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Girls with High Functioning Autism

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



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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.

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