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Girls with High Functioning Autism

Gender makes a difference when diagnosing and supporting kids with high functioning autism.

Eighty percent of people on the autism spectrum are male. Yet when it comes to the high-functioning autism spectrum disorder (ASD) widely known as Asperger syndrome, experts point out that the ratio of boys to girls diagnosed is much lower than most realize • 3.4:1, with an even lower ratio for adults, 2:1. 

Diagnosis Disappearance
In May 2013, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders folded the separate diagnoses of autism and Asperger syndrome under the umbrella diagnosis of autism spectrum disorder. Those who in the past would have received a diagnosis of Asperger’s will now be placed on the high-functioning end of the autism spectrum. Experts like Tony Attwood are concerned that this change may cause those with mild autism to fall through the diagnosis cracks. “Children diagnosed with apparently mild autism may have challenges that are profound to them,” he said in the redefinition’s wake. “If they are offered little or no support, there potentially could be tragic consequences.” Experts counsel parents of kids who exhibit Asperger-type characteristics or who have already been formally diagnosed with Asperger’s to remain keyed in to ASD support groups and to continue to advocate for the most rigorous school and medical support they feel their child needs.

Girls on the spectrum are often misdiagnosed or diagnosed late (hence the adult rate). This means that those who lack an accurate and early diagnosis do not reap the benefits of early intervention and, consequently, are often reported to suffer from depression and anxiety later in life. It is therefore imperative that caregivers, health care providers and school personnel are educated on the unique characteristics of girls with high-functioning ASDs.

The diagnosis dilemma

“Girls fly under the radar of diagnosis,” says Tony Attwood, PhD, an internationally known ASD expert and author of The Complete Guide to Asperger’s Syndrome. “They tend to be on the ‘invisible end of the spectrum’ because they are able to camouflage their disorder. They are chameleons and ‘fake it till they make it.’ ”

Although boys and girls with high-functioning ASDs exhibit many of the same characteristics and traits • including impaired social interaction, obsessive interests and inflexible thinking • there is often a difference in their outward behavior and coping skills. Boys tend to act out their frustrations by being disruptive. Girls withdraw or become mute when they experience social anxiety.

“My daughter internalizes her emotions,” says Suzanne Gunther, mother of a teenager diagnosed with Asperger's before those parameters changed last year (see “Diagnosis Disappearance”). “When she was younger, she went about her business and didn’t really display emotions like anger or frustration.”

This is common. Many girls on the spectrum are able to keep emotions in check during the school day and in public. However, parents often see a different side to their child. “My daughter would hold it all together, and then when she got home in a ‘safe’ environment, she would unravel,” explains Gunther.

It’s not uncommon for girls to be diagnosed with attention deficit disorder, obsessive compulsive disorder or an expressive or receptive language delay. An accurate diagnosis can be made only after a trained professional has observed the communication, behavior and developmental skills of the individual. Parents’ observations and concerns are also an integral part of the diagnostic puzzle.

 

Teenage traps

Valerie Paradiz, PhD, author of Elijah's Cup: A Family's Journey into the Community and Culture of High-Functioning Autism and Asperger's Syndrome and developer of an evidence-based autism curriculum, claims that girls find ways to compensate for their social disabilities by throwing themselves into academics or obsessive solitary interests. “I was an academic nerd, studying all day long,” says Paradiz. “Although I got straight As, this pattern followed me through college and graduate school, which rendered me not so adept in understanding the social aspects of work.”

Attwood clarifies that the enormous stress of “pretending to be normal” can cause low self-esteem, which can subsequently lead to other problems, such as abusive relationships and anxiety or eating disorders. Anorexia nervosa, for example, is a huge concern for teenage girls on the spectrum, for whom weight control and calorie counting can become an obsessive interest. 

These teens may also have a hard time negotiating sexual attention. “Girls on the spectrum are intoxicated by the interest that boys give them, so they are a target for predators,” says Attwood. “This is partly due to a lack of character judgment and inability to read nonverbal cues.” Adds Paradiz, “Explicit support is needed with the social aspects of sexuality, especially how to identify abuse, coercion and date rape.” 

Girls on the spectrum also develop emotionally differently than their peers do.  “My daughter is emotionally at a much younger age, and it’s hard for her to deal with situations that other 17-year-olds are prepared to handle,” says Gunther.

Looking to the future

For girls with ASDs who pursue a college degree, parents should contact prospective institutions to inquire about support for students on the spectrum. It may be beneficial to attend a community college for the first two years, so youngsters can mature emotionally and socially without the added pressures of independent living.

It is also imperative she find a career suited to her special talents in a comfortable environment. For instance, if noise can be a distraction, she should seek a position where she can work in a quiet space.

Finding an ASD support group is critical as young women look ahead. Both the Autism Women’s Network (Autismwomensnetwork.org) and GRASP: the Global and Regional Asperger Syndrome Partnership (Grasp.org) cater specifically to girls on the spectrum. Says Gunther, “We are lucky to be able to connect with people beyond our geographic location through the Internet, and there are many associations and forums available to lend support and share knowledge and information.”

Myrna Beth Haskell is a freelance writer.

Jun 23, 2014 12:56 pm
 Posted by  Olivia's Mommy

Very informative.

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