Autism Spectrum Disorder – Is It Different For Girls?

Imagine trying to identify a ‘problem’ pupil in class who is eager to please by being extremely helpful, has a desire to succeed and may even have perfectionist tendencies.

Alternatively, the ‘difficulty’ could be that she has a passive personality, is compliant and may be one of the quieter pupils in the room. Perhaps she comes across as shy, innocent and unassuming and is very unlikely to be disruptive.

Yet a girl displaying some or all of these behaviours may well have an undiagnosed autism spectrum disorder (ASD). Worryingly, if the condition isn’t spotted, she could be experiencing eating disorders or self-harming and developing mental health issues that last into her adult life.

Under the radar

The trouble is that to a harassed teacher, with 30 demanding pupils and a range of behavioural issues, the girl with these traits may sound like the ideal student. Furthermore, she may be very good at camouflaging her difficulties by mimicking more sociably able pupils in the class, making her condition even more difficult to recognise.

Contrast this with a lot of boys who have an ASD and display a number of recognisable traits, such as a lack of empathy or an obsessional interest with obscure subjects, such as light bulbs. The condition has been described by prominent autism expert Simon Baron Cohen as the ‘extreme male brain’ [PDF], and it may be this male dominance, coupled with the comparative ease in recognising the condition in boys when looking for autism, which causes the females to be missed.

It has been notoriously difficult to find a ratio of male to female autism that everyone agrees on, with figures ranging from, at one extreme, a 2:1 male to female ratio, to others believing that only one girl to every 16 boys has the condition.

Hans Asperger, who lent his name to the syndrome, initially believed that it was a condition that only affected males, which only highlights the difficulty of identifying female pupils with an ASD. From my own experience of working in an autism unit for over a decade, our numbers typically break down to one girl for every ten boys. A National Autistic Society survey from 2012 [PDF] shows how problematic it is to get a diagnosis for a girl – while 50% of boys with an ASD were diagnosed by the age of 11, only 20% of girls were. Just as worryingly, 42% of girls were reported as having been misdiagnosed, compared with 30% of boys.

Undiagnosed dangers

While these girls may outwardly be model pupils, their stress will often have to be released through another outlet such as self-harming or an eating disorder. In fact, an increasing number of young women are being diagnosed with an ASD after being initially seen by a doctor for an unrelated condition. An article published in Neuropsychiatric Disease and Treatment last year identified a connection between young women who have been diagnosed with anorexia nervosa and Asperger syndrome.

The risk is that the autistic element of these girls’ mental make-up is overlooked as clinicians look to treat the eating disorder, which may then lead to a simplification in the diagnostic consideration and therapeutic procedures.

The good news is that once they have received a diagnosis the girls can receive additional support. With greater understanding of self, their anxiety will lessen and they will be less likely to take part in harmful activities which could cause lasting physical damage. By contrast, if left undiagnosed, in later life they might have a history of mental health issues and in extreme cases, feel suicidal.

What to watch for

Here is a checklist of 12 signs that teachers and pupil support assistants can use to identify girls who may be on the spectrum:

• She may display social immaturity compared with the more worldly girls in the classroom

• She may have intense special interests, such as a favourite author, which are still typically ‘feminine’

• Her eye contact may be ‘different’ or she might not meet your eyes at all

• Her handwriting may be poorer compared with other girls in the class

• Related to this, she have poor gross motor coordination, which could also present in the form of clumsiness

• She may be isolated from the class and get teased by her peers

• Her results in assessments may gradually be getting poorer

• She might just be viewed as ‘odd’, without you being able to put your finger on why

• She could be generally disorganised, taking longer to get equipment out of her bag, or frequently leaving her possessions behind when leaving the classroom

• She might be passive and show a complete lack of interest in classroom activities

• She could lack empathy with others around her, or even in with characters in the books she is reading

• When she engages with teachers, it might be through a series of repetitive questions

Gordon Cairns is an English and forest school teacher, and also works in a an ASD unit for secondary pupils

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