Girls and ASD (Autism): why does it seem so popular now?

By Dr Emma – The MotherMind Doctor

One of the hot topics making the rounds in socials is neurodiversity, which includes autism spectrum disorder (ASD) and ADHD (attention deficit hyperactivity disorder).

There is lots of speculation around why these conditions are so popular and really it’s probably a combination of many factors that is led to this phenomenon.

One of the significant factors, is that the diagnostic criteria in the DSM, the mental Health ‘guidebook’ as it often referred to, has been modified. That means that in the current edition, the DSM 5 TR, it is possible to have a diagnosis of ADHD as well as ASD which previously was not possible. We now understand that these conditions can co-occur, making it important to be able to diagnose both for people in order to access treatment and supports. In fact, both conditions have shared genetic and environmental risks.

The other significant change is that there are no subgroups and the previous specific disorders such as Asperger’s and pervasive developmental disorder have been absorbed into the general classification of the spectrum of autism. Age of onset does not have to be a parent before three years, however functional impairment must be present for a diagnosis.

Finally, and importantly, the number of criteria has been slightly altered so that instead of meeting at least six behavioural criteria overall, there are three required ones in one category with at least two in the second category. These categories have been rearranged somewhat to combine categories and some to be made as specifiers.

ASD, or autism, is now considered a high prevalence condition, with a 700% increase over the last 20 years and the number of girls being diagnosed has increased significantly.

There are several factors in considering a diagnosis, including the co-occurrence of other issues that tend to accompany neurodevelopmental disorders. These can include learning, communication, sleep, mood, attention, digestive, neurological and immune issues.

ADHD is the most common comorbidity with ASD, up to approximately 40% (where intellect is intact). The issue is that there is significant symptomatic overlap with sensory sensitivity, hyper focus versus distractibility, executive dysfunction and social communication difficulties.

The complication of presentation in girls is that camouflaging can confuse the picture further. And those who have learned how to cover up autistic traits have higher levels of mental health difficulties. In fact and camouflaging has been directly associated with lower self perception, autonomy esteem, hope for the future and suicidality.

Girls therefore tend to be diagnosed later than boys and tend to have greater impairment before receiving a diagnosis or may be less likely to receive a diagnosis after having been referred for an evaluation. A diagnosis of autism is often secondary to other disorders such as an eating disorder, obsessive compulsive disorder (OCD) or anxiety, depression, gender issues or a personality disorder.

There are symptoms that overlap ASD and personality disorders, which then create diagnostic uncertainty, particularly in women. One study found that 68% of patience with Asperger’s (as per the old DSM-IV criteria) would also be classified in at least one category of personality disorder. Another study of borderline personality disorder patients found 15% fulfilled criteria for ASD.

Professor Tony Attwood, a renowned specialist in ASD is developing a specific questionnaire for girls due to the different presentation to boys and talks about the different signs to look for in girls:

The signs to look for in girls may be more subtle such as

-       lower information processing speed in social situations

-       difficulty verbalising her emotions or expressing her needs.

-       difficulties with planning and organising or initiating activities

-       sensory issues related to bright lights or loud noises

-       evidence of difficulty with change

-       Parents may be concerned about temper tantrums or school refusal which are not evident to others, even teachers.

It Is important to consider that there are risks associated with not being diagnosed with these conditions if they are present. There are health related risks such as higher rates of substance use, accidents, legal offences, lower levels of income education, and of course the impact on the ability to socialise.

Our family has lived experience with consideration of neurodevelopmental disorders and had to navigate the complexity of the system in order to obtain assessments. Now that these conditions are in the public zeitgeist, more people are aware of it and open to consideration for diagnosis. While there is no specific treatment for ASD, the relief for some people and the potential supports for study or work can be life changing.

If you or someone you know feels they may benefit from an assessment, then discuss this with carers, teachers and/or your GP, who can refer you for an assessment.