How does autism present differently in girls and boys?

To anyone in the know it’s no secret that the diagnostic ratio of boys to girls with autism is heavily weighed in favour of the boys. For every 4 boys diagnosed with autism only 1 girl receives a formal diagnosis. Researchers increasingly theorise that this may be in part due to the differences in the male and female phenotype (the set of observed characteristics) of autism. But what actually are the differences in how autism presents in girls vs boys?

Inward and outward manifestation of difficulties

Boys with autism are more often prone to exhibiting challenging behaviour than girls. This occurs when they are struggling to express themselves and their needs. The behaviours are the outward manifestation of the fact that they are struggling to process situations or emotions. For girls however these problems and feelings are more often internalised. This means that, contrary to what many believe they are not struggling less just expressing it differently. Whilst boys often engage in disruptive behaviour to get what they want, girls may be persistently ‘ill’ to gain control over the situation instead. Because of this girls are less often singled out for behavioural problems, but are more at risk of developing anxiety and depression than boys. Because of this social struggles are often misunderstood as shyness or anxiety. This is also evidence of a difference in comorbidity in girls vs boys with autism. Boys are more likely to be diagnosed with ADHD in addition to their autism whereas for girls it is more often anxiety, depression or eating disorders.

Social Differences

Studies suggest that girls with autism seem to be more socially motivated than boys. This is thought in part to be because of the way in which girls, from as early as nursery aged, are much more aware of social behaviour and the desire to conform to social norms. Females with autism display greater interest in people and interacting with them than boys. Because of this they are more likely than their male peers to invite social interaction. However despite this they often struggle to maintain friendships. This can be for many reasons, such as being socially immature and attempting to dominate play so that they can maintain order and control, or not wanting to play cooperatively with their peers. It has also been observed that girls often find the idea of a social hierarchy difficult to understand, so many often react inappropriately to authority figures.

Masking

Probably the biggest difference between the male and female autistic phenotypes is the occurrence in females of what is called ‘masking’. This occurs because of the social mimicry that females tend to engage in. Girls learn social behaviours by observation and copying in order to try and adhere to social norms. Often they don’t even realise that they are attempting to fit in by copying the behaviour of those around them. This is also true for girls with autism, but is less often seen in boys. This means that whereas boys tend to express their feelings through impulsive and disruptive behaviours, girls often mask negative feelings and suppress them until they are home or in a ‘safe place’ where they do not feel the social pressure to ‘fit in’. They are thus more prone to have meltdowns or shutdowns at home not in public. Because this happens out of sight more often for girls than boys, it can contribute to missed diagnoses in girls.

Conclusion

There are many subtle differences between how autism presents in men vs women. Because the stereotype of autism is largely masculine the subtle differences are misinterpreted as girls struggling less than boys. Recognising the differences between autism in males and females is the first step in making sure more girls don’t go misdiagnosed and can get help earlier in life.