Recent research suggests thatautism spectrum disorder(ASD) may look quitedifferent in girls—so different, in fact, that it can be difficult to use existingautism diagnostic criteria. This is because most early studies of autistic children were focused on boys, but there may be other reasons.
A diagnosis is often missed in autistic girls and women.This may occur because they have fewer intenseautism traits(like intellectual disability) than boys. Or, girls may be better at masking (hiding) their autism traits. A missed diagnosis means delayed intervention that can affect a lifetime, and the potential for co-occurring conditions likeanxiety.
This article will discuss the differences between female children with autism vs. male children with autism. It refers to boys and girls on the basis of their assigned sex at birth, while acknowledging that there is significant gender identity variation among autistic people (but no clear consensus on the link).
Kristin Rogers Photography / Stocksy United
Is Autism More Common in Boys vs. Girls?
An autism diagnosis is far more common in boys; it’s four times as likely, and researchers continue to work to understand why.Some of the possible reasons include:
Studies suggest there really is a higher incidence of autism in males, but the ratio is closer to three-to-one because so many autism diagnoses are “camouflaged” and therefore missed in girls.
Some of the reasons thatautism traitsmay be missed or misidentified in girls include:
Some study authors note that their results are based on assigned sex at birth, but it’s known that there are greater sex and gender identity variations (andgender dysphoria) among autistic people.
A predictive model based on population data estimated that 39% more women should be diagnosed with ASD. These autism diagnoses are missed for a range of reasons, including bias among healthcare professionals about autism in females and in the autism diagnostic tools themselves.
How Autistic Girls Differ From Autistic Boys
There’s some evidence to suggest progress in how girls are diagnosed with autism. A study of 2,684 people in nine European nations looked at sex, age, and other factors when assessing results of common autism diagnostic tests: the Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS), or both.
Social Skills and Play
It’s common for different play styles to emerge among neurotypically developing boys and girls. These differences can make an autism diagnosis more obvious in boys, as was the case in a study of 96 children: 24 autistic boys, 24 autistic girls, and their corresponding neurotypical peers.
Autistic boys play alone, so it’s visible to others when they’re not participating in organized games with other boys. Autistic girls find it easier to “blend” among their friends and camouflage their autism traits because the social framework allows them to stay closer to the support of friends.
An autistic girl’s mentors, though, may drift off as they enter adolescence and find other interests or groups of friends. Autistic girls who rely on masking may find it harder to do so with the increasing social and relationship demands of adolescence and adulthood, leading to the later diagnosis.
Social Communication and Language
While boys' social communication issues become challenging very early in their lives, girls may be able to manage the social demands of early childhood but run into difficulties as they enter early adolescence.
Autistic boys may tend to engage in disruptive behavior to gain objects, while autistic girls may tend to engage in disruptive behavior to get attention.Autistic girls are less likely to behave confrontationally or intensely and more likely to be passive or withdrawn, but they may be more prone to co-occurring disorders like anxiety and depression.
Autism and EpilepsySome research studies suggest thatepilepsy(a seizure disorder) is more likely to co-occur in autistic girls, even though boys are more likely to be diagnosed with autism overall.
Autism and Epilepsy
Some research studies suggest thatepilepsy(a seizure disorder) is more likely to co-occur in autistic girls, even though boys are more likely to be diagnosed with autism overall.
The ADI-R and Other Tests Used to Make an Autism Diagnosis
Summary
Both boys and girls are diagnosed with autism, though it’s more common in boys. Some studies have identified underlying reasons for why there’s a higher incidence of an autism diagnosis in boys, but genetic and sex differences don’t fully account for the lower rate of diagnosis in girls.
Other studies point to cultural biases, including the ways that tests are used to diagnose autism. They’ve estimated the degree to which autism in girls is missed or misdiagnosed, and called for increased awareness to ensure that women and girls are accurately diagnosed and treated.
What Is the Best Treatment for Autism?
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ochoa-Lubinoff C, Makol BA, Dillon EF.Autism in Women.Neurol Clin. 2023 May;41(2):381-397. doi:10.1016/j.ncl.2022.10.006.Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM.Is it autism? A critical commentary on the co-occurrence of gender dysphoria and autism spectrum disorder.J Homosex.2021 Apr 14:1-19. doi:10.1080/00918369.2021.1905385Ratto AB, Kenworthy L, Yerys BE, Bascom J, Wieckowski AT, White SW,et al.What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills.J Autism Dev Disord. 2018 May;48(5):1698-1711. doi:10.1007/s10803-017-3413-9.Huys M, Dhondt K.Gender variance or gender dysphoria and autism spectrum disorder in children and adolescents.Tijdschr Psychiatr. 2022;64(1):25-31. PMID: 35178690.Tillmann J, Ashwood K, Absoud M, Bölte S, Bonnet-Brilhault F, Buitelaar JK,et al.Evaluating Sex and Age Differences in ADI-R and ADOS Scores in a Large European Multi-site Sample of Individuals with Autism Spectrum Disorder.J Autism Dev Disord. 2018 Jul;48(7):2490-2505. doi:10.1007/s10803-018-3510-4.Dean M, Harwood R, Kasari C.The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder.Autism. 2017 Aug;21(6):678-689. doi:10.1177/1362361316671845.Autism Research Institute.Autism and Seizures.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ochoa-Lubinoff C, Makol BA, Dillon EF.Autism in Women.Neurol Clin. 2023 May;41(2):381-397. doi:10.1016/j.ncl.2022.10.006.Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM.Is it autism? A critical commentary on the co-occurrence of gender dysphoria and autism spectrum disorder.J Homosex.2021 Apr 14:1-19. doi:10.1080/00918369.2021.1905385Ratto AB, Kenworthy L, Yerys BE, Bascom J, Wieckowski AT, White SW,et al.What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills.J Autism Dev Disord. 2018 May;48(5):1698-1711. doi:10.1007/s10803-017-3413-9.Huys M, Dhondt K.Gender variance or gender dysphoria and autism spectrum disorder in children and adolescents.Tijdschr Psychiatr. 2022;64(1):25-31. PMID: 35178690.Tillmann J, Ashwood K, Absoud M, Bölte S, Bonnet-Brilhault F, Buitelaar JK,et al.Evaluating Sex and Age Differences in ADI-R and ADOS Scores in a Large European Multi-site Sample of Individuals with Autism Spectrum Disorder.J Autism Dev Disord. 2018 Jul;48(7):2490-2505. doi:10.1007/s10803-018-3510-4.Dean M, Harwood R, Kasari C.The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder.Autism. 2017 Aug;21(6):678-689. doi:10.1177/1362361316671845.Autism Research Institute.Autism and Seizures.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ochoa-Lubinoff C, Makol BA, Dillon EF.Autism in Women.Neurol Clin. 2023 May;41(2):381-397. doi:10.1016/j.ncl.2022.10.006.Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM.Is it autism? A critical commentary on the co-occurrence of gender dysphoria and autism spectrum disorder.J Homosex.2021 Apr 14:1-19. doi:10.1080/00918369.2021.1905385Ratto AB, Kenworthy L, Yerys BE, Bascom J, Wieckowski AT, White SW,et al.What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills.J Autism Dev Disord. 2018 May;48(5):1698-1711. doi:10.1007/s10803-017-3413-9.Huys M, Dhondt K.Gender variance or gender dysphoria and autism spectrum disorder in children and adolescents.Tijdschr Psychiatr. 2022;64(1):25-31. PMID: 35178690.Tillmann J, Ashwood K, Absoud M, Bölte S, Bonnet-Brilhault F, Buitelaar JK,et al.Evaluating Sex and Age Differences in ADI-R and ADOS Scores in a Large European Multi-site Sample of Individuals with Autism Spectrum Disorder.J Autism Dev Disord. 2018 Jul;48(7):2490-2505. doi:10.1007/s10803-018-3510-4.Dean M, Harwood R, Kasari C.The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder.Autism. 2017 Aug;21(6):678-689. doi:10.1177/1362361316671845.Autism Research Institute.Autism and Seizures.
Ochoa-Lubinoff C, Makol BA, Dillon EF.Autism in Women.Neurol Clin. 2023 May;41(2):381-397. doi:10.1016/j.ncl.2022.10.006.
Fortunato A, Giovanardi G, Innocenzi E, Mirabella M, Caviglia G, Lingiardi V, Speranza AM.Is it autism? A critical commentary on the co-occurrence of gender dysphoria and autism spectrum disorder.J Homosex.2021 Apr 14:1-19. doi:10.1080/00918369.2021.1905385
Ratto AB, Kenworthy L, Yerys BE, Bascom J, Wieckowski AT, White SW,et al.What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills.J Autism Dev Disord. 2018 May;48(5):1698-1711. doi:10.1007/s10803-017-3413-9.
Huys M, Dhondt K.Gender variance or gender dysphoria and autism spectrum disorder in children and adolescents.Tijdschr Psychiatr. 2022;64(1):25-31. PMID: 35178690.
Tillmann J, Ashwood K, Absoud M, Bölte S, Bonnet-Brilhault F, Buitelaar JK,et al.Evaluating Sex and Age Differences in ADI-R and ADOS Scores in a Large European Multi-site Sample of Individuals with Autism Spectrum Disorder.J Autism Dev Disord. 2018 Jul;48(7):2490-2505. doi:10.1007/s10803-018-3510-4.
Dean M, Harwood R, Kasari C.The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder.Autism. 2017 Aug;21(6):678-689. doi:10.1177/1362361316671845.
Autism Research Institute.Autism and Seizures.
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