It's well-known that the number of children diagnosed with autism spectrum disorders has increased dramatically over the past decade, and no one quite understands why -- though theories abound. Researchers also agree that autism cases are four times more common in boys than they are in girls, and no one understands the reasons for the gender differences, either.
For parents like me, who are blessed with lovely girl children who also have an autism spectrum disorder, the biggest issues are the unique challenges faced by girls with autism. Females are biologically and socially expected to be nurturing, intuitive and empathetic, and yet autism is primarily a social-emotional disorder that profoundly affects relationships and social behavior. For girls, the collision between autistic characteristics and social expectations can be especially difficult -- and almost unsurmountable during the teen years.
Of course, some researchers suggest that autism spectrum disorders might appear milder in girls (and perhaps harder to identify, which would explain the disparity in prevalence), because their biological programming might actually give them a skills boost over their male counterparts.
On the other hand, all children with autism are less aware of the impact of their behavior, which can lead to fatal errors in the social minefield that is middle school. Typically-developing girls are often hyper-aware of even the smallest social misstep, and can be very adept at subtly ostracizing or ridiculing the transgressor. As a result, girls with autism are often at a double disadvantage, because of the collision between their disability and their gender.
Hygiene, Crushes and Fashion Are Hurdles
The natural and inevitable effects of puberty are one area of challenge, because they bring with them increased hygiene and grooming expectations for girls. Sensory sensitivities or attentional issues mean that girls may be less attentive to the need to bathe more frequently, shave or pluck body hair, wear deodorant, or practice good skin care.
Adolescent crushes can also be problematic -- for boys and for girls. Typical adolescents would usually rather die than reveal their feelings to the object of a crush; autistic teens are less likely to be aware that romantic feelings are embarrassing unless they are reasonably expected to be reciprocated. Girls are expected to be subtle with their romantic interests, but girls with autism are usually hard-pressed to understand subtlety.
I have personally observed that typical boys generally react very badly to the overtures of a subtlety-challenged girl who is unaware that an unreciprocated crush is embarrassing; on top of that embarrassment, the male crush object is generally teased mercilessly by his typical girl counterparts, which leads him to be even more upset by the actions of the female crush initiator.
Finally, since adolescence is a time when children become extremely aware of group behavior and norms, fads and fashion take on great importance. For girls, wearing the "right" fashions is a good way to signal awareness of group norms. Girls with autism may appear "behind" if their sensory or attention deficits do not allow them to shift trend awareness as quickly as their peers.
One obvious example is ear piercing. At age 10 or 11, typical girls often ask to have their ears pierced, which requires a briefly painful procedure and several weeks of attentive hygiene before you can change earrings along with your outfit. For a girl with autism, the "cool" factor of pierced ears is difficult to square with the idea and reality of the pain of the procedure. While I don't think pierced ears are at all necessary for a happy and productive life, it's just a reality that they can help an awkward teen to fit in a bit better with her peers.
All it Takes Is One Friend
Researchers like Ami Klin of Yale, Catherine Lord of the University of Michigan and Shana Nichols of New York's Fay J. Lindner Center for Autism say that more research into the particular challenges and strengths of girls on the autism spectrum is desperately needed, because there are clearly gender-based differences in how autism and related disorders present themselves. They say that girls with autism can benefit greatly from peer support and relationships with other girls on the spectrum.
My personal mantra is: "All it takes is one friend." Experiencing the joys of a real friendship -- someone who shares your interests, however off-beat they might be; someone who thinks you are funny and wonderful and worth spending time with -- can make all the difference in what you want and expect in your life. "It’s striking how much girls with autism can care about each other and other people and develop friendships that are really a source of joy for them,” Dr. Lord told The New York Times in 2007.
In the end, what little research that exists has indicated that girls with autism are particularly at risk for depression and anxiety-related disorders later in life. Dr. Lord and others believe that investing in programs that help to build social skills and awareness, as well as fostering real friendships and relationships for teens and adults with autism, will make a huge difference in life success for girls on the spectrum.
References
Nichols, S., A Girls Eye View: Detecting and Understanding Autism Spectrum Disorders in Females, Interactive Autism Network, December 2, 2009, accessed January 13, 2011
Bazelon, Emily, What Autistic Girls Are Made Of, The New York Times, August 5, 2007, accessed January 13, 2011.
Ernsperger, Lori, et. al. Girls Under the Umbrella of Autism Spectrum Disorders, Autism Asperger Publishing Co., 2007
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