Quirky Girls: Why Do Girls Receive an Autism Diagnosis Later than Boys?

Autism Spectrum Disorder (ASD) is, as the name suggests, a spectrum, which means it looks different for each person diagnosed. One individual may have more repetitive behaviors than another, and someone else might have more communication difficulties. Even when autism presents itself in a comparable way, one person with autism might need more support than another. Because it looks different for different people, there are often differences in how boys and girls with autism receive diagnoses.

The rates of diagnosis for boys and girls are similar around the ages of two or three years old, but as children reach school age and social skills become more important, the rates begin to diverge, according to several recent peer-reviewed studies. Boys are diagnosed more frequently. But does this mean that there is truly a larger share of boys with autism than girls? Or is being a girl a protective factor against autism? Well, no. Girls are, on average, diagnosed later than boys, especially in cases of those with lower support needs. The theory is girls respond to the pressure of social norms and it results in being misdiagnosed more often.

According to Jamie Jones, PhD, clinical supervisor at Boundless, girls are socialized to fit in from an early age, and belonging is highly valued for girls in our society. At the same time, girls are taught it’s acceptable to cry and show emotion. In comparison, Jones said that boys are generally taught that belonging is less important and that they shouldn’t cry or express all their emotions. In all genders, these social norms can conceal autism. For example, if a girl gets overwhelmed by noise or light, it’s normal for her to cry about her frustrations, even if the cause is considered quirky. If the same thing happened to a boy, a tantrum would go against social norms of boys being tough. If a boy does not show a lot of emotions, that’s seen as normal, but if a girl’s affect seems flat, that’s usually seen as a problem. If a boy does not have any close friends, it might be seen as traditionally masculine behavior, but if a girl has no close friends, it’s an obvious warning sign of autism. Diagnosis in low support need cases of autism can be tough for all genders, not just girls, but as children begin to follow social norms, girls are disproportionally affected.

Because belonging is so highly valued for girls, if they perceive themselves to be different than their peers, they will work hard to imitate others. This imitation of “normal” behavior is called masking or camouflaging. Jones said that girls seem to teach themselves how to appear “normal” more than boys. “In research, we definitely see it more with girls, and a lot of it goes back to the social norm stuff,” Jones said. “Girls are told to just fit in.”

An example of masking that might hinder an autism diagnosis is imitating eye contact. People with autism typically tend to have trouble making eye contact, but some girls with autism will make too much eye contact. They notice other people make more eye contact or are told that eye contact is important, so they force themselves to make eye contact on an ongoing basis even when it’s uncomfortable. However, because the eye contact skills aren’t natural to them, they sometimes overestimate how much eye contact is necessary and make very intense, constant eye contact. While too much eye contact may seem a little quirky, the fact that they make eye contact is wrongly confused as proof that they do not have autism.

Girls who are labeled quirky throughout childhood are often diagnosed with autism in their teen years because that is when they start to care a little less about fitting in. During the teenage years, it is normal development to want to show more personality and having autism doesn’t change that developmental milestone. To show their true personality, girls will start to mask or camouflage less, and quirks suddenly become more obvious problems to those around the teenagers. If autism isn’t diagnosed in early childhood, it’s likely that those differences will have the biggest impact on friendships and relationships during teenage years.

Another barrier to diagnosis for girls is misdiagnosis. A misdiagnosis can explain away signs of autism, especially the signs that aren’t masked. For girls, the most common misdiagnosis is anxiety, which is sometimes used to rationalize that a person does not have autism. According to Jones, “When you see someone who is not communicating very well, we get many practitioners, parents, and teachers who say ‘oh, they’re just really shy’ or ‘they’re just really anxious and don’t know what to say.’” If there are true communication difficulties or other symptoms of autism, they can’t be explained away by anxiety, even if anxiety is also present. It goes beyond normal shyness and beyond quirkiness.

At the end of the day, Jones recommends asking, “Are they just quirks or are they impacting their functioning, their ability to make friends, or their ability to progress in school or to work or be out in the community?”

If you suspect your daughter might have autism and needs more support, Jones suggests doing some research on reliable websites like WebMD.com or CDC.gov. If the warning signs and diagnostic criteria match your daughter’s behavior, speak with her pediatrician. “The sooner they get help, the better,” Jones said. The more support your daughter receives and the more skills she builds, the more she will succeed in school, in work, and in life.