Why Is Autism Underdiagnosed in Girls? The Reason Is Sorta Sexist

Autism is generally thought of as a "male" disorder — it’s diagnosed in boys at nearly five times the rate of girls. But, according to a new story from NPR, gender bias may play a huge role in how autism is diagnosed in girls: some girls display different symptoms of autism than boys do, making the disorder less recognizable to doctors, delaying diagnosis and treatment.

Autism, or autism spectrum disorder, which also includes Asperger’s syndrome, is most often diagnosed early in childhood, when differences in social behaviors — such as difficulty making connections, engaging in repetitive actions, or nonverbal communication — begin to emerge. A parent may notice that their child doesn’t make eye contact as much as their peers do, or that they focus intensely on one activity to the exclusion of all else. Some people with autism are more high functioning, and have a quality of life similar to their peers who aren't autistic; others may need more intervention and hands-on care.

There are a few different ways that these diagnoses are affected by gender bias. According to NPR, girls are more likely to engage in “social camouflage” behaviors that mask the most overt signs of autism, like hanging out in groups or showing signs of empathy. Repetitive or obsessive acts, like collecting things or having intense interests, are seen more like endearing quirks than as anti-social behaviors. (Also, a girl with an all-consuming obsession with Disney princesses is perceived differently from a boy who feels the same way about, say, math.)

Gender roles aside, the way the diagnostic criteria for autism were developed is problematic of itself; they’re based on data acquired from studies of basically only boys, according to Scientific American. Similarly to how a heart attack presents differently in women, there are critical differences between how autism presents in girls versus in boys. Some obsessive or repetitive behaviors in girls might take on characteristics closer to obsessive-compulsive disorder, or even anorexia; the diagnosis could then be one of those diseases, which have higher incidence in women, before realizing the root cause is autism.

There are differences at the brain level, too. Kevin Pelphrey, an autism researcher at Yale, has found that the brains of girls with autism look most similar to those of neurotypical boys of the same age. “They're still reduced relative to typically developing girls,” he told Scientific American, but they’re not immediately recognizable as autistic.

These days, autism affects one in 68 kids in the U.S., according to the Centers for Disease Control, and that number is only going up as more parents become aware of symptoms to look out for. The earlier a child is diagnosed, the better the outcome: a 2015 study in the journal Pediatrics found early intervention could improve social abilities, communication skills, and even IQ. But some researchers think that there might be as much as a two-year lag in diagnosis for girls with autism, according to CBS News. Reducing this gender gap is critically important to make sure that girls have the same access to treatment and care that their male counterparts do. With awareness and education, girls with autism can have every chance to live the lives they deserve.