Gould and Ashton-Smith (2011) identified the different way in which girls and women present under the following headings: social understanding, social communication, social imagination which is highly associated with routines, rituals and special interests.
Girls are more able to follow social actions by delayed imitation because they observe other children and copy them, perhaps masking the symptoms of Asperger syndrome. Girls are often more aware of and feel a need to interact socially. They are involved in social play, but are often led by their peers rather than initiating social contact. Girls are more socially inclined and many have one special friend.
In our society, girls are expected to be social in their communication. Girls on the spectrum do not ‘do social chit chat’ or make ‘meaningless’ comments in order to facilitate social communication. The idea of a social hierarchy and how one communicates with people of different status can be problematic and get girls into trouble with teachers.
Evidence suggests that girls have more active imaginations and more pretend play. Many have a very rich and elaborate fantasy world with imaginary friends. Girls escape into fiction, and some live in another world with, for example, fairies and witches.
The interests of girls in the spectrum are very often similar to those of other girls – animals, horses, classical literature – and therefore are not seen as unusual. It is not the special interests that differentiate them from their peers but it is the quality and intensity of these interests. Many obsessively watch soap operas and have an intense interest in celebrities.
Signs of autism in girls
- boys with ASD tend not to appear motivated to be socially interactive, but girls on the spectrum do. However, girls have a history of failure in achieving and maintaining friendships
- girls gravitate towards older girls, who tend to mother them and act as a form of social “protection”
- girls may be socially immature and make a preference to play with much younger children who are not challenging and would allow the child with ASD to dominate play, giving them the predictability and control children with autism crave
- girls with Asperger’s may “adopt” a less able peer, perhaps someone with a learning difficulty, who may themselves be marginalised so they are open to being dominated by the child with ASD
- girls with Asperger’s may be unnecessarily dependent on their mother (or other primary carer) whom they regard as their best friend and confidante in a social world which they find challenging and frightening.
- boys engage in disruptive behaviours, whereas girls may be persistently “ill” to gain what they want or control their situation
- girls with ASD tend to act passively and ignore daily demands, while boys become disruptive in response
- girls appear more able to concentrate than boys, who become distracted more easily and can be disruptive
- girls tend to learn social behaviours by observation and copying, which can disguise their social deficits
- girls may find the idea of social hierarchy difficult, so they can respond inappropriately to people in authority, such as teachers
- children with ASD of both sexes need to learn the rules of “small talk” which they often find incomprehensible as a pastime. Girls’ difficulties tend to be masked by their passive behaviours and ability to mimic without understanding.
- parents may perceive their daughter as being non-specifically “odd”, but without being able to pinpoint the cause
- imaginative play does exist, but it is intense in nature, often focused on stereotypical female interests, such as dolls, make-up, animals and celebrities – which is why girls with ASD may not seem that different to females not on the spectrum. The key is the intensity and quality of these special interests, which are exclusive, all-consuming and experienced in detail
- children with ASD can engage in repetitive questioning well beyond the age that those who are not on the spectrum would normally do. They can exhibit poor empathic skills and a lack of social interest. They can also seem disinterested in the classroom and exhibit immature, impulsive and unusual behaviours. An inability to “move on”, even with basic matters, can be common – for example, not being happy to throw away old toys or clothes which the child has long since grown out of. This “cluttering” behaviour can outline their difficulties with change. While such types of behaviour may be common to both sexes, the ways in which they present can be different for boys and girls.
It seems that girls on the autistic spectrum may be less noticeable than boys because they are less disruptive and have an ability to mimic behaviours. However, they lack social understanding and any deep knowledge of language. This becomes increasingly obvious at secondary school level, when there are no younger children to associate with, when peer groups are more mixed and any “protection” may have dissolved. Additionally, multiple stimuli (such as crowds in corridors or screams in playgrounds) and changes to routines which occur at secondary education can increase individual anxiety greatly. Adolescence, involving unstoppable changes, such as menstruation and the growth of breasts and body hair, can profoundly affect girls with ASD, heightening anxieties due to lack of control over what is happening.
Mental health issues for girls
Anorexia nervosa has been called “female Asperger’s” because around one fifth of girls who present with anorexia have traits which are peculiar to the autistic spectrum; around 20 to 30 per cent of anorexic patients are perfectionists and demonstrate rigid modes of thinking and behaviour, which are common autistic traits. Anorexia offers girls with ASD what they perceive to be a positive outcome because lack of nutrition prevents menstruation and physical development.
It is not until puberty that girls’ social difficulties become more obvious, particularly as they enter secondary school when they can become the subject of bullying or can be generally marginalised and perceived as strange. Unlike boys, they become withdrawn, depressed and quiet, rather than aggressive.
Profound anxieties may be demonstrated in altered behaviours, lower grades at school, poor sleep patterns, low mood/depression and obsessive behaviour.
Research from 2011 found that many women who were later diagnosed as being on the autistic spectrum initially were thought to have learning difficulties, personality disorders, obsessive compulsive disorder or eating disorders. This differential diagnosis could be related to lack of awareness of how ASD present in females.
All research suggests that an early diagnosis of ASD, followed by appropriate interventions, will optimise the person’s life chances by increasing independence, understanding and accumulation of language and social abilities. To date, the ways in which females present with Asperger’s have not been thoroughly examined or used as the basis for diagnostic tools, which continue to be male dominated.