Girls with Asperger's Syndrome and other autism spectrum disorders may be underdiagnosed because their social deficits are not as conspicuous.

Although there are 4 boys for every girl diagnosed with Asperger’s Syndrome (AS), high-functioning girls with autistic spectrum disorders may not be as easy to recognize due to a number of differences in their social interactions and behavior. This results from the fact that girls are more inclined to adopt effective strategies to hide their differences in social situations.

Invisibility Strategies

Girls with AS are adept at disappearing within a large group, staying safely at the periphery without really interacting socially. Because they are less inclined to be “bitchy” or “fickle” in their interactions, such girls are often befriended by at least one more socially skilled girl who feels compassion for her naive companion. The establishment of one or more such friendships can make it appear as though the girl with AS has a “normal” social life. However, it is the other girl or girls who generally make the friendship overtures.

Camouflaging Strategies

Girls with AS may appear to use ordinary gestures and facial expressions during a conversation and to reciprocate appropriately. However, in many cases they are basing these gestures, facial expressions and responses on someone they have observed who is socially adept. Additionally, they use their intellect rather than natural social intuition to choose the correct responses.

Due to the need to copy a more socially skilled individual in given situations, girls with AS will often wait quietly on the sidelines in new social situations until they learn the rules of the game, after which they are able to imitate the correct responses that other children have made. However, if the nature of the game changes the strategy fails, and the social deficits become apparent.

Seemingly Normal Interests

Autistic spectrum disorders are characterized by narrow, obsessive interests. Although boys who are obsessed with trains or bus schedules tend to stand out, there are few who question a young girl’s obsession with dolls or horses. However, the girl with AS will prefer to play with her dolls alone rather than with other children. She will probably have a much larger collection than other girls, and she will spend time arranging them in various configurations (such as alphabetical order). She will have more interest in organizing and categorizing than creating social storylines for them.

Avoiding Physical Activities

Because girls are less inclined to engage in rough-and-tumble play, their difficulties with motor coordination may be less apparent. Girls with AS may avoid physical activities in which their motor skill deficits would be noticeable.

Anorexia Nervosa

Girls with AS may suffer from other disorders that mask the underlying problem. Eating disorders such as anorexia nervosa are common among those with autism spectrum disorders. Up to 23% of all girls who suffer from anorexia also show signs of AS.

Those with autistic spectrum disorders may refuse foods that have particular textures, tastes or smells due to sensory hypersensitivity, or have unusual food preferences and meal or preparation routines. However, because eating disorders are so common among adolescent girls, they are rarely identified as problems related to AS.

Psychological Escape

Individuals with AS may escape into their imaginations, in some cases creating an entire imaginary world that is more hospitable than the one in which they find themselves. In such cases, the children simply appear creative or imaginative, and few suspect AS, particularly among girls.

Reactive Depression and Anxiety Disorders

Reacting to social difficulties, those with AS may lapse into depression in adolescence, becoming socially withdrawn and self-critical, or suffer from severe anxiety disorders. This depression or anxiety is caused by the conflict between the importance placed on social interaction and the child’s lack of social skills. However, because adolescents are prone to depression and anxiety, conditions which are more common in girls than boys after age 11, the underlying cause may not be identified.

Key Differences

Overall, girls are raised to be sociable, and as such, girls with AS tend to devote more effort to learning the required social cues and scripts. Girls will turn their considerable intellectual skills to the task of analysing social interactions and conventions. Additionally, they are less inclined to develop the conduct disorders that attract notice among boys with autism spectrum disorders.

Girls with Asperger’s Syndrome will in many cases come across as “little professors” in the same way that boys do, speaking in a pedantic manner, displaying an impressive vocabulary and talking obsessively on subjects of interest. However, due to their stronger social abilities, such behaviors in girls are more likely to be taken for general intelligence than as evidence of an autism spectrum disorder.

For more information on AS, see Tony Attwood’s The Complete Guide to Asperger’s Syndome and The Asperger’s Syndrome Foundation.

References:

• Attwood, T. (2007). The Complete Guide to Asperger’s Syndrome, Jessica Kingsley Publishers, London.
• Goleman,D. (10 May 1990). “Health Psychology: Why Girls are Prone to Depression.” The New York Times.