Statistics show a higher diagnosis of autism in boys than girls, with data in the UK showing a ratio of 4:1 (Ambitious About Autism, 2017). However, as available statistics are generally based on multiple studies, both national and international, this ratio is likely to be lower. Recent research in the USA suggests a ratio of 3:1 (Loomes et al., 2017). Rachel Loomes and her colleagues, in their systematic review of male to female ratios in autism suggest that girls who meet the autistic spectrum disorder (ASD) criteria are at a greater risk than boys of not receiving a clinical diagnosis. Rivet (2011) on the other hand, suggests that boys may be more likely to show hyperactivity or aggression than girls, which would lead to a clinical examination. Other researchers suggest that autism may present differently in girls or girls may ‘camouflage’ symptoms (Dworzynski et al., 2012). What the research highlights is that autism in girls is probably more common than was previously thought and that girls on the autism spectrum may present with different or less pronounced symptoms or may mask the symptoms. In many situations it may not lead to a clinical diagnosis.
Carol Povey, Director of the National Autistic Society, believes this was the case, but says that “people’s awareness is now growing. Clinical referrals to specialist diagnosis centres such as our Lorna Wing Centre for Autism have seen a steady increase in the number of girls and women referred.”
“We are also getting more and more women coming to us with misdiagnosis in childhood. They had been diagnosed with ‘something’ in childhood and felt, as they got older, that it may be something different’. In school, it is often picked up because a teacher may see a girl struggling. She may be bright, but she is still getting it wrong. She may have no friends - often because of underlying autism. But she may be good at camouflaging. Our specialist psychologists- Dr. Judith Gould and Dr. Sarah Lister Brooke -see the increase. We now recognise a whole group of girls in this category”.
The National Autistic Society (2017) describes autism as “a lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them.” Given this definition, it is perhaps not surprising that much of our knowledge on autism is informed by research within schools. In this environment, children on the autism spectrum have to face the daily challenge of social interaction with peers. Evidence shows that boys on the autism spectrum are more likely to play on their own than with the group and often have special interests which are different to those of other boys their age (e.g. train timetables). Teachers are more likely to identify a special educational need with boys as they are often hyperactive and have a poor attention span in class. Girls, on the other hand, may equally have exaggerated interests, but these may be similar to other girls, e.g. animals or soap operas, but not being unusual, they are not considered symptomatic of ASD. Earlier research suggested that girls, who generally interact in smaller peer groups than boys, may be better at mimicking the socialising skills of their peers than boys (Attwood, 2006).
Carol Povey says, “with very young girls, they usually pick up language quicker than boys. If they are slower, teachers and practitioners can pick it up. Children on the autism spectrum may have very focused interests- e.g. boys focus on planets, whereas girls focus on animals. But a lot of children are like this. So, it is not always easy to pick up when children are younger. As we know from the research by Gould and Ashton-Smith (2012), it is not the particular hobbies that set them apart from their peers, but ‘the quality and intensity of these interests and the length of time spent on these’ that set them apart from others.
“And teachers do pick up ASD in girls, but it is often later. In later years, they pick up the secondary symptoms, for example, eating disorders or self-harming. These secondary symptoms are more evident”.