Why Do Symptoms Of Autism In Girls And Women Show Up Later Than In Boys?

Here's a little exercise. What kind of person do you imagine when you hear the word "autistic"? I've got no idea what else will have come to your mind (OK, the Big Bang Theory, maybe), but the person most people conjure up will be male. You may well be laboring under the impression that a statistic that often floats around — for every four autistic males, there will be just one female — is true.

It isn't. More recent research has concluded that that rate is more like three to one, with the caveat that autism is very often un- or misdiagnosed in girls and women to the real numbers may be an awful lot bigger. 

Why is it that girls on the spectrum might not get the correct diagnosis? Several key reasons could explain why autism is still perceived as a predominantly male brain-wiring difference:

• Girls and women actually have different autistic symptoms (or traits). 
• More autistic girls and women learn to mask autistic behaviors to the point where they are able to pass as neurotypical.
• Society is simply not looking hard enough or correctly enough to be able to identify autistic traits in females. 

Do the symptoms of autism really show up later in girls than boys?

No. The firth and current version of the diagnostic and statistical manual of mental disorders, which US clinicians use to diagnose autism, reminds us that the symptoms of autism are typically recognized somewhere during the second year of a child's life — between 12 and 24 months.

If a child has blatantly obvious autistic traits (or someone is looking very carefully), their autism may be spotted even earlier. If the symptoms are more subtle (or nobody's looking or looking properly), they may be spotted later or much later, or never identified as autism. 

What might autism look like in girls?

Autism is characterized by two core features, each of which can manifest in a number of ways. The first defining characteristic lies in differences in (or challenges with, or as the DSM-5 says, "impairment in") social communication and interaction. The second, meanwhile, is certain behavioral traits, typically described as "restricted" and "repetitive". Since both are required for a diagnosis, autistic girls and women will have characteristics from the first and second domains alike, but they may look a whole lot different. 

Communication-wise, autistic girls and women may:

• Be seen as shy rather than autistic during earlier childhood, only for real differences to become apparent during adolescence, as this is a time that's hard to cope with. This may be one reason some people seem to think autism shows up later in girls. Really, what shows up later is the noticing!
• Be rather vocal! Some autistic girls who have no qualms about speaking out, including in very blunt and direct ways that may be seen as socially-inappropriate or rude. This may earn them the labels "bratty" or "spoiled". 
• Struggle with eye contact. Have unusual body language. 
• Have a hard time knowing when to start speaking and when not to. Speak rather loudly or rather quietly, and with a "strange" accent or intonation. 
• Not be stereotypical "girls". Clothes communicate, too, and females on the spectrum might prefer comfort over looks or have "quirky" tastes. 
• Some autistic girls who were previously very verbal may develop selective mutism, in which they find themselves unable to speak in certain situations, during puberty.
• Study the way in which other people interact in-depth, allowing them to develop the ability to mimic phrases and ways of communicating they see around them — sometimes to the point where nothing seems different at first glance.

Behaviorally, girls on the spectrum might:

• Have passions (obsessions, special interests) that don't seem all that odd because they're typical for girls their age. They could include things like horses, a band, makeup, or a TV series, for instance. (Passions obviously vary from person to person, and autistic girls could also be into anything from UFOs to Shakespeare or the history of swear words! But those with more socially-accepted interests are more likely to fly under the radar.)
• Get so into those passions that they forget to engage in activities like personal hygiene, assigned school work, or social interactions with the people around them.
• Seem to be playing with toys in typical ways, when they are, in fact, lining them up or sorting them in some way.
• Hang around the periphery of girls' social groups, never quite being a full part of them. 
• Be hypersensitive to sensory input — things like bright colors and lights, loud noises, quiet but annoying noises, fabric textures, large groups of people, smells, or in short, irritating details that many people totally miss. Exposure to these things can cause them to become withdrawn or have meltdowns. This is common to many autistic people, female or not, but girls might be more likely to be labeled as "just sensitive" or even "drama queens". 
• "Stim". Short for self-stimulatory behavior, which can help control stress and anxiety or express excitement, almost all autistic folks stim. There are many different ways to do it, though, and though you may have heard of stereotypical hand-flapping or rocking, stimming can also involve activities that don't look out of place. They'd include nail-biting, using a fidget spinner, listening to a favorite song over and over, tapping a pencil, playing with squishies, and so on. 
• Be rather rule-focused or "black and white" in their thinking, with a strong sense of right and wrong. This may earn girls the label "bossy". 
• Not like to be touched.
• Be anxious, because even if the world doesn't know they're autistic, it is certainly aware they're different. The world may not be kind to them, leading to anxiety and depression.

Girls on the spectrum? Other things you may want to watch out for

Girls on the autism spectrum tend to have better motor function than boys, research has shown — with the exception of gross motor activities like catching balls or jumping. Their clumsiness may stand out less because of societal ideas that girls are not as good as sports.

Girls with autism can have all the same inherent tendencies that boys on the spectrum might, but because society tends to place a greater emphasis on social communication in girls and women, they may internalize the need to adapt and make proactive changes by mimicking behaviors they see around them.