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How Autism Diagnostics Overlook Girls

One in 68 kids in the U.S. is affected by autism, with boys receiving four times as many diagnoses as girls. New research suggests that that disparity may be the result of girls on the spectrum getting overlooked and misdiagnosed.  

Science journalist Maia Szalavitz writes about the topic in her story  “Autism—It’s Different in Girls,” which is in March issue of Scientific American Mind. This week on "Think," she spoke with Krys Boyd as part of KERA's Breakthroughs series about some of the reasons girls might be underdiagnosed with autism spectrum disorder and what particular challenges are faced by girls with ASD. 

Listen to the full conversation here.

On why girls might receive fewer diagnoses

There’s a common misconception that girls simply don’t have autism. There are a few reasons for this, Szalavitz says.

For one, the diagnosis itself might be skewed towards boys. “For the same level of autistic traits, girls needed to have either intellectual disability or severe behavioral symptoms," Szalavitz says. "It’s very clear that girls at the higher end of the spectrum are getting missed.”

Symptoms may also be dismissed as just regular female behavior.

"[Girls] try to hack socializing. Autistic people tend to be better at systematic thinking than socializing, so the girls just bring their brilliant systemizing brains. They look like they’re behaving like other girls, but inside it’s an enormous amount of anxiety and effort just to be able to play that role.”

Girls may also be better at masking the symptoms of autism.

“Autistic people tend to have special interests, a sort of obsessive interest,” she says. “The typical examples are trains, computers or math. Girls tend to have more typical ‘girl’ obsessions. It might be Barbies or Disney or things like that that don’t seem as far out of the norm. What seems out of norm is the intensity of their interest.”

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On the surprising link between autism and anorexia

While you wouldn’t necessarily think the two are connected, they have quite a few characteristics in common: compulsive rigidity, a meticulous level of attention to detail, anxiety, a distaste for change and need for control.

“What may be going on in some girls is that they turn the obsessive special interest—which autism makes people prone to—to eating and food, which is socially sanctioned for people to do,” Szalavitz says. “It unfortunately seems like a very typical interest [for girls], so they can get connected with people and have an obsession they can talk about that other people will understand.”

On why girls with autism are at risk for sexual assault

As a generalization, people with autism are very trusting and very direct. Szalavitz says this can put girls with ASD at elevated risk in intimate relationships.

“Because autistic people tend to be very direct—‘I want this’—they might go up to a boy and say, ‘I want to have sex with you,’” she says. “This is not generally the courtship technique that is good for girls, to put it mildly. It can also be disastrous, because autistic people in general tend to believe what other people tell them, like ‘Oh, yes, I’ll love you forever.’ You’ll just fall for stuff that other women wouldn’t fall for.”

For individuals who fall on the more severe end of the spectrum, there is additional danger, Szalavitz says.

“People with disabilities are more at risk for sexual exploitation. In a more institutional setting or a place without a lot of oversight, that’s where a lot of sexual predators tend to go. There’s rarely enough money for the proper regulatory oversight. This can be a problem across the spectrum.”

Think airs at noon and 9 p.m. Monday through Thursday on KERA 90.1,  or you can stream the show live.