Feminine side of the spectrum: Why autism looks different in girls

|

Nine years ago, doctors diagnosed Frances Pelphrey with autism. Babbling, speaking her first words, and walking—these and other milestones had come late for Frances. Those clues led to her diagnosis at age 3, but her younger brother, Lowell, was identified as having ASD much younger, at just 16 months.

The Pelphrey children aren’t a unique case as it’s typical for girls to be diagnosed with autism spectrum disorder (ASD) later in life than boys, often after the girl has been misdiagnosed with something else.

As a toddler, Frances was obsessed with American Girl dolls and Disney movies. That sounds rather standard for a female toddler, much different from the stereotypical autistic behavior we see in movie characters like Dustin Hoffman’s in the 1988 film Rain Manwho obsessed over the TV schedule and had a super-human memory.

“[Frances] was very social and a very happy, easy baby,” their father, Yale-New Haven Hospital neuroscientist Kevin Pelphrey noted in an interview with Spectrum News. That’s not typical of ASD, but it’s not uncommon for girls with ASD. It’s also not uncommon for ASD to go unrecognized in girls way into the teenage years and beyond, for a simple reason: a lot of what we know about ASD comes from studies in boys. Because in girls, it manifests differently.

Picking up ASD

dustin-hoffman-rain-man-1ASD is prominent on the radar screen, whether for medical professionals, specialists, or teachers because it’s fairly common. It affects 1 in 68 children in the U.S., and the number of diagnoses is on the rise, with a 30 percent increase over the last couple of years. Although the reasons for this increase are controversialmore children today are diagnosed on the spectrum than ever before. It has been in popular culture for a while too, with Rain Man being the most notable example, but also the 2005 movie Mozart and the Whale. From these famous examples and the prevalence, most of us now have a basic understanding of what ASD looks like but only when it comes to males.

But that standard is slowing changing. ASD diagnostic criteria were updated extensively in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, published 2013). The changes allow for a broader number of people to be included, making it easier to make an identify girls on the spectrum as well as others who don’t fit stereotypes of the condition.

Atypical ASD symptoms that may be typical for ASD female

A boy with ASD often stands out in school and other social settings, because he doesn’t follow age-appropriate social norms and doesn’t care about them. He may not form friendships, but isn’t seeking them in the first place.

ASD girls, on the other hand, often attempt to fit in and frequently can make it look as if their relationships are healthy. This is particularly the case when the girl is intelligent. Researchers think that ASD girls can mimic normal behavior, not because they are learning age-appropriate body language or employing other subtle communications, but rather because they can learn to imitate the behavior of their female peers. This can make ASD girls hard to notice at school or in other group settings, but at home, surrounded by family, such children often have meltdowns—as if expending so much effort at school to appear normal that they just have to let it all out at home.

ASD girls’ tend to have more friends that are boys because boys’ behavior is less subtle and easier for ASD girls to imitate. In a certain sense, non-ASD males are slightly more ‘autistic’ than non-ASD females. Boys tend to occupy a boundary area near the start of the autism spectrum. Often, rather than being recognized as a possible case of ASD, females in this category often receive diagnoses of other conditions, such as eating disorders (like bulimia nervosa and anorexia nervosa), obsessive-compulsive disorder (OCD), and depression. Things get complicated, because these other disorders, particularly eating disorders, can coexist with ASD.

Women are from Venus and men are from Mars, and so are women with ASD

screen-shot-2016-10-04-at-10-02-10-pmYou can think of the spectrum that we call ASD as running from one extreme represented by an individual whom you rate zero regarding social skills, and mild side of the spectrum merging with people who may meet one or two ASD criteria, but not enough to qualify for an ASD diagnosis.

So while ASD affects more males than females, it may be that the condition is more subtle in girls because they tend to be in the mild part of the spectrum. This is not to say there are no boys in this zone; on the contrary, there are plenty, but many of them might go unrecognized, but for the fact that because of the gender skew the boys are more on the radar screen from the onset. But, also because there are more boys with ASD, there are more of them deeper into the spectrum.

Studies of the brain, such as those using imaging to see which parts of the brain react to various social cues, show that girls with even mild ASD are very different from non-ASD girls. The pathways in the brain that ASD girls use to react to subtle language and body movements are distinct from those that non-ASD girls use for the same reactions. That’s because the reactions are different; they’re forced, not natural. But neurologically, they’re also different from ASD boys, so are they in a category by themselves?

Not really. The brain pathways used by ASD girls for social cues are similar to those of males that do not have ASD. What could this mean? It might mean we could add a new dimension to the concept promoted in the 1992 relationship best-seller Men are from Mars and Woman are from Venusbecause it seems that females with ASD might be at home on a planet inhabited by men who are not on the spectrum.

David Warmflash is an astrobiologist, physician and science writer. Follow @CosmicEvolution to read what he is saying on Twitter.

  • ALenny Schafer

    Please! Please stop trying to revise the definition of the autism spectrum. There is no “mild side” to it. Everyone on the autism spectrum is disabled to the point of being at significantly higher risks in life due to their restricted functionalities. Even the most highest functioning person on the autism spectrum is disabled. It does harm to the disabled to trivialize or minimize their hardships as “mild”, Please consult the DSM-V quoted in this report and you will find that autism is not defined as “mild” in any way. Autism is also not subtle so as to slip by professional diagnosticians. The problem is not female “mildness” but rather professional incompetence. Please also note that the DSM-V removed non-disabled Asperger syndrome sufferers from the spectrum in order to shed the idea that autism has mild versions. Nobody benefits from soft-peddling disabilities as a scapegoat for dx shortcomings.

    • Ingrid

      Hi, i think he means here with the “mild side”, is that it is mild compared to other people with Asperger’s. We are all different, and, i think, of course there are diversity and differences within the spectrum, as well.
      Some might fit some of the descriptions, but not all – but, still struggle enough to it to effect their life immensly. – and, by not being recognized for it, their problems may grow and expand to result in seriously illness – psyphological and physical.

    • Ingrid

      And, one thing i haven’t heard of, so curious about it – can you tell me what non-disabled Asperger’s syndrome is/was?

  • Tina

    wtf does “Women are from Venus and men are from Mars, and so are women with ASD” mean???

  • Duncan Hackett

    Warmflash is saying that any female who tries to “fit in” socially and doesn’t stand out as having ASD, could still be diagnosed as ASD. Girls who “mimic normal behavior” or try to make their relationships seem healthy, presumably in a school environment, are suspect. So that is every single female on the planet basically. Is this totally irresponsible journalism or what?

  • David Ashton

    Generalizations cannot be made from single examples, but this private story may have some interest. My wife is familiar as a teacher with autism in boys and girls (ignoring PC “gender categories” currently fashionable) mostly of below-average IQ. I have read a fair bit about it and talked to carers.

    We have one adult unmarried daughter “officially diagnosed” as on the “Asperger spectrum” as a “high achiever” only three years ago. She has always been psychologically “dependent” on us, even today demanding “help” from her mother constantly with telephone messages for every sort of perceived problem, medical or otherwise. She is also highly intelligent, musical (in a prestigious choir), artistic (strong aesthetic sensibility), and also keen on acting.

    Her brain may have been affected by her mother’s long labour before birth.

    At the tender of age of 13 in 1980 she acquired perpetual severe tinnitus (without deafness) from an ear infection coinciding with a problematic streptomycin injection. Later she showed early signs of paranoia. By about 19 she presented florid language, violent frustrations and hypomania symptoms, which were misdiagnosed and mistreated. This aspect of her life has improved, controlled by her high IQ rather than any drugs, but her “solipsism”, misreading comments, sensitivity to noise, and reduced empathy persist.

    However, I believe that “mimicking behaviour” is probably a factor in her adult life. Her life is nevertheless sadly disadvantaged and also that of her parents.

    As for gender differences in the nervous system and hormones, apart from reproductive organs, these are on a “spectrum”, but generally my money is on Lionel Tiger, Steve Goldberg and Richard Lynn.

  • David Ashton

    Has anyone read “Unraveling the Mystery of Autism as a Male Disorder” (February 2016) by Dr Brett Cohen? Email: ebicis@aol.com

  • Sam

    I’m a woman with ASD but this does not apply to me. According to this, I am VERY male with how I expressed my autism.

    I never managed to “blend” in with other peers, and never picked up social cues that allowed me to. I was pretty overt and obviously autistic from the outside, which got me bullied. Social norms were confusing for me, and I didn’t even want to fit in with them because I thought they were “stupid” as a child.

    I had no friends at all. I never learned how to socialize with people, and remained completely alone during my high school years.

    My obsessions were more than just simple interests or TV shows (although I did have a Pokemon obsession). I was obsessed with memorizing words and the order of certain things.

    I had more aggressive meltdowns as well. I would break toys, scream, and sometimes hit people as a child. I also had meltdowns publicly at school. I am not like this anymore, as I’ve learned to not have those scenes as an adult. But when my feelings are hurt today, I’m still more aggressive than ‘sad’.

    My interests were very childish and I didn’t follow age-appropriate norms, much like boys.

    I’m not saying this article is wrong, simply because I don’t relate to it as a woman myself. But it does beg the question whether or not I was born with a male brain. Was I meant to be male? I’m not completely masculine, but it does seem like I’m more of an “autistic boy” with female anatomy.

  • Rebecca

    Found this article that looks like the author “borrowed” word for word from plus added his own interesting definitions like men are from ars etc. Its why the article comes across as strange. Bits and peices of different articles pasted together. http://www.scientificamerican.com/article/autism-it-s-different-in-girls/