The Difference in Autism Diagnosis Rates Between Girls and Boys

The Difference in Autism Diagnosis Rates Between Girls and Boys     

Today marks the first day of Women’s History Month! This month is not only an opportunity to celebrate the achievements of women, but to also recognize the many barriers that women face daily. In the spirit of Women’s History Month, Connec-to-Talk will be exploring the obstacles girls face in securing an autism diagnosis. Addressing the gender bias in the autism diagnosis process is a crucial step towards ensuring equitable care. 

Autism has historically been believed to impact boys at disproportionately high rates. In a study conducted by the CDC, (Maenner, et. al.), it’s reported that autism is nearly four times more likely in boys than in girls. However, in reviewing this statistic, one should keep in mind that boys are more likely to be diagnosed, not necessarily more likely to have the condition. Much of the founding and continued research has been conducted on white male children, resulting in a long-standing confirmation bias in the field. Indeed, this research – that has historically excluded female and minority populations – formed the basis for the diagnostic tools physicians use. In last month’s blog, we briefly explored how many diagnostic tools do not account for the presentation of autism across different cultural and ethnic backgrounds. For example, only 25% of studies conducted between 1990-2017, “included data related to the race and ethnicity of their participants” (Steinbrenner, et. al. 2022). Similarly, many long-standing diagnostic tools and trainings may not be accounting for presentations of autism across genders. 

Recent research suggests that girls with autism have significantly less social deficits than boys. Girls are particularly adept at social masking, which may result in them flying under the radar until they reach a point of burnout-induced crisis. Masking refers to the ability to mimic others’ verbal and non-verbal behaviors in a socially acceptable way. Girls are more likely to struggle in the domain of executive functioning, suggesting that symptoms are more often internalized. Boys tend to exhibit more overt behaviors that people usually associate with autism. It’s this external expression that typically leads more boys to be diagnosed during the evaluation process. This misunderstanding of the different symptoms consequently results in girls being misdiagnosed with personality or mood disorders as opposed to autism. According to Psychology Today, “42 percent of women with autism received at least one misdiagnosis before securing an autism diagnosis.”

When seeking an autism diagnosis for yourself or for a young girl in your family, it is important to not be defeated if your first physician is dismissive of your symptoms. If your doctor is unfamiliar with the concept of autistic masking or female specific presentations of autism, Connec-to-Talk encourages you to seek out a more neurodivergent-affirming physician.

Sources: 

1. Steinbrenner, et. al.  Patterns in reporting and participant inclusion related to race and ethnicity in autism intervention literature. Sage Journal. (2022). Link 
2. Maenner, et. al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years. MMWR. (2023) Link
3.  Robert T. Muller. Why Women With Autism Are So Often Misdiagnosed. Psychology Today. (2019). Link