Pharmacy Daily | Under-detection of Autism in girls

GIRLS with autism tend to be diagnosed later than boys, largely because they can present with different characteristics than those classically related to autism.

This means that they may not receive the supports they need.

Researchers at Flinders University have found that under-detection of autism in girls may be partly driven by differences in the way they typically present compared to boys.

In addition, clinicians have a restricted conceptualisation of how autism can be expressed, often using tools designed around a male presentation.

"Tools currently being used to measure ASD (Autism Spectrum Disorder) traits are based on research conducted on male participants, meaning that they are not sensitive to how girls present," said lead researcher Dr Joanna Tsirgiotis, from the College of Education, Psychology and Social Work at Flinders University.

"We need to better understand the unique challenges of girls so that we can improve our diagnostic assessment processes, ensuring they are appropriate for them."

Dr Tsirgiotis shared that the research demonstrated that autistic females may have less obviously unusual intense interests and fewer repetitive behaviours, & are often highly socially motivated and eager for friendships, unlike what is often assumed about children with autism.

In addition, females often had better imaginative and social mimicry skills which may allow them to copy the behaviours of others and, therefore, camouflage their difficulties, resulting in the diagnosis being overlooked.

"This is important because, without a diagnosis, they likely will not receive the support that they may need," stressed Tsirgiotis.

To investigate specific behaviours in which differences lie, the Flinders researchers analysed profiles of 777 children using two commonly used diagnostic tools measuring ASD traits.

This provided insight into how ASD presentations may differ between diagnosed male and female children.

They found that differences between boys and girls identified in this study, both in symptom type and severity, may render the female presentation of ASD less recognisable to referrers, such as parents and teachers, and clinicians tasked with assessment.

"Girls tend to engage in less obviously neurodivergent behaviour and this can add murkiness to the diagnostic picture.

"If we don't have a clear idea of ASD in girls, their characteristics can be misinterpreted as anxiety, quirkiness or even as 'normal' behaviour," explained Tsirgiotis.

"If the female presentation is less recognisable, ASD diagnosis may be delayed or overlooked entirely."