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Autism Spectrum Disorder and Some Differences Between Boys and Girls

By: Azlen Theobald, PsyD
Neuropsychologist

Children and adolescents with Autism Spectrum Disorder (ASD) are increasing as a population with 1 in 44 children diagnosed with ASD nationwide according to a 2018 surveillance study published by the Centers for Disease Control (CDC) in 2021.

Studies suggest that ASD is 4.2 times as prevalent among boys as among girls. Recent research suggests that since girls may not present the typical signs of autism as early as boys (and their behavioral features are different), they may not be accurately represented by this statistic.

So what are the common differences?

  1. Boys with autism tend to have very repetitive and limited areas of play. Girls with autism tend to be less repetitive and have broader areas of play.
  2. Girls with autism are more likely than boys to be able to respond to non-verbal communication such as pointing or gaze following. They are also somewhat more focused and less prone to distraction.
  3. While boys’ social communication issues become challenging very early in their lives, girls may be able to manage the social demands of early childhood, but run into difficulties as they enter early adolescence.
  4. It is fairly common for girls with autism to appear socially competent during preschool and elementary school, but they may be neglected or rejected by peers upon approaching middle school age. This is thought to be a result of friendship groups/cliques forming and children developing more awareness of differences among their peers.
  5. Girls with autism are more likely than boys to experience anxiety and/or depression symptoms.
  6. Although girls with autism do have perseverative interests, they are more likely to develop interests (such as TV stars or music) that appear more typical than, for example, many boys’ perseverative interests, such as schedules, statistics, or transportation.
  7. Girls with autism are less likely to have aggressive behaviors and are more likely to be passive or withdrawn.

An issue in current research is the relatively low frequency of females represented in Autism studies.

Ultimately, as the sex and gender differences among children with ASD are more closely examined, many experts have observed that girls may be better at imitating socially appropriate behaviors and have fewer behavior concerns than boys. Given these findings, it is important that clinicians attend to milder presentations of Autism Spectrum-related behaviors among younger girls and provide the support and skill-building that girls also need to be successful in school, in relationships, and in life.

References

Maenner MJ, Shaw KA, Bakian AV, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Surveill Summ 2021;70(No. SS-11):1–16. DOI: http://dx.doi.org/10.15585/mmwr.ss7011a1

Frazier, TW, Georgiades, S, Bishop, SL, and Hardan, AY. Behavioral and cognitive characteristics of females and males with autism in the Simons Simplex Collection (2014). Journal of the American Academy of Child Adolescent Psychiatry, 53(3), 329-40.

Nordahl, CW, Andrews, DS, Dwyer, P, Waizbard-Bartov, E, Restrepo, B, Lee, JK, Amaral, DG. (2022). The Autism Phenome Project: Toward identifying clinically meaningful subgroups of Autism. Frontiers in Neuroscience, 15, 1-9.

Ruigrok A., Lai MC. (2020). Sex/gender differences in neurology and psychiatry: Autism. Handbook of Clinical Neurology. 175, 283-297.

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