Autism Spectrum Disorder (ASD) is often discussed in the context of its more visible symptoms, but it’s crucial to recognize that the condition can manifest differently, particularly in females. Historically, autism has been under-diagnosed in girls, leading to a gap in understanding and support. Here’s why autism may be missed in females and how we can better address these discrepancies.

Why Autism is Often Missed in Females

1. Different Presentations: Autism in females can present differently than in males. Girls may exhibit subtler signs or adapt their behavior to blend in with peers, making their difficulties less apparent. They might excel in masking their challenges, leading to a misdiagnosis or delayed diagnosis.
2. Social Camouflage: Many girls with autism develop advanced social mimicry skills. They may imitate social behaviors and responses, which can mask their true difficulties. This social camouflage often makes it harder for parents, teachers, and even healthcare providers to recognize their signs of autism.
3. Different Interests and Behaviors: Females with autism may have interests and behaviors that align more closely with typical female activities, which can further obscure their diagnosis. For example, they might engage in repetitive play with dolls rather than more “stereotypically autistic” behaviors like lining up objects.
4. Internalizing Symptoms: Girls are more likely to internalize their struggles, leading to higher rates of anxiety, depression, or eating disorders. These secondary conditions can sometimes overshadow the underlying autism, complicating the diagnostic process.
5. Gender Bias in Diagnostic Criteria: Traditional diagnostic criteria and research have been primarily based on male presentations of autism. This gender bias can contribute to an incomplete understanding of how autism manifests in females, leading to missed diagnoses.

Addressing the Discrepancy

1. Increase Awareness: Educate yourself and others about the less obvious signs of autism in females. Understanding that autism can present differently in girls is essential for accurate identification and support.
2. Encourage Comprehensive Evaluations: If you suspect autism in a female, seek a thorough evaluation from professionals experienced in recognizing the diverse manifestations of the disorder. A comprehensive assessment should consider both overt and subtle symptoms.
3. Support Social and Emotional Needs: Recognize and address the social and emotional challenges that may arise from internalized struggles. Providing support for anxiety, depression, or other conditions is crucial for holistic care.
4. Promote Open Dialogue: Encourage open discussions about emotions and social experiences. People who feel heard and understood are more likely to express their true feelings and challenges.
5. Tailor Interventions: Implement interventions that are sensitive to the unique ways autism manifests in females (and individuals - everyone is unique and not all experiences are the same!). This might include self-advocacy coaching, executive functioning training, and strategies to support emotional regulation.
6. Advocate for Gender-Inclusive Research: Support and advocate for research that explores autism across genders. Gender-inclusive studies can provide a more complete understanding of how autism affects females and lead to better diagnostic criteria and interventions.
7. Seek Specialized Support: At Bright SpOT, our team of occupational therapists and speech therapists are trained to recognize and address the nuances of autism in females. We offer personalized therapy evaluations and tailored strategies to support each individual's needs. If you believe that autism might be missed or misdiagnosed, we are here to provide comprehensive support, guidance, and referrals.

Understanding and addressing missed autism in females requires a shift in perspective and increased awareness. By recognizing the unique ways autism can present in girls and taking proactive steps to support them, we can ensure that all individuals receive the care and understanding they deserve.

If you have concerns about a potential missed diagnosis or need specialized support, reach out to Bright SpOT. Our team is dedicated to providing the expertise and personalized care needed to support each child’s unique journey.

Warm regards,Caitlin Sanschagrin, OTR
Occupational Therapist, Bright SpOT

Choosing the right pediatric therapist for your child is a significant and personal decision that can greatly impact your child’s development and well-being. Whether your child requires occupational therapy, speech therapy, or any other form of therapeutic support, finding the ideal therapist match can take time and multiple consultations with different providers. It is important to keep in mind that finding the right therapist can be similar to dating - the therapist may be a great person and good at their job and yet they still might not be the best match for your child/family. In this blog post, we'll explore important factors to keep in mind in order to help you make an informed choice for your child's unique needs.

Does the Therapist Listen to Your Concerns?

One of the first signs of a great therapist is their ability to listen to, and have genuine interest in. your concerns. You can begin to gauge this by having a short consult (either in person or on the phone) prior to the initial evaluation. Typically there is extensive dialogue during the initial evaluation, when your child will first be formally working with the therapist. Consider if the therapist is attempting to understand your concerns and from where they are rooted rather than excessively suggesting - or even imposing - their own goals and milestones. Occasionally, therapists can get “stuck” on what they think a child “should” be doing rather than focusing on the reason families are seeking therapy. For example, you might come into an occupational therapy (OT) evaluation for difficulty managing emotions/behavior and the therapist focuses on fine motor and handwriting differences. During your initial meetings, consider whether the therapist takes the time to understand your child's barriers, your family's goals, and your specific worries. A therapist who listens openly and attentively can tailor their approach to address your child's individual needs effectively.

Does the Therapist Try to Build a Genuine Relationship with Your Child?

Building a genuine and trusting relationship with your child is essential for successful therapy.  Watch for signs that the therapist is skilled at connecting with your child on a personal level. They should create a safe and supportive environment where your child feels comfortable and valued, fostering a positive therapeutic relationship. It is important to keep in mind that your child is most likely going to be addressing difficult and even sensitive issues while in therapy. In order for them to get the most out of therapy, they must feel safe enough to do so. If a child never builds a relationship with their therapist, they will not be getting the maximum therapeutic benefit that they deserve. 

Does Your Therapist Feel Comfortable Being Questioned or Receiving Feedback?

Effective communication between you, your child, and the therapist is vital. A therapist who welcomes questions, feedback, and collaboration is more likely to provide personalized and effective care. Don't hesitate to voice your concerns or ask for clarification during the therapy process. If you find the therapist is uncomfortable when being asked to clarify or even justify their explanations/therapeutic approaches, that is concerning. No one person knows everything, no matter the profession. Therapists best serve their patients when they come from a place of wanting to learn and understand regardless of how long they have been practicing. 

Does the Therapist Use Individualized Treatment Activities/Strategies?

Every child is unique, and their therapy should reflect their individual needs. A skilled therapist customizes treatment activities and strategies to address your child's specific challenges and goals. Look for a therapist who tailors their approach to your child’s strengths and interests while working on their barriers to success. 

Does the Therapist Give You "Homework"?

Supporting your child's progress outside of therapy sessions is crucial for long-term success. A therapist who assigns "homework" or suggests activities for you to practice with your child at home is invested in their progress and understands the importance of caregiver buy-in and consistency for generalization of skills. This approach empowers you to contribute to your child's development actively.

Does the Therapist Make You and Your Child Feel Valued?

Last but not least, a great therapist should make both you and your child feel valued and respected. They should demonstrate empathy, patience, and a genuine commitment to your child's well-being. A therapist who acknowledges your efforts as a parent and the strengths of your child creates a positive and empowering therapeutic experience.

Choosing the right therapist for your child involves careful consideration of these key factors. The ideal therapist will listen to your concerns, establish a genuine rapport with your child, encourage questions and feedback, tailor treatment strategies, provide opportunities for at-home practice, and, most importantly, make you and your child feel valued and supported throughout the therapeutic journey. By prioritizing these aspects, you can ensure that your child receives the high-quality care they deserve.