fewer repetitive behaviours and narrow interests than boys, and these can look different. For example, boys might be intensely interested in car companies, train timetables or facts about dinosaurs. But girls might develop special interests in areas like teddy bears or doll collections. In many cases their interests are similar to those of typically developing girls.

Girls diagnosed with ASD might be more likely than boys to have intellectual disability. This might be because the different characteristics of ASD in girls are more easily spotted if girls also have an intellectual disability. Girls with ASD who have an average or slightly above average IQ might be being missed by those involved in diagnosis.

About three-quarters of children with autism spectrum disorder (ASD) are boys, but it’s not clear why.

Diagnosing autism spectrum disorder in girls

There are several factors that might influence whether autism spectrum disorder (ASD) is diagnosed in girls, and how often. Here are some theories about how these factors work.

Social factors
Girls with ASD, like typically developing girls, are likely to have better social skills than boys with ASD. Because of this, ASD characteristics in girls might stay ‘hidden’ from carers, school teachers, peers and those involved in diagnosis because girls are better at masking them.

Although girls with ASD might seem to have better social skills when they’re younger, they have trouble making two-way friendships and can be bullied or socially isolated when they’re teenagers. Older girls with ASD might also struggle more socially because society tends to expect different social behaviour from girls than boys.

Social struggles in the early teenage years might lead to an ASD diagnosis for some girls.

Genetic factors
Many genes can play a role in the development of ASD.

It’s also possible that the developing female brain might be ‘protected’ from neurodevelopmental disorders like ASD. This is called the ‘female protective model’. In this model, developing male brains need fewer gene abnormalities than female brains to develop ASD. Girls get some protection from developing ASD by having a higher threshold for genetic abnormalities.

This model might explain why more boys than girls have ASD.

Sex hormones
Sex hormones produced soon after a child is conceived might influence the development of different thinking and learning styles in boys and girls.

Boys seem to be better with systems, mechanical objects and factual information. They have good attention to detail and practical thinking styles. Girls, on the other hand, seem to be more people focused and better at understanding emotions.

One theory is that people with ASD think, learn and act in ‘male’ ways, regardless of whether they’re girls or boys. This is called having a male profile. People might develop a male profile because more male hormones were produced in the womb around the time of their conception, regardless of whether they’re male or female.

Why girls with autism spectrum disorder aren’t diagnosed

Girls who have autism spectrum disorder (ASD) sometimes miss out on a diagnosis because their behaviour doesn’t match the current ASD diagnostic criteria. This might be because the criteria are weighted towards the more ‘male’ profile of ASD.

Some people think that we need more research to understand the ‘female profile’ of ASD. They also think we need more appropriate diagnostic criteria for girls with ASD.

There are some tests to diagnose the female profile of ASD, but these tests are still being developed. And we can’t say whether a specific diagnostic test will identify girls with ASD more successfully than current methods.

Girls with ASD who are missed at an early age and who then find it hard to cope in complex social situations in their teenage years can be misdiagnosed with personality disorder, mood disorder, anxiety disorder or eating disorders like anorexia.

Other possible misdiagnoses for girls include attention deficit hyperactivity disorder (ADHD), attachment disorder and selective mutism.

Where to get help for girls with autism spectrum disorder

If you think your daughter has autism spectrum disorder (ASD), it’s best to make an appointment with a health professional as soon as possible.

A good place to start is with your GP, who can refer you to a paediatrician. The paediatrician can refer you to psychologists, occupational therapists and speech therapists if your child needs them.

You can read more about what to do if you’re worried your child has ASD and how ASD is diagnosed.
  • Last updated or reviewed 26-09-2016
  • Acknowledgements This article was developed with help from Nicole Rinehart, School of Psychology and Psychiatry, Monash University; and Rucha Joshi and Cheryl Dissanayake, Olga Tennison Autism Research Centre, La Trobe University.