7 Reasons girls are not recognised as having autism

We frequently find that parents of girls with autism report their daughters being missed for significant periods of time. In my own therapy and coaching practice, I invariably meet a large number of girls aged 14 and above who have not been referred for assessment, and who have had significant challenges emotionally, socially and with regard to their mental health as they were trying to mimic the world around them, without the accommodations that would have helped make their adolescents more enjoyable. These later diagnoses, can often come with a parallel of both relief that they now understand the nuances of behaviour and reactions that they noticed were different to their peers, and grief and sadness that they were not identified sooner and that their adolescence could have been better supported. So, why do so many girls fall through the cracks of being referred for assessment?

1.For many parents, the traits that indicate that their child may have Autism Spectrum Disorder (ASD) are evident by the age of 2-3 years. However, where traits are less pronounced these can be misread or interpreted as behavioural or emotional needs, and this can delay diagnosis until adolescence or adulthood.

2. Girls have been recognised as being better able to mask (camouflage) their symptoms and mimic the social behaviours of their peers more successfully. In early childhood, this often means that other than a slight delay in response times, their behaviour appears developmentally appropriate. However, with age, and increasing presentation of individual identities, the ability to mimic effectively becomes harder. Therefore, it is frequently at the stage of secondary school that the differences become more apparent to the young person.

3. Camouflaging is an exhausting process, and where it is used as a coping strategy, children with ASD are likely to present with symptoms of anxiety, low mood, self-harm, depression or low self-esteem which can create a barrier to diagnosis as we become focussed on the symptoms of camouflage, rather than the causative factors.

4. The assessment criteria for ASD is typically based around male characteristics. For many years it was believed that girls could not be autistic. Much of our information and understanding is still focussed on male characteristics and as girls frequently present differently they do not fit these ‘traditional profiles’.

5. Females who have ASD often have internalised issues and needs, which are not as obvious to those around them. In comparison, males often present with externalising needs such as behaviour and conduct needs, which may influence the approach and interventions that are put in place.

6. Females with ASD have been found to have a higher language ability and IQ, and demonstrate less repetitive behaviours, hyperactivity and aggression.

7. Traits of ASD may be mis-diagnosed or overshadowed where children also present with self-harm. Research has found that 20-30% of children with autism will self-harm. The types of self-harm used are often different, and referred to as self-injurious behaviours and are often linked to emotional dys-regulation, arousal levels and communication needs, but where a child is labelled as self-harming their underlying diagnosis may not be picked up.


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