On The BI Blog

Why Are More Boys Diagnosed with Autism than Girls?

September 18, 2023
By: Heather Gilmore, MSW, BCBA, LBA
autism male to female ratio, signs of autism in boys, autism in boys, autism in girls, autism in males vs females

Boys are diagnosed with autism spectrum disorder more often than girls. There are many possible reasons why there may be a higher prevalence of autism diagnoses in boys compared to girls. However, it is important to note that this difference in diagnosis does not necessarily mean that more boys actually have autism than girls. Girls just might not be diagnosed as often for the reasons we will discuss here. 

Possible Reasons Why Boys Are Diagnosed with Autism More Often Than Girls

Let’s explore some of the possible reasons why males are diagnosed with autism spectrum disorder (ASD) in comparison to females.

Diagnostic Bias

Historically, autism has been studied and diagnosed primarily in boys, leading to a potential bias in clinical understanding and recognition of autism symptoms. The symptoms that have been identified as suggesting autism spectrum disorder may be more commonly seen in boys, even though this may be an inaccurate or incomplete way of identifying autism. This bias can result in girls being underdiagnosed or misdiagnosed with other conditions.

What is Autism Spectrum Disorder?

Autism spectrum disorder, or autism, has specific traits that characterize the disorder. These traits may be more easily recognized in boys although, with a closer look, they can be noticed in girls, as well.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, as well as restricted, repetitive patterns of behavior, interests, or activities. Some common symptoms and characteristics associated with autism include the following:

  • Social communication difficulties:
    • Difficulty with verbal and nonverbal communication, such as challenges in understanding and using gestures, facial expressions, and tone of voice
    • Delayed or limited development of spoken language
    • Difficulty initiating and maintaining conversations
    • Difficulty understanding and responding to social cues and social norms
    • Difficulty developing and maintaining relationships
  • Restricted and repetitive behaviors and interests:
    • Engaging in repetitive movements or actions, such as hand-flapping, body rocking, or repetitive tapping
    • Strong adherence to routines and rituals, becoming distressed by changes in routine
    • Fixation or intense focus on specific interests or topics
    • Sensory sensitivities, such as being overly sensitive or under-sensitive to certain sounds, light, textures, tastes, or smells

Autism can present differently in each individual and the severity and combination of symptoms can vary.

Presentation and Expression of Symptoms

Girls with autism may exhibit different patterns of behavior and social interactions compared to boys. They may have more subtle or camouflaged symptoms, which can be harder to recognize and diagnose. For example, girls might be better at mimicking social cues, making it more challenging for clinicians to identify their difficulties with social interaction.

Gender Socialization and Masking

Girls may learn to develop coping mechanisms and strategies to fit into social norms more effectively than boys. This tends to make their autism symptoms less noticeable and consequently delays or prevents their diagnosis.

What is Masking?

Masking in autism refers to the phenomenon where individuals with autism learn to camouflage or hide their autistic traits and behaviors in order to fit in and conform to social expectations. It involves consciously or unconsciously adopting social behaviors, norms, and communication styles that may not come naturally to them.

Masking can manifest in different ways and may involve various strategies, such as:

  • Mimicking or imitating others: Individuals with autism may observe and imitate the behaviors, social cues, and mannerisms of neurotypical individuals to appear more socially adept.
  • Social scripting: They may develop scripted or rehearsed responses to various social situations, relying on memorized phrases or learned social rules to navigate interactions.
  • Suppression of stimming or repetitive behaviors: Stimming refers to self-stimulatory behaviors like hand-flapping, rocking, or other repetitive movements that individuals with autism may engage in to self-regulate or manage sensory input. When masking, individuals may consciously suppress or minimize these behaviors in public to avoid judgment or social stigma.
  • Exhaustion and burnout: Masking requires significant cognitive and emotional effort, often leading to exhaustion and burnout over time. The constant need to consciously monitor and regulate one's behavior can be mentally draining, leading to increased stress and difficulties in managing emotions.

It is important to note that masking is not a universal experience for individuals with autism. Some may mask more than others. The ability to mask can vary depending on various factors, including the individual's age, gender, support systems, and individual traits.

Recognizing and understanding masking is crucial for providing appropriate support and interventions for individuals with autism. It is important to create inclusive environments that allow them to express themselves authentically and provide support for developing their social skills in a way that aligns with their needs and strengths.

Burnout in Girls with Autism

Girls with autism might have a unique experience with autistic burnout.

Girls with autism may engage in masking behaviors to fit in socially, as mentioned earlier. This constant effort to mask their autistic traits and adhere to social expectations can be mentally and emotionally exhausting which contributes to burnout.

Girls with autism may face unique social and communication demands in social settings. They may have to constantly monitor and regulate their behavior, interpret social cues, and navigate social interactions, which can be overwhelming and lead to burnout. Girls often feel a great pressure to fit in and be like their peers in a way that is different from the pressure boys experience. Boys also have a pressure to fit in but it is more acceptable for boys to stand out from the crowd.

Many individuals with autism, including girls, have sensory sensitivities. These sensitivities can heighten their stress levels and contribute to burnout, especially when they are exposed to overwhelming or distressing sensory stimuli for extended periods. Girls are often thought of as more emotional and more sensitive than boys. Despite how stereotypical this judgment may be, this may contribute to the experience of sensory overload. The tendency for girls to exert great effort in blending in and concealing their sensory overload can play a role in the higher likelihood of girls being disregarded in the assessment for autism compared to boys.

Mental Health Diagnoses

Girls with autism may also experience co-occurring mental health conditions, such as anxiety or depression. These conditions can increase stress levels and contribute to burnout, as girls navigate both the challenges of autism and their mental health. Instead of considering autism spectrum disorder as the existing condition, many concerned adults will more likely assume that a girl has another mental health disorder, such as anxiety or depression.

If you or someone you know is experiencing burnout or struggling with the challenges of autism, it is advisable to seek professional support from a healthcare provider or therapist who specializes in working with individuals on the autism spectrum, such as the staff at Behavioral Innovations.

Understanding the reasons behind the gender disparity in autism diagnoses is an active area of research and the scientific community is continuously working to gain more insight into this complex topic.