Asperger Syndrome: Some Common Questions
Do Girls Have A Different Expression Of The Syndrome?
The boy to girl ratio for referrals for a diagnostic assessment is about ten boys to each girl (Gillberg 1989). However, the epidemiological evidence indicates the ratio is 4:1 (Ehlers and Gillberg 1993). This is the same ratio as occurs with Autism. Why are so few girls referred for a diagnosis?
So far there have not been any studies that specifically investigate any variation in expression of features between boys and girls with Asperger's Syndrome, but the author has noticed that in general boys tend to have a greater expression of social deficits with a very uneven profile of social skills and a propensity for disruptive or aggressive behavior, especially when frustrated or stressed. These characteristics are more likely to be noticed by parents and teachers who then seek advice as to why the child is unusual. In contrast, girls tend to be relatively more able in social play and have a more even profile of social skills. The author has noticed how girls with Asperger's Syndrome seem more able to follow social actions by delayed imitation. They observe the other children and copy them, but their actions are not as well timed and spontaneous. There is some preliminary evidence to substantiate this distinction from a study of sex differences in Autism (McLennan, Lord and Schopler 1993).
Girls with this syndrome are more likely to be considered immature rather than odd. Their special interests may not be as conspicuous and intense as occurs with boys. Thus, they can be described as the "invisible" child — socially isolated, preoccupied by their imaginary world but not a disruptive influence in the classroom. Although girls are less likely to be diagnosed, they are more likely to suffer in silence.
An important issue for girls is that during adolescence the usual basis for friendship changes. Instead of joint play with toys and games using imagination, adolescent friendship is based on conversation that is predominantly about experiences, relationships and feelings. The young teenage girl with Asperger's Syndrome may want to continue the playground games of the primary school and starts to reduce her contact with previous friends. They no longer share the same interests. There is also the new problem of coping with the amorous advances of teenage boys. Here conversation is acceptable but concepts of romance and love as well as physical intimacy are confusing or abhorrent.
In an attempt to be included in social activities, some teenage girls have described how they have deliberately adopted a "mask" like quality to their face. To others at school they seem to continuously express a smile, but behind the mask the person is experiencing anxiety, fear and self doubt. They are desperate to be included and to please and appease others but cannot express their inner feelings in public.
The author has observed girls with the classic signs of Asperger's Syndrome in their primary school years progress along the Autism/Asperger's Syndrome continuum to a point where the current diagnostic criteria are no longer sensitive to the more subtle problems they face. The author's clinical experience would suggest that girls have a better long-term prognosis than boys. They appear to be more able to learn how to socialize and to camouflage their difficulties at an early age. This is illustrated by Vanessa's poem.
Ironing Out the Wrinkles
Life was once a tangled mess.
Like missing pieces, in a game of chess.
Like only half a pattern for a dress.
Like saying no, but meaning yes.
Like wanting more, and getting less.
But I'm slowly straightening it out.
Life was once a tangled vine.
Like saying yours, and meaning mine.
Like feeling sick, but saying fine.
Like ordering milk, and getting wine.
Like seeing a tree, and saying vine.
But I'm slowly straightening it out.
Life is now a lot more clear.
The tangles are unraveling,
And hope is near.
Sure there are bumps ahead.
But no more do I look on with dread.
After fourteen years the tangles have straightened.
Reprinted with the permission of MAAP Service, Inc. © 2008 MAAP Service, Inc.