Learn more about why diagnosis rates for Autism Spectrum Disorder (ASD) are different for boys and girls, and how you can support girls with ASD who mask their symptoms.
Masking in Autism Spectrum Disorder: How It Impacts Diagnosis for Girls
Masking in Autism Spectrum Disorder: How It Impacts Diagnosis for Girls
Whole Child Neuro
Why are boys diagnosed with Autism Spectrum Disorder (ASD) more often than girls?
Past research estimated that for every girl diagnosed with ASD, 4 boys would be diagnosed, but more recent studies have determined that the ratio is actually closer to 2 to 1, where for every two boys diagnosed there is one girl diagnosed with ASD.
It’s not that there are suddenly more girls developing Autism Spectrum Disorder, it’s that medical professionals are starting to get better at seeing the differences in presentation for ASD in boys and girls.
There are a few different reasons why the diagnosis rate for ASD has been different in boys and girls. Girls with autism may not show some of the classic or stereotypical symptoms that present in boys. Their difficulties may be more subtle and they are often more successful at fitting in socially. Part of the reason comes down to something called masking, which refers to the techniques that neurodiverse people use to camouflage their symptoms and blend in with neurotypical folks. Girls with Autism Spectrum Disorder often mask their symptoms, so it’s harder for parents, teachers, and medical professionals to assess what’s going on.
While masking can make it harder to tell when a child is dealing with ASD, it’s not impossible, and experienced neuropsychologists will be aware of masking strategies and take them into account when evaluating your child. As a parent, it’s also helpful for you to understand some of the less familiar signs of ASD so you can advocate for your child.
What is Autism Spectrum Disorder?
Autism Spectrum Disorder, or ASD, is a developmental disability which has a number of causes, some of which are known and some of which aren’t. ASD is thought to be influenced by genetics and environment, and often leads to changes in the brain itself.
Autism Spectrum Disorder may involve communication difficulties, social difficulties, and learning difficulties. Children with ASD may have difficulty with social interaction and communicating with others, and often pick up masking behaviors to help compensate for these difficulties.
How is ASD diagnosed
Providers have to look at the child’s history, ask questions of the parents, and observe the child to make an accurate diagnosis. When a child is skilled at masking their differences, it can make it harder to assess whether the child is truly dealing with ASD.
Medical professionals, unfortunately sometimes are influenced by bias and stereotypes, just like everyone else. Sometimes this leads to difficulty with being diagnosed with disorders like Autism Spectrum Disorder (ASD) because providers don’t realize that folks who aren’t neurotypical often find ways to adapt, or “mask” their symptoms, which then go unrecognized.
What does masking look like?
Masking refers to the strategies that a child with ASD uses to camouflage their symptoms and fit in with their neurotypical peers. Sometimes masking is conscious, and sometimes it’s unconscious, without the child noticing they’re doing it.
Children with ASD are often quite observant, and they pick up on the way that others act in social situations.
These are some examples of masking:
Rehearsing social interactions or creating scripts to follow during interactions
Suppressing stimming behaviors (such as rocking self, flapping hands etc.)
Copying mannerisms or behavior of others
Minimizing special interests
Mirroring body language of others
Maintaining eye contact, even when it’s uncomfortable for them
Masking takes a lot of mental energy, and requires almost constant monitoring on the part of the masking person. While some people with ASD mask successfully most of the time, it’s exhausting to mask all of the time. It’s also difficult to feel like you can never let your real self out without losing all of your social connections. Trying to find the balance between masking successfully and being themselves can be tricky for anyone, and especially for children and teens.
Why do girls mask more than boys?
There are different social expectations for girls rather than boys. Girls are expected to play well with others and to be interested in “girly” things. Following these societal rules can be hard for girls with Autism Spectrum Disorder, who then mask their discomfort to fit in. However, once friendships become more complex during the teenage years, it often becomes more challenging to hide symptoms and social difficulties may become more apparent.
What are the consequences of masking?
While masking can be a helpful strategy for children (and adults) with ASD to fit in socially, it doesn’t come without consequences. It takes tremendous effort to play the role of a neurotypical person when you are not neurotypical.
Some of the effects of autistic masking include:
Overwhelm
Bullying
Meltdowns
Anxiety disorders
Depression
Eating disorders
A lack of identity
Self-harm
Potentially missed diagnosis and therefore missed interventions and skill building
So how can you tell if a girl has ASD if she masks well?
Masking makes getting an ASD diagnosis more difficult, but it’s not impossible. A formal neuropsychological evaluation with a provider who is experienced in diagnosing girls can help identify what’s going on and offer resources to support your child/teen and your family after diagnosis. It can also be helpful to familiarize yourself with the signs and symptoms of Autism Spectrum Disorder in children, especially in girls.
If you have a girl in your life who you suspect is masking their ASD, there are ways to support them. Here’s what you can do:
Educate yourself about ASD
The more you can learn about Autism Spectrum Disorder (ASD), the better. Not only will it help your child feel seen and understood, but it will help you be a more effective advocate for them when they need it. There are lots of resources available online, whether it’s in an article or an account on social media, where you can learn about the reality of living with Autism Spectrum Disorder. Often, following accounts that educate about ASD can help you and your little one recognize that their unique way of looking at the world is valuable.
Advocate for them
It can be harder for children with ASD to advocate for themselves without letting their mask slip, and in some situations, letting their mask slip may lead to consequences or even punishment. Being the advocate for your child shows them that they always have someone in their corner who they can count on and who understands their needs. You can advocate for your child in medical settings, to make sure they are properly diagnosed and treated; in school, to make sure they are receiving the accommodations they are entitled to; and even socially, to help them build up a community.
Give them space to let their mask slip
It’s exhausting to mask and hide your true self all of the time. Some kids spend all day masking at school and then come home and have to keep the mask on to have their needs met. Offer your child a place where they can let their mask slip and be their true self. Maybe that means that their space is designed with their sensory needs in mind, or that they can stim to their heart’s content. Giving them a space where they can truly be who they really are shows them that they can be loved and cared for no matter what their diagnosis is, and that they can be their true self around you.
Help them find community where they can be themselves
Finding peers who understand what your child is going through can make a huge difference. Encouraging them to spend time with other autistic children, or helping them find an accpeting place where they can be themselves reminds them that they’re not alone, and that the way they experience the world isn’t wrong. Having another space where they can let their mask slip can help them feel less overwhelmed by the effort that it takes to mask.
Interested in learning more?
At Whole Child Neuro, we are determined to provide you with answers that can help your child reach their full potential. Our child psychologists will work with you and your child to determine a plan of treatment that is right for them. Reach out to our office in Encino today to get started.