Historically, it was thought that Autism was largely a condition of boys, indeed it has been called, ‘the extreme male brain’ but in recent years there is a greater recognition of the prevalence of Autism in girls. Girls typically present with more subtle traits, not the traditional asocial model, but still presenting challenges to their development and interaction.
Is autism in girls different to autism in boys?
Boys with Autism tend to be less social than their peers and display prominent and obvious areas of obsessive interests and compulsions. Girls with Autism, however, are more able to follow or imitate social actions. When they are younger they can mimic socially appropriate behaviour, without understanding what they are doing or why they are doing it. This can have the effect of masking their difficulties.
Girls with Autism often feel the need to socially interact. They can join in play but are often led by their peers. They may not initiate social contact and can appear socially passive or odd. They feel that they would like to have friends but do not understand how to make friends. This can cause lots of unhappiness and can create feelings of isolation. Social cues, recognising facial expressions and understanding social hierarchies can be difficult, with girls not understanding why we would want to communicate with other people. This can mean that people’s responses to them are surprising and bewildering, causing problems at school, and in wider society.
Often girls on the spectrum have a good imagination, and compared to boys with Autism are relatively good at pretend play. They can spend a long time indulging in elaborate fantasy worlds, which can be complex and full of detail, and can be sustained over long periods of time. Their fantasy world can dominate play; the girls might be able to talk about their world in depth, and often the line between fantasy and reality can become blurred.
Girls with Autism often have special interests. When they are young these interests can include age-appropriate topics such as horses or animals, boy bands or certain films. This in itself it not unusual. It is the intensity of their interest and how long the special interest lasts that will be different. As other girls move on to other areas of interest, girls with Autism often do not. This causes gaps to appear between their social development and that of their peers.
Sensory needs can also add to an already complicated picture. Autistic girls may be particularly sensitive to loud noises, bright lights or touch; may hate wearing tight clothing or particular fabrics; or conversely, may love to be tucked in super tight clothes, or need to have their hair tied back in a tight ponytail.
Eating can also be a battleground, with girls only prepared to try certain foods and textures. Not eating or controlling their food intake is another characteristic, and there is ongoing research into the prevalence of anorexia amongst women and girls on the autistic spectrum. There is also growing evidence to support a link between gender dysphoria and Autism in girls.
Anxiety in girls with Autism
A high level of anxiety is common among girls with Autism. The world can be a confusing and unpredictable place. To minimize this, they may need to exert a high level of control on their environment and the people in it. This can result in quite ritualised behaviour, inflexible routines and meltdowns when unplanned events occur.
Autistic girls often want to please and will spend all day at school trying very hard to do the right thing. As a result, home life often suffers as they vent their frustration and anxiety for hours at the end of every school day. Alternatively they may ‘implode’ and internalise their anxiety, causing mental health difficulties. Living with such high and unrelenting levels of anxiety is exhausting and frustrating, and can have a significant impact on the young person’s school performance and on their family.
With thanks to Sarah Wild, headteacher at Limpsfield Grange School