Once upon a time (not too long ago), experts thought that autism spectrum disorder in girls was rare, and if it was present, was most likely associated with an Intellectual Disability and extreme behaviours of concern. Research however has taught us that ASD in girls is much more common that originally thought, and that the current 1:4 ratio of girls to boys diagnosed with ASD may still be missing many girls. There are numerous reasons for this, with the greater ability to imitate and ‘mask’ their symptoms meaning that girls tend to be older when they are diagnosed (if at all).
As a clinician assessing for the presence or absence of ASD, we look for several traits. This can include difficulties with social communication, including difficulties with non-verbal communication (e.g. eye contact, body language, gestures etc.), difficulties in understanding and maintaining relationships with others, and not always being able to read the emotions of others or pick up on social cues. We also see if there are any repetitive behaviours present, such as repetitive speech patterns or body movements, difficulty coping with change, an intense interest area or being hyper or hyposensitive to sensory input from the environment. How these difficulties manifest in girls can be subtle.
Some possible ‘signs’ of ASD in the female population include:
- Being the ‘model student’ at school but having intense emotional outbursts once they get home.
- Being intolerant of change, especially when it is unexpected.
- Disliking grooming, such as having their hair brushed, particularly as they approach puberty.
- Seeming bothered by bright lights or certain smells or tastes.
- Seeming to tire easily.
- Preferring to play alone, or when they play with others try to dictate the rules. They may also adopt a passive role and rely on another child to guide them and speak for them.
- Being shy in social situations, often seeming to watch and copy other girls’ behaviour.
- Having a ‘special interest’ that seems typical for their age, e.g. animals, music or literature- but this interest is much more intense and all-consuming compared to their peers. It may dominate majority of their conversation.
- Enjoying arranging or organising things.
- Having a strong imagination and often retreating into a fantasy world.
- As a younger child, may have appeared to engage in pretend play, but if examined closely resembled a static visual scene (rather than a storyline).
- Beginning to noticeably struggle socially as the social world becomes more complex (at the onset of adolescence). This may include difficulties in making and keeping friends.
- Seeming immature for their age, including speaking in a tone of voice like a younger child.
- Not picking up on the ulterior motives of others due to some social naivety (unfortunately making them “easy prey” for bullying etc.).
- Experiencing depression, anxiety, an eating disorder, obsessive-compulsive disorder or epilepsy (although these can occur in the absence of ASD, those with ASD are more at risk of developing these disorders).
If you are considering ASD as an explanation for a girl or young woman’s presentation, consider if there are a number of ‘signs’ present; whether these have been consistent across her life; and whether they are negatively affecting her everyday life and functioning. If this is the case, it is likely worthwhile pursuing a diagnostic assessment to increase understanding and provide better support for her. Feel free to get in touch with us at NCCD and HCCD if you’d like to learn more about the assessment process.
Olivia Smith is a registered psychologist and is completing her registrar program in Educational and Developmental Psychology. Olivia is a strong believer in the importance of working collaboratively with families and other professionals to ensure a holistic approach to child wellbeing. She is passionate about advocating for and working with children presenting with anxiety and/or neurodiversity (e.g. ASD, ADHD and specific learning disorders) and their families. Olivia strives to make therapy sessions engaging, effective and applicable to everyday life, and views the relationship between child and therapist as key to success. Outside of her work at NCCD, Olivia works as a clinician in the area of early identification of autism in children (aged 12 to 36 months) at the Olga Tennison Autism Research Centre at La Trobe University.