Elizabeth Mantush | staff writer

As a child, it’s natural to look for people like you in the media that you consume. “The Good Doctor,” “Rain Man” and “Young Sheldon” all feature people who represent the spectrum differently, but this diversity is missing one thing … Where are the girls with autism?

Just last year, the U.S. Department of Health and Human Services reported that 1 in 31 children are diagnosed with Autism Spectrum Disorder (ASD).

While this number can be surprising to some, the growing number of ASD diagnoses can be traced to a growing understanding of what the condition looks like.

ASD can present differently in different people. Overall they are characterized by “some degree of difficulty with social interaction and communication,” said the World Health Organization.

According to a 2023 article from UCLA Health, boys are four times more likely to be diagnosed with autism, compared to girls.

“There’s no medical test to identify autism. Health care professionals rely on the information they gather from a person’s developmental history, symptom assessments and behavior to reach a diagnosis,” according to the article.

In the past, physicians and families were under the impression that autism was more prevalent in boys than girls, so much of autism research has been male centered.

“The model that we have for a classic autism diagnosis has really turned out to be a male model. That’s not to say that girls don’t ever fit it, but girls tend to have a quieter presentation, with not necessarily as much of the repetitive and restricted behavior, or it shows up in a different way.” said Susan F. Epstein in an article titled “Why Many Autistic Girls Are Overlooked,” published by the Child Mind Institute, a global nonprofit focused on children’s mental health.

The National Health Service describes symptoms of autism as “repetitive movements, such as flapping their hands, flicking their fingers or rocking their body,”“avoiding eye contact,” “not smiling when you smile at them,” and “not talking as much as other children” among others.

UCLA Health said that girls experience more sensory sensitivity and less difficulty in communication ability than boys with autism. Symtoms don’t look the same for everyone with ASD, let alone between boys and girls. It’s not fair for the girls who internalize their struggles to be told that just because their symptoms don’t look the same as boys, their condition is any less valid.

The most prevalent issue in diagnosing girls with autism is that they respond to their symptoms internally, through a process called masking, resulting in other psychiatric problems.

Masking is used to appear neurotypical in social situations. Strategies can include; the use of facial expressions, eye contact, regulation of tone of voice, repression of stims, mirroring behavior of others and scripting what you are going to say, according to the National autistic society.

The National Autistic Society said, “While this strategy can help them get by at school, work and in social situations, it can have a devastating impact on mental health, sense of self and access to an autism diagnosis,” the society said.

Another sign of autism in children is an intense interest in certain things. In girls it can be harder to detect than in boys. Because, with girls, that thing tends to be something other girls that age also enjoy (such as horses or celebrities), so the behavior doesn’t call attention.

In childhood, unless a girl experiences cognitive or behavioral issues, they usually go undiagnosed until later in life, if at all.

Co-conditions that occur simultaneously with ASD are more likely to develop in women than men if their disorder is left untreated. Conditions like anxiety, ADHD, Depression, OCD and tic, sleep or eating disorders can develop if a child’s symptoms are not addressed early in their life.

When transitioning to adulthood, women often have a harder time communicating and interacting in social situations than men.

These symptoms can be misinterpreted by healthcare providers as different psychiatric conditions, leading to misdiagnosis or treatment.

Waiting to receive a diagnosis until adulthood delays an autistic woman’s access to support and clinical care. Symptoms of autism can be interpreted as different psychiatric conditions, leading healthcare professionals to misdiagnose them.

“Personality disorders were the most frequent perceived misdiagnoses, followed by anxiety disorders, mood disorders, chronic fatigue syndrome/burnout-related disorders, and attention-deficit/hyperactivity disorder,” said a study published in 2024 by eClinical Medicine.

In the study, researchers concluded that 31.7% of autistic women reported they had been misdiagnosed with another psychiatric condition compared to 16.7% of males.

Many women spend their childhoods confused about what’s different about them, and later in life struggle to receive treatment. Sometimes, it feels like boys are the face of autism, and girls are left behind. While research about how ASD appears in different people is ongoing, it is frustrating for women as a whole, who know something is different, but aren’t getting the real answer.

Elizabeth Mantush can be reached at mantushe@duq.edu