Why autistic girls are often undiagnosed

Posted on 3 April 2018

Ongoing research suggests that girls with autism spectrum disorder (ASD) are more likely to camouflage their symptoms than boys. This means they are not being accurately diagnosed – and are not getting the help they need.

Diagnosing autism spectrum disorder (ASD) is not a simple matter. There is no single medical test that can confirm whether your child suffers from this complex developmental condition.

‘Generally speaking, ASD is characterised by repetitive, compulsive behaviours, a lack of interest in social interaction and little or no eye contact,’ says Dr Birgit Schlegel. Schlegel is a paediatrician at Mediclinic Constantiaberg with a special interest in paediatric neurology.

During routine paediatric visits, your child should be screened for developmental delays. If your doctor suspects signs of a problem, he should refer you to a multi-disciplinary team for a comprehensive diagnostic evaluation.

Diagnosis by a multi-disciplinary team

Typically, this team comprises a paediatrician, psychologist and occupational therapist who will observe your child’s behaviour and review his or her developmental history.

People on the austism spectrum can have severe learning difficulties and display challenging behaviour. At the other extreme, they may display normal or even extraordinarily high levels of ability in particular areas such as music or maths.

However, as Dr Schlegel explains, while there is little difference in boys and girls on the more severe end of the autism spectrum, girls who don’t display obvious signs of ASD (such as repetitive behaviours and a low IQ) are often misdiagnosed or under-diagnosed.

‘This is because many autistic girls can be very good at masking or camouflaging their autistic behaviours,’ Dr Schlegel says. For instance, girls on the autism spectrum are more likely to imitate social interactions than their male counterparts. This is because, unlike autistic boys who often isolate themselves in an obvious way, girls with the condition might appear to be making social connections.

Female vs. male brain

In a 2015 study, researchers at the Stanford University School of Medicine compared brain structure differences in autistic boys and girls. The brain scans showed distinct differences between the two sexes when it came to motor-related areas. In other words, girls are less likely to display the visually obvious motor behaviours (such as repetitive motions and hand-flapping) that are traditionally associated with a diagnosis of autism.

As Dr Schlegel adds, boys on the autistic spectrum can often fixate on a particular object, which drives them away from socialising (such as rocks or train timetables), and can make an early diagnosis easier. Autistic girls on the other hand might gravitate towards more ‘culturally-acceptable’ obsessions. For example, dolls, celebrities or collecting stickers, which may pass unnoticed by parents and medical professionals.

Early identification and access to the correct support services is key to a better future for those with autism. However, girls who are undiagnosed can endure years of stress or anxiety.






In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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