Why is autism underdiagnosed in girls?

The Neurodiversity Paradigm

Autism has been largely misunderstood throughout time. Our understanding is rapidly changing and new information and insights are being introduced daily. We’ve shifted from “this is a disorder and needs to be fixed” to having a greater understanding of the fact that neurological differences in the population are normal, natural and come with their own benefits.

The neurodiversity paradigm embraces that there is not a “right” or “wrong”style of neurocognitive functioning. It sees autism as a neurologically based variation that requires acceptance, respect, and accommodation, rather than seeking treatments that will make autistic people appear neurotypical or aim to rid them of their autism. (Myers, Carol. Neurodiversity: A Changing Paradigm 6/13/2022.)

What does the term ‘neurodivergence’ mean?

Neurodivergence simply means, your brain is wired differently than what is considered typical or “normal” from the rest of the population. This includes the way your brain processes information, the way you think, learn and interpret the world.

The term “neurotypical” is a term that’s used to describe people with typical neurological development or functioning. In other words, it’s not used to describe someone who has neurological differences.

Do you have a child who is neurodivergent or autistic?

Being a parent of a neurodivergent child means that there is a possibility that you also are neurodivergent (as it’s known to be genetically inheritable.)

Similarly, if you are a parent of an autistic child, it’s possible that you are also autistic.

You may be thinking “but wouldn’t I have been diagnosed if I was autistic? And surely I would know if I was autistic, right?”

The truth is, so many people have gone their entire lives or well into adulthood before receiving an autism diagnosis. Many autistic adults report feeling like the weight of the world has been lifted off of them when they receive their autism diagnosis later in life.

They have gone their whole life feeling like they’re on a completely different wavelength than the rest of humanity, struggling daily in a neurotypical world. Receiving an autism diagnosis turns the feeling of being a “damaged, disabled person” into “I’m a perfectly good autistic person.”

Many autistic people have never been diagnosed. This is especially true when it comes to women because most girls are often overlooked and not diagnosed as kids.

There’s a few reasons why autistic girls are less likely to get diagnosed:

1. Autistic girls exhibit different symptoms than boys

One of the main reasons autistic girls are less likely to be diagnosed is that they exhibit different symptoms than boys. Autism is often associated with stereotypical behaviors like repetitive behaviors such as flapping or rocking. However, autistic girls tend to be quieter, socially withdrawn, and less disruptive in a classroom environment. Put simply- girls are being overlooked because they don’t fit autism stereotypes.

Additionally, many milder autistic traits in girls may be overlooked or not understood for what they are. For example, 21 year old autistic blogger @neurodivergent_lou says “Autism is more than just a sum of external experiences. A lot of being autistic to me is the parts that are not visible and these autistic traits are equally valid, even if they are not spoken about enough.” One example she gives is about internal echolalia saying it can “also be internal where someone repeats words or sounds in their head rather than out loud.”

2. Autistic girls are better at masking their autistic traits

What’s masking?

Autistic masking is when someone suppresses their autistic traits and mimics certain behaviors in order to appear more neurotypical. Girls especially are more likely to learn how to mimic neurotypical behavior. This is known as “masking,” and it can make it difficult for doctors and educators to diagnose autism in girls.

This can include things like:

Making eye contact even though it feels painfully uncomfortable
Scripting conversations
Imitating gestures/ facial expressions
Trying to not stim or choosing a less obvious stim
Hiding/ minimizing personal special interests.

In this article, Carol Povey, director of the National Autistic Society’s Centre for Autism states, “Recent research suggests that the number of males and females on the autism spectrum is far more equal than previously thought and diagnostic statistics suggest. The problem is that professionals often don’t understand the different ways autism can manifest in women and girls, with many going through their lives without a diagnosis and an understanding of why they feel different.”

There’s been some debate about why girls and women may mask autistic traits more than boys and men do. This 2015 study suggests that autistic girls and women may be more inclined to develop friendships than autistic boys and men. Girls often mask (such as scripting or imagining/ practicing future conversations) which results in superficial social competence.

3. The diagnostic criteria are based on male traits

The criteria for ASD diagnosis are based on data sets taken almost entirely from studies on boys with autism. This means that they may not accurately reflect the experience of autistic girls. For example, the criteria for diagnosing autism include a lack of eye contact, limited language ability, repetitive behaviors, etc. However, autistic girls may have better eye contact and language skills, making it more difficult for doctors to diagnose them.

The Takeaway

Autistic girls do not often get diagnosed because their symptoms are different from boys, they are better at masking, and diagnostic criteria was developed specifically around males. To close the autism gender gap, we need to raise awareness about the unique experiences of autistic girls and ensure that doctors and educators are trained to recognize their symptoms.

Author: Christina Kozlowski, Occupational Therapist, OTR/L & Owner of Sensory TheraPLAY Box