Girls' social camouflage skills may delay or prevent autism diagnosis

January 4, 2018, Children's National Medical Center

On parent-reporting measures, girls with autism seem to struggle more than boys with performing routine tasks like getting up and dressed or making small talk, even when the study group is normalized to meet similar basic clinical diagnostic criteria across sexes. The findings add to the growing evidence that girls with autism may show symptoms differently than boys, and that some of the social difficulties experienced by females with autism may be masked during clinical assessments.

The new study, led by researchers from the Center for Autism Spectrum Disorders at Children's National Health System, was published in the Journal of Autism and Developmental Disorders.

"Based on our research criteria, parents report that the in our study with autism seem to have a more difficult time with day-to-day skills than the boys," says Allison Ratto, Ph.D., lead author of the study and a clinical psychologist within the Center for Autism Spectrum Disorders at Children's National. "This could mean that girls who meet the same clinical criteria as boys actually are more severely affected by ongoing social and adaptive skill deficits that we don't capture in current clinical measures, and that autistic girls, in general, may be camouflaging these types of autism deficits during direct assessments."

The study used an age-and IQ-matched sample of school-aged youth diagnosed with ASD to assess sex differences according to the standard clinical tests including the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R), as well as parent reported autistic traits and adaptive skills.

"This study is one of the first to eliminate many of the variables that obscure how sex impacts presentation of and symptoms. Though today's clinical tools do a really good job capturing boys at a young age, with a wide range of symptom severity, they do it less effectively for girls," adds Lauren Kenworthy, Ph.D., director of the Center for Autism Spectrum Disorders, and another study contributor. "This is a crucial issue considering how much we know about the success of early interventions on long-term outcomes. We have to find better ways to identify girls with so we can ensure the best approaches reach all who need them as early as possible."

Specific evidence of women more effectively masking or camouflaging social and communication deficits is limited, but autistic self-advocates theorize that the unique social pressures and demands on girls at a young age may teach them to "blend in" and "get by," including maintaining successful, brief social interactions.

Explore further: Females with autism show greater difficulty with day-to-day tasks than male counterparts

More information: Allison B. Ratto et al, What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills, Journal of Autism and Developmental Disorders (2017). DOI: 10.1007/s10803-017-3413-9

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