Why do girls
seem to develop autism later than boys?
And does
this affect the way girls are diagnosed and treated for the condition?
Those are
questions being discussed intently at an annual conference in California.
A research
team, led by William Mandy, PhD, senior lecturer in clinical psychology at
University College London, says it has gained new insights into the different
ways that autistic characteristics present themselves in girls during
adolescence.
Mandy
presented the findings today at the 16th Annual International Meeting for Autism
Research (IMFAR) in San Francisco.
The findings
are new, but they echo theories offered by Hans Asperger in 1943 that were never tested.
Asperger, a medical theorist, is known for his early work into autism spectrum
disorders.
Mandy’s team
conducted a longitudinal study, which repeatedly gathered data for the same
test subjects over a period of time.
Researchers
found that while boys tend to display stable, similar autistic characteristics
throughout their adolescence, girls are more likely to see these
characteristics ramp up during the teen and preteen years.
The findings
could help explain why boys tend to be diagnosed with autism earlier than girls,
and also how guidelines for diagnosing autism in children could be biased against
girls.
1. A difficult disorder to pin down
Autism is
not the easiest condition to diagnose.
“Unlike some
physical health difficulties, we don’t have a biomarker for autism,” Mandy told
Healthline. “We don’t have blood tests or brain scans. We can’t actually see
autism itself, so instead we do what people do in all mental health disorders,
pretty much. We diagnose it not by looking at the thing itself, but by looking
at its manifestation, its size, and its symptoms.”
In short,
diagnosing autism isn’t quite an exact science. The criteria for diagnosing
autism includes a group of observable characteristics and behaviors that the
medical community has come to a consensus on as representing autism.
Generally
speaking, these characteristics come down to difficulties in the realm of
social communication and flexibility when it comes to things like switching
activities and focus. Other autistic characteristics include sensitivity to
outside stimuli like bright lights or loud noises.
“Autism is
not a black and white thing,” said Mandy. “It’s a dimensional condition. So the
people that we label as having autism are really just at the extreme end of a
continuum that extends all the way through the population with no clear natural
cut point between those that have autism and those that don’t. And what’s
become clear from the research is that having autistic traits, even if they’re
not at the level where we would conventionally label someone as having a
clinical diagnosis of autism, that’s still a risk factor for a range of
difficulties. For example, developing social anxiety problems, conduct problems,
or anorexia.”
Read more: Waiting seven years for an autism diagnosis »
2. Research is first of its kind
Mandy’s team
looked at autistic traits in the general population, rather than limiting
itself just to those people who are at the extreme end of the spectrum.
Autistic
traits for the same group of children and adolescents was measured at ages 7,
10, 13, and 16.
Boys who
showed high levels of autistic traits at age 7 tended to remain consistent over
time, demonstrating similar traits at older ages.
Girls, on
the other hand, showed a marked increase in levels of autistic social
difficulties between the ages of 10 and 16.
Mandy said
the findings were surprising, as previous medical wisdom stated that girls and
women with autistic traits tended to “camouflage” them as they got older.
“If
anything, I expected to see a decline in autistic symptoms in girls over time,”
he said. “What’s very interesting is that there was one person who suggested
the opposite, and that was Hans Asperger himself. There’s this rather
intriguing sentence from this paper he wrote in the 1940s, where he’s wondering
why we never see girls with what he would call ‘autistic psychopathologies.’
And he said, ‘Well, maybe it’s because these traits don’t show onset until
adolescence with females.’ And nobody tested that idea. So it’s intriguing that
that would be what we appear to have found on this occasion.”
3. Possible diagnostic pitfalls
So, are
girls getting short-changed when it comes to autism diagnoses?
“It’s
possible — it’s likely, in fact — that our current diagnostic criteria are
rather biased toward the male presentation, and biased against the female
presentation, said Mandy. “And there’s always been a sort of circular
situation, that almost all autism research is done on males, which means that
your diagnostic criteria reflects males, which means that you can continue to
recruit a predominance of males in your research, and so it goes on.”
Besides this
apparent bias, there’s also a strong likelihood that girls with autism present autistic
characteristics in ways that are different – and subtler – than what are seen
in boys.
One
characteristic of autism, that holds true with both sexes, is a strongly
focused interest on a particular topic.
Where the
sexes often differ, says Mandy, is in the nature of this interest.
“There’s
emerging evidence, and this certainly fits with my clinical impression, that
girls with autism, their special and focused interests, are a little bit
unusual than autistic boys,” he said. “They’re less likely to focus on
something technical and specific, and perhaps more likely to focus on the
social realm.”
So while a
boy with autism might show a preoccupation with something technical like trains
or buildings, a girl with autism is more likely to focus on hierarchies or
lists of family and friends.
“Often,
girls are more likely to be almost stereotypically gender-specific,” said
Mandy. “So you meet a lot of autistic girls who are really into animals or
horses, or fashion. And those interests, of course, don’t jump out at you as
much. If you get a kid who comes along and says, ‘I’m obsessed with the
District Line on the London Underground,’ then that looks unusual, and you
think autism might be an issue. If you have a girl who says, ‘I’m obsessed with
wearing the latest styles,’ that obviously doesn’t seem as unusual, so it’s
less likely to alert people to the presence of autism.”
Mandy also
points out that the way girls’ autistic traits seem to accelerate between the
ages of 10 and 16 mirrors a changing and complex social world.
“I think for
girls, there’s a phenomenon where they can be doing fine at primary education,”
he explained, “but as the social world starts to become more complex, as they
transition over into secondary school and the social demands of the adolescent
female social world rapidly accelerate, these girls can really struggle, and
people often don’t understand.”
4. Support always key
While
changing guidelines to reflect traits of autism in girls seems like an obvious
partial solution, it’s really not that simple.
Because
autism exists on a spectrum and, as Mandy tells us, it’s not a black-and-white
diagnosis, changing diagnostic guidelines could shift the focus too much.
“I think the
way to go is to keep the same fundamental diagnosis,” Mandy said. “Fundamentally, this is about difficulties with social communication, a tendency toward inflexibility, but I do think that people need to be more flexible in thinking in terms of how these manifest and whether the way these manifest in girls and women — especially girls and women with a normal range IQ — is a bit different.”
People with autistic traits can thrive, but it’s crucial that their needs are recognized and that they’re placed in an environment where they’re able to excel.
“I think we
need better understanding of the early presentation of autism in girls, so we
can identify them in a timely way, and for those that need help, we can put
that support in place before things start to go wrong in adolescence,” said
Mandy. “I think we need to get better clinically at thinking dimensionally, and
not just thinking in these black-and-white terms. Trying to understand people
in a more subtle way, and thinking about if they have traits or conditions for
autism diagnosis, those are important.”
Mandy says
that now that his team has gleaned some new insights into autism in girls,
they’d like to go more in-depth in order to better understand the condition.
“I think
what we need to do now is look at it in a bit more depth. Who are these girls
who are apparently not showing autistic traits in childhood, and who are
showing them in adolescence?” he said. “And asking questions like, ‘Are these
social difficulties actually autistic in nature, or are they arising from
something else?’ If they are autistic in nature, what were the early indicators
that were being missed by this measure of autistic traits in childhood? So,
it’s really about trying to get a more detailed picture so we can properly
understand the meaning of this finding.”
The post Why Do Girls Show Signs of Autism Later Than Boys? appeared first on How People Do.
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