SM Clinic

Peculiarities of Girls’ Development with Autism Spectrum Disorder

On average, girls are diagnosed with autism spectrum disorder (ASD) at an older age than boys. This is largely due to the fact that instruments and clinical descriptions of autism focus on manifestations that are more characteristic of boys. This means that girls may not be getting the help they need.

Diagnosis 

Studies have shown that parents of girls and boys begin to notice behavioral features of their children associated with autism spectrum disorder at approximately the same age. Girls are diagnosed much later than boys (average age 81 months for girls, 61 months for boys). The age of diagnosis is also influenced by cognitive functioning: children with more pronounced intellectual disabilities are diagnosed earlier, which may be related to the greater number of developmental challenges they and their families face. Statistics show that girls with autism are less likely to have cognitive impairment than boys. This may be why the difficulties of these girls go unnoticed in the diagnostic process.

Social communication difficulties in autism spectrum disorder

Social communication difficulties in autism can manifest themselves in a variety of ways: the child has difficulty maintaining a conversation, does not read the social context, uses inflexible facial expressions, gestures and gaze when communicating, and does not understand social relationships and his or her role in them. Girls with autism spectrum disorder may be more successful in socializing than boys, even though they too have interaction and communication difficulties.

The girls wiggling and holding hands

This “masking” (i.e., masking the manifestations of autism and compensating for specific difficulties), although not a natural and automatic behavior for a child with autism spectrum disorder, may not be fully understood, especially if learned at an early age.

Research shows that autistic women utilize masking strategies to a greater extent compared to autistic men. Adult women with autism spectrum disorder also report that throughout their lives they have struggled to understand social rules and imitate behaviors that are expected of them. This difference is also seen in childhood, and partially explains the difficulty in diagnosing autism spectrum disorder in girls.

Differences in social interactions between girls and boys with autism spectrum disorder

Even with masking, girls with autism spectrum disorder differ from their neurotypical peers. For example, they are less likely to “talk about nothing” and have difficulty understanding the social subtleties and nuances of relationships, especially as social demands and interaction options become more complex with age. Keeping secrets, gossiping, pretending to maintain relationships, and “lying for the greater good” can be difficult for an adolescent girl with autism spectrum disorder, while to her peers these failures may seem like a deliberate betrayal.

Peer interaction differs between girls and boys with ASD. Observations of children’s free play on the playground show that boys with autism spectrum disorder are more often alone, away from groups of neurotypical peers, and busy with their own games. The social difficulties of such boys are easy to notice, as their detachment from other children is conspicuous.

A boy with autism spectrum disorder playing in his room

Girls with ASD tend to play with younger children or with boys of the same age, as their games are simpler and more structured. This makes it appear to parents and teachers that the girl is socializing and playing with other children, and problems in communication and interaction may go unnoticed.

Girls with autism spectrum disorder often show themselves in this sphere better than autistic boys, for example, they use more gestures and do it more expressively, skillfully combine non-verbal techniques with speech, maintain eye contact during conversation. Autistic girls learn all of this by observing and copying their peers.

Restricted and repetitive behaviors and interests in autism

Children with autism spectrum disorder tend to engage in repetitive behaviors, dislike change, and often exhibit restricted interests, diving deep into them. These behaviors may manifest as habitual play or repetitive actions. Girls with autism are characterized by fewer of these traits, especially those without cognitive impairment.

Girls with autism spectrum disorder often try to hide their features by using compensatory strategies. Because the diagnostic criteria for autism focus on repetitive behaviors, these “hidden” features may not be noticed.

Repetitive behaviors in girls are often less noticeable. Instead of repetitive movements, girls may read the same book or re-watch movies, which gives them predictability and comfort. This behavior does not disturb those around them, and it often goes unnoticed.

Girls with autism are also less likely to openly express discomfort with changes in routines. They may seek ways to compensate, such as being more demanding of themselves and following strict rules.

The interests of girls with autism spectrum disorder are often similar to those of their peers – animals, books or movies. Despite this, they spend a lot of time exploring their hobbies, just like boys with autism.

A girl reading a book on her bed with her teddy bear.

Some studies show that girls with autism may experience more vivid sensory reactions, both hypersensitivity (can’t tolerate loud noises) and desensitization (don’t notice hunger or pain). There may also be behavioral responses to sensation seeking.

Comparison

Here is a comparison table based on the presented developmental characteristics of girls and boys with autism spectrum disorder:

Feature

Girls with ASD

Boys with ASD

Age of diagnosis

Diagnosis occurs later, at an average of 81 months

Diagnosis occurs earlier, at an average of 61 months

Cognitive impairments

Cognitive impairment is less common

Cognitive impairment is more common

Difficulties in social communication

Can be more successful in communication despite difficulties

May have great difficulty in communication

Masking (masking autism)

Use masking strategies to a greater extent, often without awareness

Masking is less pronounced if it is used

Social interactions

Less likely to “talk about nothing”, difficulty understanding social subtleties

May be more open but suffer from communication difficulties

Playing with other children

Tends to play with younger children or peers, problems may not be noticeable

More often play alone, away from peer groups

Use of gestures and facial expressions

More pronounced, skillfully combining nonverbal techniques with speech

Less expressive gestures, less attention to nonverbal communication

Repetitive behavior

Less pronounced, girls may repeat reading books or watching movies

Often manifested in stereotyped movements or echolalia

Interests

More diverse and similar to the interests of neurotypical peers (animals, books, movies)

Often limited to objects and techniques

Sensitivity to sensory stimuli

May experience more vivid sensory responses (increased or decreased sensitivity)

Sensitivity may also be pronounced, but research is limited

Response to change

Less likely to openly express discomfort with change, use compensation

Strongly experience changes in routine, may show discomfort openly

The table highlights key differences between girls and boys with autism, showing that girls often have a more hidden presentation of symptoms and difficulties, which has implications for diagnosing and helping them.

Conclusion

Girls with autism spectrum disorder often have less visible symptoms, making early diagnosis and getting help more difficult. The use of masking strategies, social features, and hidden interests make the manifestations of autism in girls less pronounced. Although the same difficulties in social communication, play, and interests are found in girls, their modes of interaction may be more similar to neurotypical peers, making the disorder more difficult to identify. It is important to recognize these differences in diagnosis in order to provide girls with the support they need and improve their quality of life.

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