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Veronica and Benedict are three-year-old twins who are currently diagnosed with autism. Would there be variation manifested in the diagnosis, presentation and support needs among different genders like Veronica and Benedict?
The differences between Veronica and Benedict will be explained in two ways namely diagnostic differences and presentation or symptom differences.
Diagnostic Differences
According to Loomes, et al., 2017, boys are more frequently diagnosed with ASD than girls, with a ratio of approximately 4:1. This gap may be partly due to diagnostic criteria and tools that were developed based on primarily male samples, potentially missing out on the subtler display of ASD- leading to underdiagnoses in females. However, there might also be differences in how boys' and girls' brains develop with ASD.
Brain Differences
A longitudinal study involving 290 autistic children and 139 non-autistic children found differences in the development of the cortex between autistic boys and girls ages 2-13. At ages 3, girls diagnosed with autism had a thicker cortex than non-autistic girls, comprising about 9% more cortical surface area- The cortex is made up of layers of neurons that fire together allowing thinking, learning, memory, and emotions, hence, thicker cortex is associated with higher cognitive function. The disparity among boys with ASD and non-autistic boys of the same age isn't significantly different. The study also found that females with ASD had a faster rate of cortical thinning into middle childhood compared to males with ASD and non-autistic individuals. However, by middle childhood, differences between boys and girls with ASD were blurred due to the more rapid thinning in females.
Presentation and Symptom Differences
Social and Communication Differences:
Boys: They tend to showcase obvious social and communication difficulties, such as noticeable challenges in making friends, maintaining eye contact, and initiating and maintaining conversational exchange. They might prefer solitary activities with objects instead. This leads to increased social exclusion and bullying.
Girls: They often showcase subtler social difficulties. They may be better at masking their symptoms or have better-developed social imitation skills by mimicking the neurotypical behavior of peers. This camouflaging behavior can lead to delayed diagnosis or misdiagnosis, underreporting and lower intervention of ASD in females. Restricted and Repetitive Behaviors:
Boys: According to research conducted by Frazier et al., 2014, they are more likely to engage in stereotypical repetitive behaviors such as hand flapping, rocking etc., and have pronounced, specific interests (e.g., lining up trains, numbers). Since these behaviors are easier to spot, these might explain to some extent how ASD is easily diagnosed often and earlier among boys than girls.
Girls: Tend to have interests that are more socially accepted (e.g., arranging animals, and dolls), which can be overlooked as typical behavior for their gender (Hiller et al., 2014). Also, girls might be better at masking their challenges commonly known as “camouflaging”. For instance, girls might mimic a likeable peer’s social behaviors to fit in, even when the purpose of the behaviors is not well understood by them. Co-occurring Conditions Girls with ASD are more likely to have co-morbid conditions such as anxiety, depression, and eating disorders. These conditions are attributed to their ability to camouflage, hence leading to misdiagnosis or can overshadow ASD symptoms, complicating the diagnosis and treatment of autism, as the main focus might shift to addressing these comorbidities instead. Cognitive and Sensory Processing
Boys: They are more likely to show hyperactivity and externalizing behaviors like stimming etc.
Girls: They are prone to internalizing behaviors, such as having anxiety and depression, which can affect their sensory processing experiences.
Implications for Diagnosis and Support
The differences in how ASD presents in boys and girls showcase the need for gender-sensitive diagnostic criteria and tools and a need for clinicians to be aware of the potential for camouflaging in girls and consider a broader range of behaviors and symptoms.
While research explores potential differences, it's important to remember that every child with ASD is an individual. They will all have their unique strengths, challenges, and developmental trajectories.
Here at Nuture, We understand The Uniqueness of Every Child! Our team of specialists is committed to understanding and supporting all children with ASD, regardless of gender. We provide a variety of early intervention and support services to help your child maximize their potential.
References
Dean, M., Harwood, R., & Kasari, C. (2017). The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder. Autism, 21(6), 678-689. https://doi.org/10.1177/1362361316671845
Frazier, T. W., Georgiades, S., Bishop, S. L., & Hardan, A. Y. (2014). Behavioral and cognitive characteristics of females and males with autism in the Simons Simplex Collection. Journal of the American Academy of Child & Adolescent Psychiatry, 53(3), 329-340.e3. https://doi.org/10.1016/j.jaac.2013.12.004
Gould, J., & Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice (GAP), 12, 34-41.
Hiller, R. M., Young, R. L., & Weber, N. (2014). Sex differences in autism spectrum disorder based on DSM-5 criteria: Evidence from clinician and teacher reporting. Journal of Abnormal Child Psychology, 42(8), 1381-1393. https://doi.org/10.1007/s10802-014-9881-x
Lai, M.-C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11-24. https://doi.org/10.1016/j.jaac.2014.10.003
Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 466-474. https://doi.org/10.1016/j.jaac.2017.03.013
Mandy, W., & Tchanturia, K. (2015). Do women with autism spectrum conditions experience eating disorders differently to non-autistic women? Journal of Autism and Developmental Disorders, 45(9), 3133-3142. https://doi.org/10.1007/s10803-015-2488-y
Mandy, W., Chilvers, R., Chowdhury, U., Salter, G., Seigal, A., & Skuse, D. (2012). Sex differences in autism spectrum disorder: Evidence from a large sample of children and adolescents. Journal of Autism and Developmental Disorders, 42, 1304-1313. https://doi.org/10.1007/s10803-011-1356-0
University of California - Davis Health. (2024, May 23). Key differences in brain development between autistic boys and girls. ScienceDaily. Retrieved July 10, 2024 from www.sciencedaily.com/releases/2024/05/240523112614.htm
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