Girls and Asperger Syndrome

Are We Missing Girls with AS?

Even though a male dominant prevalence is not unusual for individuals with developmental or other disabilities (e.g., ADHD, learning disabilities, or emotional/ behavioral disorders), studies have shown that the number of males is especially prevalent in the area of ASD, including AS. Generally, the male-to-female ratio is suspected to be 4:1, similar to the ratio of other ASDs. However, some researchers suggest that the more accurate male-to-female AS ratio is much higher, at 2.5:1 (Attwood, 2007; Hill, 2009; Gillberg, 2005).

Many parents and professionals clam that girls with AS are under-identified because they exhibit different characteristics than boys. In addition, many educators pay more attention to boys, who generally show more externalizing behaviors, such as aggression, hyperactivity and conduct problems, compared with girls in classrooms (Ernsperger & Wendel, 2007).

Getting a diagnosis can be often the first hurdle in obtaining help for girls with AS and their families. As a result, late diagnosis of AS for girls decreases the chance for early intervention, which is a critical factor for better outcomes.

Understanding Gender Differences

The reasons for under-identification of girls with AS can vary. One of the possible reasons is related to gender-based characteristics. Many researchers and parents have noted that girls with AS are more likely to be ignored in the process of identification because of different social expectations, socialization or social development patterns for girls. Generally, girls with AS are assumed to show more problems in internalizing behavior (e.g., depression or anxiety) rather than externalizing behavior (e.g., aggression or hyperactivity).

It is very difficult to understand the profiles of girls with AS since most studies include few girls with AS and often do not even report separate scores for each gender. However, recent studies about gender differences found that girls with ASD have lower scores in both cognitive and adaptive functioning compared to boys with ASD (Lee, 2008). This suggests that girls who show severe problems are more likely to be diagnosed, and girls with AS who have higher functioning have been under-diagnosed. Therefore, some researchers also suggest that we should develop and use gender-specific norms to diagnose AS and other ASDs. The under-identification of girls with AS shows the need to understand gender-based characteristics in terms of better identification and support.

What Do We Know About Girls with AS?

Although more research is needed to determine the differences of gender-based characteristics, girls with AS tend to be internalized and are better able to imitate others’ social behaviors. In addition, girls with AS show their feelings of caring for others and tend to be more social than boys with AS. Girls’ good communication skills are also noted, and those skills often disguise the symptoms of AS, such as difficulties in understanding the social environment.

Different social expectations or assumptions of boys and girls can also impede appropriate understanding about girls with AS. For example, when girls have difficulties making eye contact or initiating social interactions, people might assume they are just shy or embarrassed.

The following characteristics have been reported in girls with ASD/AS (Attwood, 2007; Ernsperger & Wendel, 2007; Attwood et al., 2006; Nichols, Moravcik, & Tetenbaum, 2009):

• Good social imitation skills
• Depression and anxiety issues
• Passive participation (e.g., staying quiet in class)
• Poor social skills and understanding 
• Odd play skills
• Lack of understanding nonverbal cues (e.g., facial expressions, voice tones, body postures, etc.)
• Literal interpretation
• Poor motor skills
• Lack of empathy
• Poor organizational skills
• Attention problems

What Parents and Teachers Need to be Concerned About

Parents who have girls with AS face many issues different from those who have boys with AS. Parents and teachers need to be aware of several issues as well as characteristics in girls with AS across the lifespan in order to provide appropriate support for girls. The following areas can be considered as important issues related to girls with AS (Ernsperger & Wendel, 2007; Nichols, Moravcik & Tetenbaum, 2009; Attwood, 2008):

• Different cultural and social expectations for different ages (e.g., culture of teenage girls, patterns of friendship in girls, manners of girls at different ages in different settings)
• Dealing with emotional crisis related to depression and anxiety
• Puberty and sexuality (e.g., dealing with “growing-up” anxiety caused by body changes such as menstruation and breast development, and premenstrual syndrome issues)
• Hygiene issues (e.g., changing pad or using a tampon appropriately, regular check-up for pelvic exams)
• Safety issues (e.g., dealing with sexual harassment and bullying at school)

It is also important to be aware that girls with and without disabilities have to deal with gender-specific social biases. For example, the social bias for beauty and women’s body image has created a very stressful social situation for both girls with and without AS, and can affect the self-perception and self-confidence of girls (Nichols, Moravcik & Tetenbaum, 2009). Providing accurate information about gender-specific issues, including the social bias of girls, can be very important since those issues often cause emotional difficulties.

References

Attwood, S. (2008). Making Sense of Sex: A Forthright Guide to Puberty, Sex and Relationships for People with Asperger’s Syndrome. London: Jessica Kingsley Publishers.

Attwood, T. (2007). The Complete Guide to Asperger Syndrome. London: Jessica Kingsley Publishers.

Attwood, T., Grandin, T., Snyder, R., Wagner, S., & Faherty, C. (2006). Asperger’s and Girls. Arlington, TX: Future Horizons Inc.

Ernsperger, L., & Wendel, D. (2007). Girls Under the Umbrella of Autism Spectrum Disorders: Practical Solutions for Addressing Everyday Challenges. Shawnee Mission, KS: Autism Asperger Publishing Company.

Gillberg, C. (2005). The epidemiology of autism. In M. Coleman (Ed.), The Neurology of Autism (pp. 119-135). NY: Oxford University Press, Inc.

Hill, A. (2009). Doctors are failing to spot Asperger's in girls. Guardian News and Media. Retrieved April, 12, 2009, from http://www.guardian.co.uk/lifeandstyle/2009/apr/12/autism-aspergers-girls.

Lee, H. (2008). A meta-analysis of gender differences in autism spectrum disorders. Journal of the Korean Association for Persons with Autism, 8, 67-81.

Nichols, S., Moravcik, G.M., & Tetenbaum, A.P. (2009). Girls Growing Up on the Autism Spectrum: What Parents and Professionals Should Know About the Pre-Teen and Teenage Years. London: Jessica Kingsley Publishers.