It seems to me that over the last few years of working in a mainstream primary school, the number of children being diagnosed with autism has risen quickly. In our school we now have 10% of children on the SEN register with a diagnosis of having ASD. However, there seems to be a bigger fight for girls to be awarded the diagnosis than boys.
“Statistics show that more men and boys than women and girls have a diagnosis of autism.” (NAS, 2016) In this blog I will attempt to discover why this has happened, and whether perceptions are changing. It is very important that a diagnosis happens as it allows teaching to be tailored specifically to that child. On a personal level, as a Year Two teacher, I have a girl who has been passed to me from the previous teacher as “a bit quirky”. She has a younger brother who is diagnosed with non-verbal autism. I have spoken to her parents about an assessment of ASD for her, but they have said when they went to the doctor their worries were dismissed. However, we have bypassed the doctors and gone to CAMHS, who are completing assessments now. It is very frustrating that either because she is high-functioning, or a girl, she has been dismissed as a concern. A diagnosis will mean that all teachers will be aware of her needs as she moves through school.
There are many reasons for the misdiagnosis of girls, starting more than 70 years ago.
- Leo Kanner published his first paper “Autistic Disturbances of Affective Contact” in 1943, describing 11 children who did not seek social interaction, 3 girls and 8 boys.
- A much bigger ratio of boys to girls were observed.
- Hans Asperger published the first definition of Asperger syndrome “Autistic psychopathy in childhood” in 1944 and described four boys who had a pattern of behaviour.
- As the two main studies at the beginning of exploring this condition focused on boys rather than girls, this may have led to an unintentional focus to be on boys rather than girls.
- “Girls, as a group, tend to be less violent, less motorically active, more socially adept, and better at using language skills for communication.” (Gillberg, 2010) However, Gillberg states that as there is better awareness of “disorders” in girls, more cases will be highlighted over the coming years. (Gillberg, 2010)
- Reading some of Gillberg’s journal entries shows that from 1993 to 2010 he took part in many different studies, and each time he published a new entry, he became more aware of the differences between girls and boys. I think that the more research that is done, the more obvious it has become that there are differences between the girls and boys, but that does not mean that girls are not as affected by ASD.
- In 2011 Gould and Ashton-Smith completed research to find out to what extent females with ASD present differently from males. (Gould & Ashton-Smith, 2011) They found there were five main areas in which males and females differed in ASD presentation.
- Having the differences written down will have made a big difference to the diagnosis of girls as now professionals can see the differences in black and white. However, the differences have not been made into a “checklist” and so diagnoses can still be missed. (NAS, 2016)
- Andersson and Gillberg completed further studies in 2012 where they matched 20 girls with 20 boys and found that there were no gender differences. This suggested that either gender differences were exaggerated, or girls may not be diagnosed as early as boys. (Andersson, Gillberg, & Miniscalco, 2013)
- Again, Gillberg has completed further research that contradicts his earlier studies. It is becoming much more obvious here that there are differences in the way girls and boys are diagnosed, but the differences in ratios are not as wide as first thought.
- Engelking suggests that girls have “a higher tolerance for harmful genetic mutations and therefore require a larger number of them than boys to reach the diagnostic threshold of a developmental disorder.” (Engelking, 2014)
- This backs up other research where girls show fewer ASD tendencies, but as they get older the differences are more prevalent.
- In 2015 a study started with the statement “one of the most striking features of ASDs is the fact that they are diagnosed around four times more often in boys that in girls.” (Aggarwal & Angus, 2015) This study found that the ratio was 7:4, with a sample of 21 males to 12 females. They state that the reduced gender gap could be due to looking at an older sample of adolescents, and the fact that the sample was chosen from people who had been referred for psychiatric support rather than ASD support.
- An ASD diagnosis often comes with the diagnosis of a separate condition as well. It is possible that other conditions are more obvious and so hides the ASD when being assessed.
- In 2016 a document was released explaining some of the differences between diagnosing girls and boys with ASD. It lists all of the known ways that girls present differently than boys, however explains that as people become more aware of ASD, it is becoming more likely that everyone will be given the diagnosis that they need. (autismwestmidlands, 2016)
- This document is very useful when thinking about an ASD diagnosis for girls. However, it is very important that this be shared widely with schools and healthcare professionals otherwise the concern might be that girls continue to go undiagnosed.
From this research I have found that although there was obviously a higher ratio of boys to girls being diagnosed with ASD a few years ago, there is a lot more awareness of the differences of girls now. I think the original studies having such a high ratio of boys set the standard and for lots of years it was not questioned. However, from 2010 onwards there have been a lot of studies looking at the differences between boys and girls. This new information has helped and made it more obvious that although boys and girls have different traits, it is equally as prevalent with girls.
It is important that research continues, as there are still theories that genetics plays a major part in the diagnosis of ASD. However, these are still theoretical and so we need to be aware of the different ways in which ASD presents so that children and adults are given the diagnosis that they need.
Aggarwal, S., & Angus, B. (2015). Misdiagnosis versus missed diagnosis: diagnosing autism spectrum disorder in adolescents. Australasian Psychiatry, 120-123.
Andersson, G. W., Gillberg, C., & Miniscalco, C. (2013). Pre School children with suspected autism spectrum disorders: Do girls and boys have the same profiles? Research in Developmental Disabilities, 413-422.
autismwestmidlands. (2016). Women and girls with autism. Birmingham: Autism West Midlands.
Engelking, C. (2014, February 27). Genetics May Explain Why Autism Is More Common in Boys. Retrieved from Discover: Science for the Curious: http://blogs.discovermagazine.com/d-brief/2014/02/27/genetics-may-explain-why-autism-is-more-common-in-boys/#.WBYdJIXXLug
Gillberg, C. (2010). The ESSENCE in child pyschiatry: Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations. Research in Developmental Disabilities, 1543-1551.
Gould, J., & Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice, 34-41.
NAS. (2016, October 30). The National Autistic Society. Retrieved from http://www.autism.org.uk/about/what-is/gender.aspx