Why there is a “gender gap” with ASD identification and treatment?
About 1 in 68 children in the US are estimated to have autism spectrum disorder (ASD), recent statistics from the nation’s Center for Disease Control and Prevention (CDC) reveal. Quite interestingly, the CDC reports that ASD is approximately 4.5 times more prevalent among boys than girls. In addition, boys are referred for evaluation and are diagnosed in greater numbers than girls. This diagnosis also comes at an earlier age for boys. Is there a “gender gap” that overlooks girls and denies them the support and services they need?
In a BestPracticeAutism.com article, Lee A. Wilkinson, a licensed school psychologist and certified cognitive-behavioral therapist, discusses the common symptoms observed in those with ASD.
“[An] evaluation of psychiatric comorbidity in young adults with ASD revealed that 70% had experiences at lease one episode of major depression and 50% reported recurrent major depression, Although typical boys and girls show similar levels of depression in childhood, the risk for internalizing disorders in girls increase dramatically in adolescence.”
Wilkinson compared these findings to a study in the Journal of Autism and Developmental Disorders which compared typically developing boys and girls ages 8-18 to those with ASD. Below is a summary of the findings:
“The researchers found that boys and girls were similarly impaired as evidenced by comparable diagnostic and non-diagnostic ASD symptom scores. However, girls with ASD differed markedly from typical girls on symptom measures, indicating that girls with ASD differed from typical girls in terms of language and social abilities. Girls with ASD also appeared to be at greater risk for internalizing psychopathology than boys with ASD and typical girls. In adolescence, girls with ASD had significantly higher parent-reported internalizing scores than boys with ASD and typical girls. This suggests that being female and having a neurodevelopment disorder may result in an especially high risk of [depression] in the teen years.”
According to Wilkinson, the reason girls on the spectrum are overlooked is gender specific. He claims that females socialize differently within a society and ASD symptoms may not reveal themselves in the way they do with males. For instance, females may be less aggressive than men and show almost no signs of their mental disorder.
“Gender role socialization is critical to understanding why girls with ASD might be under identified in the general population. Since females are socialized differently, ASD may not manifest in the same way as typical male behavioral pattern. For example, girls might not come to the attention of parents and teachers because of better coping mechanisms and the ability to ‘disappear’ in large groups. Girls on the higher end of the spectrum also have fewer special interests, better superficial social skills, better language and communication skills, and less hyperactivity and aggression than boys. Likewise, girls are more likely than boys to be guided and protected by same gender peers and to have special interests that appear to be more gender appropriate. These characteristics lessen the probability of a girl being identified as having impaired social skills, the core symptom of ASD.”
Unfortunately, another important factor is that clinicians and specialists do not differentiate between the two genders and their symptomatic distinction, primarily on account of little to no research in the field.
“As a result, parents, teachers, and clinicians may not observe the obvious characteristics associated with the male prototype of higher functioning ASD. Over reliance on the male model with regard to diagnostic criteria might also contribute to a gender “bias” and under diagnosis of girls. For example, clinical instruments tend to exclude symptoms and behaviors that may be more typical of females with autism spectrum disorders.”
Drawing from the research, Wilkinson emphasizes the importance of early diagnosis and better monitoring of girls’ behavior. In addition, he claims that this is a critical area for future research. Wilkinson recommends:
“In terms of treatment, cognitive-behavioral strategies have shown promise in addressing anxiety in higher-functioning children with ASD and might be adapted to address depression in this population. Interpersonal therapy techniques have also to be effective in treating typical adolescents with depression. Commonly used approaches include individual and group social skills training, providing experiences with typically developing peers, and peer-mediated social skills interventions, all targeting the core social and communication domains.”
While females are less likely to be identified as having ASD and are diagnosed later in life, they are likely facing the same, or more severe, mental and social challenges that are facing their male counterparts. Although girls are more likely to internalize their disorders making them harder to identify, it is still very important that girls be evaluated and provided appropriate treatment. As research progresses, the “gender gap” will shrink, helping more girls be evaluated for ASD and provided with the support they need.
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