12 August 2021

Autism in girls: what to look for

Clinical Paediatrics

The condition was once thought more prevalent in males, but evidence suggests females may just experience different symptoms.


Girls with autism are less likely to present with deficits in imaginative play than their male peers – something which Australian paediatricians fear could be leading to underdiagnosis with current diagnostic tools.

Currently, females make up just 20% of all autism diagnoses, leading some to suggest that gender-based differences in presentation may have resulted in missed diagnoses in women.

In a recent paper published in the Journal of Paediatrics and Child Health, Adelaide-based paediatricians from the Royal Women’s and Children’s Hospital child development unit homed in on specific gender-based differences in autism presentations.

The researchers analysed a sample of close to 200 autistic children treated in the child development unit over a six-month period in 2018, with the cohort comprising 75% males and 25% females.

In terms of presenting features, males were more likely to display imaginative play deficits, and females were more likely to have proprioception and vestibular issues as well as fears reflecting sensory avoidance.

“Consistent with earlier literature, our study found that males were 3.64 times more likely to display imaginative play deficits than females,” the authors wrote.

“We did not observe a significant difference between genders regarding initiation and maintenance of friendships.

“This challenges previous findings that females with autism were more socially motivated than their male counterparts and displayed more developed social skills, which were comparable to typically developing males.”

Another key gender-based difference observed by the researchers was that girls were also more likely to present with less severe forms of autism, which they felt could be due to the diagnostic tools used.

“Noting these observations, further research should be aimed at the development of gender-specific diagnostic tools or the modification of existing tools to better account for gender-based differences in autism spectrum disorder,” the authors wrote in the Journal of Paediatrics and Child Health.

Repeated or learned phrases were the most common feature in both genders.

There were no gender-based differences associated with comorbid specifiers including global developmental delay, anxiety and ADHD, a finding which differed from existing research on the subject.

Multiple previous studies have identified a link between autism in girls and internalising symptoms like anxiety or depression.

“It is acknowledged that the absence of gender-based differences between autism spectrum disorder and comorbid specifiers in our cohort may reflect an underpowered study by way of small sample size,” the authors wrote.

Journal of Paediatrics and Child Health 2021, online August 2