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Adolescence unmasks autism traits in girls

by  /  13 May 2017
Tough time: The stress of being a teenager may cause autism traits to flare up in girls.

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Autism traits become more apparent as girls reach adolescence but stay stable in boys, suggests unpublished work presented today at the 2017 International Meeting for Autism Research in San Francisco, California.

The findings may explain why girls with autism tend to be diagnosed later in life than boys are1.

Girls with autism are known to be good at learning to mask their autism traits. Based on this theory, the researchers expected to see that girls got better and better at hiding these traits over time. Instead, they found the opposite. “We were genuinely surprised,” says lead researcher William Mandy, senior lecturer in clinical psychology at University College London.

The official estimate of autism prevalence in the U.S., which is based on 8-year-old children, finds a ratio of 4.5 boys with the condition for every girl. A new study that includes worldwide prevalence data reports a ratio closer to 3 to 1. The ratio drops even lower in adults with autism, Mandy says.

The new finding may explain why the ratio evens out in adulthood, as girls may be diagnosed only after adolescence, if at all, he says.

Tracking traits:

Mandy’s team looked at data from the Avon Longitudinal Study of Parents and Children. This study has collected long-term health information on more than 14,000 children born in Bristol, England, between 1990 and 1992. The researchers looked at a measure of social behavior in 4,960 boys and 4,784 girls at 7, 10, 13 and 16 years of age.

A questionnaire called the Social Communication Disorders Checklist asks parents to rate their children’s social behavior. A study last year found that the same genetic variants that increase autism risk track with poor scores on this questionnaire.

At 7, boys score worse on average than girls do on this measure, but by 16 years of age girls have average scores similar to boys’. Girls are more likely than boys to cross a cutoff for autism on the checklist at 13 or 16 years of age, rather than at 7 or 10 years, as is common for boys.

It is unclear whether autism features appear later in girls or flare up because of the stress of being a teenager. Mandy says the latter explanation is probably correct. “The social milieu at that age is growing in complexity quite rapidly,” he says. “Subtle social difficulties that didn’t matter in primary school may suddenly start to matter in secondary school.”

Alternatively, there may be biological changes related to puberty that make the traits more apparent. This would be really interesting to follow up, says Caitlin Hudac, a postdoctoral associate in Raphael Bernier’s lab at the University of Washington in Seattle, who was not involved in the work.

The study has some limitations. For one, it relies on tracking autism traits in the general population rather than looking at children diagnosed with the condition, says Mandy. It also does not assess repetitive behaviors, an important feature of autism.

“We need to look in a little more detail to say for sure that these are genuinely autistic social communication difficulties we are seeing in these females,” he says. “There’s work to be done, but it’s still intriguing.”

On the other hand, one advantage to looking at traits in the general population is that diagnostic tests for autism often miss girls with the condition, Mandy says. Relying only on diagnosed children might skew the findings.

For more reports from the 2017 International Meeting for Autism Research, please click here.

  1. Giarelli E. et al. Disabil. Health J. 3, 107-116 (2010) PubMed
TAGS:   IMFAR 2017 , autism, gender

5 responses to “Adolescence unmasks autism traits in girls”

  1. Planet Autism says:

    “Girls with autism are known to be good at learning to mask their autism traits. Based on this theory, the researchers expected to see that girls got better and better at hiding these traits over time. Instead, they found the opposite.”

    Ah, but no. Because the masking only takes place in places such as school, or outside the home. At home parents (most especially mothers) see the autistic behaviours, but the trouble is so many professionals are unwilling to listen, preferring instead to blame parenting. The authorities give credence to school opinions and ignore parents, and it is masking that is the simple reason they should listen to parents (alongside respecting the gold dust that parents have to offer on knowledge of the child of course).

    In the UK, there are bodies (including the British Psychological Society who has gone on record publicly in the NHS NICE ADHD consultation), as saying they believe parents are seeking diagnosis for access to benefits. It’s appalling.

    see P30 of stakeholder comments on the NHS NICE Guidance ADHD consultation):

    “ADD –There is also concern about the possible financial driver for parents of having a diagnosis for their child as they may benefit financially from receiving Disabled Living Allowance.”

    Screenshot attached

    This vile suspicion is mentioned publicly by other authorities as well. So it shouldn’t make any difference that females mask, because they (we – I am autistic too) don’t mask the whole time, if professionals started respecting parents as experts in their own children, instead of suspecting us all of being shysters, there would be a lot less autistic children (especially girls) diagnostically failed.

    “Professionals/Authority and The Parent Blame Culture”

    “Parental Recognition of Autism – Professionals Must Listen!”

  2. Emily Paige Ballou says:

    “It is unclear whether autism features appear later in girls or flare up because of the stress of being a teenager.”

    Or whether features that were always there but written off or mis-attributed by professionals due to sexism or prejudice about who can and can’t be autistic become less and less ignorable as a girl starts to struggle more….

    There is professional culpability here, not just difference in presentation.

  3. Kathy says:

    My daughter has always been “special.” As a baby, her ped used to say she was “on the high end of normal.” That was his gentle way of helping me understand that there is a “wide range of normal.” That was another of his sayings. He was really the best pediatrician ever, like a Fred Rogers incarnate. I was sad when we moved from that city because leaving him meant not having that lovely support. My daughter was not diagnosed as ASD until recently. She is 14 years. But, we have known for three year now that this is likely. I have been homeschooling her while we work with various professionals to “figure her out” only so we can get an IEP for school. It was really school issues that popped up in 4th grade that led to our seeking help. Now, it is quite obvious, to us, that she has been autistic all along. I don’t know how to explain it. As an educator myself, I can only say that she just did not need supports in grades K-3 but has needed supports from grade 4 on. She is quiet, shy, keeps to herself. Her issues were apparent at home but manageable at school, until 4th grade. Now, I am working on my special education endorsement and really thinking hard about this issue. I think there are more girls on the autism spectrum than we identify, particularly in the 2E areas. I hope to specialize in those areas.

    • Derp Turtle says:

      My mum told stories of how my ped would pass on words of wisdom he’d recieved way back when training.

      One of the pearls his… mentor… had given was this:

      “The average child takes their first steps at twelve months. The normal child will take their first steps somewhere between nine and eighteen months.”

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