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Autism and girls

What do we know?

Before looking at differences between girls and boys with autism, lets look at gender differences in typical children.


Some brain imaging researchers have shown evidence that the brains of men and women are wired differently. The male brain is wired from front to back, with few connections across the two hemispheres. Women, on the other hand, have more wiring from left to right, so the two hemispheres are more inter-connected.


Some brain scan studies have recently come under scrutiny and the differences attributed to cultural rather than brain wiring. However regardless of cause, in tests – girls generally have higher scores on social cognition and verbal abilities and boys at spatial processing and sensorimotor skills.


In autistic children, despite social communication being one of the criteria for diagnosis, girls seem to have strong social brain activation in brain scans. In fact, the social brain activation of girls with autism is similar to that of a typical boy. Boys with autism have significantly underactive social brain activation compared to typical boys.

And I want to have friends. I desperately want friends and I want to do what the normal girls do. I just want to fit in. M is for Autism (p. 61).

Unlike typical girls – autistic girls’ social brains seems to communicate with a brain region (the prefrontal cortex ) that usually engages in reason and planning. It may be that they keep their social brain operational by rationalising social interactions that would be intuitive for other girls. The prefrontal cortex in the brain is known to burn through a huge amount of energy, so the process is exhausting and would account for reports of girls with autism being stressed and anxious.


A small study by Jane McGillivray and others at Deakin University adds evidence to support this idea. It compared 25 autistic boys and 25 autistic girls with a similar number of typically developing children. On a measure of friendship quality and empathy, autistic girls scored as high as typically developing boys the same age—but lower than typically developing girls.

People assume I’m not friendly because I often don’t want to make eye contact. People assume I’m being dumb when I ask them to write down directions they just gave me. Rose Hughes

Girls typically receive their autism diagnoses later than boys do and are often labelled with other things before finally getting an autism diagnosis. Although every child with autism is different, here are some common characteristics in girls with autism:


- Special interests in animals, music, art, and literature

- A strong imagination (like to escape into the worlds of nature or fiction)

- A desire to arrange and organise objects

- Difficulty in playing cooperatively with other girls (eg, needing to dictate the rules of play or preferring to play alone because they need to maintain control)

- A tendency to ‘mimic’ others in social situations in order to blend in

- Able to hold their emotions in check at school, but often have meltdowns or explosive behaviour at home

- Strong sensory sensitivities, especially to smell and touch (for example; clothing tags, - socks or even deodorant).


Despite having special interests, girls appear to be able to mask them so that they don’t stand out, where boys interests, which are also often the examples used in diagnosis – tend to be different to their same age peers after a certain age – ie trains and numbers.


The difference between typical and autistic development in girls may lie less in the nature of their interests than in their level of intensity. They sometimes refuse to talk about anything else or take expected conversational turns. Often they are described using the word “too”. Too much, too intense, too sensitive, too this, too that.


It’s like all my senses are firing at once. If you ask me three questions, all at once, I will be overwhelmed. I have to remember the first question you asked me as well as remember the second and then the third. Then because of the way it makes me feel, my face over-heats, I get a flush. My ears don’t seem to work, I stumble over my words, I want to close my eyes to try and communicate and I wish I was sitting down. It’s horrible. Rose Hughes

For most autistic girls, social life does not come at all naturally. They use their intelligence to become excellent mimics and actresses, and the effort this takes can be exhausting. They study people the way others might study math. And then copy them —learning what most girls absorb naturally on the playground only through novel reading and after first making embarrassing mistakes. Many girls describe life as being characterised by crippling anxiety.

I don’t think I come across as autistic. If anything, I wish I had more confidence to say that I’m autistic. For example, when I go to a café, I like my latte a certain way. I’ve had full-blown meltdowns because the barista thinks I’m being awkward and refuses to make me a ‘warm’ latte. I can’t stand how this makes me feel, but to them I’m just being difficult and should get out of the way. Rose Hughes

Differences in play

Last year, a team of researchers in the United States visited several schoolyards during recess and observed interactions among 48 boys and 48 girls, aged 7 or 8 on average, half of each group diagnosed with autism. They discovered that girls with autism tend to stay close to the other girls, weaving in and out of their activities.


By contrast, boys with autism tend to play by themselves, off to the side. Clinicians and teachers look for social isolation, among other things, to spot children on the spectrum. But this study revealed that by using that criterion alone, they would miss many girls with autism.


Typical girls and boys play differently, says Connie Kasari, a researcher at the University of California, Los Angeles, who co-led the study. While many boys are playing a sport, she says, girls are often talking and gossiping, and involved in intimate relationships. The typical girls in the study would flit from group to group, she says. The girls with autism appeared to be doing the same thing, but what was actually happening, the investigators learned, was different: the girls with autism were rejected repeatedly from the groups, but would persist or try to join another one. The scientists say these girls may be more motivated to fit in than the boys are, so they work harder at it.


I am the master of disguise. I have always worn a mask. I also always felt like I had to hide how much I wasn’t coping or how badly I was feeling. I am a pro at this now, but I am also working on knowing how to let it out and allowing myself that breathing space to be autistic. Men with autism tend not to hide themselves nearly as much as autistic women do. Rose Hughes.

Girls tend to have a different style to boys when it comes to friendship. Friendships often also have conflict, including verbal behaviours such as gossiping, and non-verbal behaviours such as giving someone the ‘silent treatment’, ‘staring daggers’, or eye-rolling to intimate dismissal. This conflict is likely to be difficult for autistic girls to understand. Usually, the conflict takes place within the context of a ‘friendship’, requiring girls to develop a flexible understanding of ‘friends’, rather than taking people at face value (which autistic people can tend to do).


Autism and Anxiety

Recent studies have shown that more than 40 % of children with autism have an anxiety disorder and 60% have clinical anxiety symptoms. Anxiety symptoms in some studies are as high as 80% using parent report. It was found that younger children and girls with autism had more anxiety symptoms than older children and boys.

Deep breaths, like it said in one of the printouts on my bed. I focused on the cool air hitting my nostrils and not on the beast’s hold on me. The scent of jasmine drifted in through the open kitchen door. I focused on the air travelling down my throat, filling my lungs and lifting my ribcage. I could feel the oxygen hit my hot brain and ever so very slightly cool and release the tightness in my head. Slowly, I released my breath through my mouth and the beast took a step away from me. It was still there but I was in charge now. M is for Autism (p. 86).”

Parent report in one study showed the types of anxiety – half were related to

mostly sensory, uncommon, or idiosyncratic specific phobias and worries about change and unpredictability. The other half described additional common anxieties not covered in the original measure such as social, weather and environmental disasters, and animals.


Anorexia and autism

Many adolescent girls can channel their autistic hyper-focus into another area into an obsession with controlling food. One woman said “I used to have a spreadsheet of how many calories, how many grams of this, that and the other thing [I could eat],”


“There are striking similarities in the cognitive profiles [between women with autism and those with anorexia],” says Kate Tchanturia, an eating disorder researcher. In one study up to 23% of girls diagnosed with anorexia also met the criteria for an autism diagnosis. Both people with autism and those with anorexia tend to be rigid, detail-oriented and distressed by change.


Sensory issues create more problems. Even many highly intelligent girls on the spectrum have difficulties with washing their hair, wearing deodorant and dressing appropriately.


Gender norms

Emily Brooks, 26, is a writer studying for her master's in disability studies at City University of New York. She believes gender norms cause many problems for people on the spectrum. She notes, that boys are allowed far greater leeway to deviate from social expectations. “If a guy does something that is considered socially inappropriate … his friends may sometimes encourage some of those behaviours,” she said, adding that “teen girls will shut you down if you do anything that's different.”


Some women say that, in particular, they put in a great deal of effort into disguising their stimming. For many people, stimming may be a way to self-soothe, self-regulate and relieve anxiety, among other things. And yet these motions — which can include flapping hands, spinning, scratching and head-banging — can also readily ‘out’ these people as having autism.


Recent research suggests that autistic girls and woman find men easier to socialise with and don’t readily identify with strong female characteristics of femininity.

“Joe sits next to me in form time. This morning he asked me if I’d watched Claw Hand on YouTube. I told him Toby was watching Claw Hand but I was watching Skylar. Sometimes I find it easier to talk to boys than girls. I find boys straightforward. They just ask a question and I answer it. I ask a question and they answer it. Joe said he liked my hair clip and asked where I got it”

What can you do?

Autism and anxiety affect all children differently. In order to support students, you need to first build a relationship, then a profile. Our online course helps you to learn more about autism and then apply that knowledge to an individual student. Once you understand their needs, you will find strategies to support their needs. Go to the Course page to learn more.


GRAPHICS: Russian Dolls represent autism

Rosanna Rosetti is studying Graphic Design at Birmingham City University.

She chose Russian dolls to show how girls with autism feel as they are traditionally female, they also appear to be hiding within one another. She thought represented how some autistic women and girls attempt to conceal their behaviour and autistic traits by hiding them from plain sight.

References

Brain signature characterizes boys with autism. Jessica Wright. Published online June, 2016. https://www.spectrumnews.org/news/brain-signature-characterizes-boys-with-autism/


Cooker, K. et al (2018) Gender Identity in Autism: Sex Differences in Social Affiliation with Gender Groups, Journal of Autism and Developmental Disorders, 48(12): 3995–4006.

McGillivray et al (2014). Gender differences in emotionality and sociability in children with autism spectrum disorders. Molecular Autism, 5 (19)


National Autistic Society. https://www.autism.org.uk/about/what-is/gender/stories.aspx

Sedgewick, F., Hill, V., & Pellicano, E. (2019). ‘It’s different for girls’: Gender differences in the friendships and conflict of autistic and neurotypical adolescents. Autism, 23(5), 1119–1132.


Students of Limpsfield Grange School and Vicky Martin. M is for Autism (2015). Jessica Kingsley Publishers: London


The costs of camouflaging autism. Francine Russo. Published online February 2018 https://www.spectrumnews.org/features/deep-dive/costs-camouflaging-autism/


The Lost Girls. Apoorva Mandavilli in Spectrum. Published online October 19, 2015. https://spectrumnews.org/features/deep-dive/the-lost-girls


Wijnhoven Lieke A. M. W., Creemers Daan H. M., Vermulst Ad A., Granic Isabela (2018) Prevalence and Risk Factors of Anxiety in a Clinical Dutch Sample of Children with an Autism Spectrum Disorder. Frontiers in Psychiatry. Vol 9