Boys are four times more likely than girls to have Asperger’s Syndrome, the current statistics tell us. But are the stats correct? More and more experts in the field are questioning this ratio and arguing that girls may be going undiagnosed because they are better at camouflaging their social difficulties. It follows that, because their condition goes unrecognised, girls are not gaining access to the understanding and support they need.
Asperger’s Looks a little Different in my Daughter
My daughter was diagnosed with Asperger’s Syndrome when she was ten, and was referred to a Social Skills Group, with other children on the spectrum. Interestingly, the psychologist who ran the group initially questioned the diagnosis. Ashlyn was not loud and outspoken like the boys in the group—in fact, she hardly said anything at all, and had to be ‘drawn out’ to participate. She didn’t speak endlessly on computers, trains, cars or any of the other ‘typical’ special interest topics. Yet, Ashlyn was definitely struggling socially and was the victim of teasing, leading her to have meltdowns and lash out at her peers.
In a recent interview, Dr Tony Attwood suggests that the ratio of boys to girls is probably closer to 2:1. The estimate is based on his observation that this is the approximate ratio amongst the Asperger’s adults he works with. With a growing awareness of their struggles, more women are now being diagnosed in their adult years.
Reasons Girls with Asperger’s may not be Diagnosed
Based on their clinical experience, Dr Attwood and other experts can offer some suggestions on why girls are going undiagnosed . Yet, research is needed to validate these observations.
- Girls may have subtler or less severe characteristics. Because they appear to be coping reasonably well, parents may not have them assessed, and clinicians don’t want to commit to making a diagnosis.
- Boys may react in a more physically aggressive way to the frustrations and confusion caused by their condition. This leads their parents to seek out a diagnosis sooner. In our own situation, it was only when Ashlyn lashed out physically at the children teasing her that we sought out professional help. By this time, she had already been struggling with social issues for a number of years.
- Girls may generally be more passive in their personality, which means (as with Ashlyn) that their differences don’t stand out as clearly as that of a louder boy might.
- Children with Asperger’s syndrome elicit one of two responses from others: strong maternal behaviour or ‘predatory’ behaviour. Dr Attwood suggests that some girls with Asperger’s may be ‘mothered’ by other girls (gaining support and inclusion), as opposed to the bullying and teasing boys will probably encounter amongst their male peers.
- Girls may be better at imitating and modelling appropriate social behaviour, copying those that are socially adept. This ‘role-playing’ is based on intellect rather than social intuition. Constantly repressing their own behaviour (to mimic somebody else) is exhausting for a girl and Yaull-Smith suggests it may be the cause of the high degree of mental health problems amongst females on the autism spectrum.
- Struggling to make real friends may lead a girl to create imaginary friends. Evidence suggests that girls on the spectrum have better imagination and are more adept at pretend play than boys (Knickmeyer, 2008). They can have very elaborate fantasy worlds to which they ‘escape’ (this is where Ashlyn spends much of her time).
- Unlike the typical (and rather particular) special interests that boys on the spectrum have, girls may be interested in the same things that other girls are interested in, such as horses, books and celebrities. However, what sets them apart from their peers is the intensity of their interests (read more about Ashlyn’s special interest).
Why is it Important to Diagnose Asperger’s Syndrome in Girls?
A diagnosis is an important starting point for receiving the support and guidance required by someone on the Spectrum. Early interventions such as social skills training or working with the girl’s peer group (for instance in setting up a ‘buddy system’) can have a very positive effect on a girl’s sense of self-esteem and identity. This could prevent issues such as depression, eating disorders and anxiety from developing in the teen or adult years.
It is therefore critical that the issue of Asperger’s amongst girls and women be given more attention by researchers and clinicians in the Autism field.
Tony Attwood Interview on Girls with Asperger’s Syndrome.