Much like ADHD, boys are overwhelmingly diagnosed with Asperger's syndrome (AS) more often than girls. Different experts place the ratio at anywhere between 1 girl to every 16 boys and 1 girl to every 10 boys. Some experts believe that the ratio should be closer to one girl to every four boys. Again, as with ADHD, it is speculated that there are several different reasons for the large discrepancy in diagnosing boys and girls:
Symptoms of AS are generally milder in girls - some experts hypothesize that symptoms are not necessarily milder, girls tend to have a higher level of social skills and ability to express emotion. These experts argue that the current diagnostic criteria is based on AS in boys and is compared to the neurotypical behavior of boys and a different scale should be used to determine the level of symptoms in girls. For example, suppose we measured social skills on a scale of 1-10 with 10 being the highest level. We might typically measure a 7 year old boy with a 6 (these are all made up numbers and are for illustration purposes only) and a 7 year old girl with an 8. If we measured children with AS who were the same age, the boy might score a 3 and the girl a 4 or 5. Instead of comparing the AS scores with the scores of other children the same gender and age, medical professionals may compare them to the overall AS score (suppose it is a 3) and say the boy has AS but the girl did not. However, when you compare to scores of neurotypical children (in our example a boy was a 6 and a girl was a 8), both children show a difference between normal development and their current scores. Therefore, the statement symptoms are milder in girls only applies if you compare symptoms in girls to symptoms in boys rather than comparing girls with AS to girls without AS.
It is accepted that girls are quieter and more passive than boys therefore, behaviors typical of AS are accepted more readily in girls - Stereotypes of little girls include words like shy, quiet, passive, well-mannered, pleasant. As parents, we know this is not necessarily the case. Those of us with daughters know they can be aggressive, outgoing, loud, naughty. We know girls come in all sizes and shapes and have all different personalities. However, on a whole, girls tend to be quieter than boys, not as aggressive as boys, and shier than boys. Because of this, symptoms of AS, which include being self-involved with a special interest, less interested in social relationships than their peers and a difficulty getting along with others that can cause a child to prefer being alone, are seen as typical girl behavior and not addressed as readily by parents or medical professionals.
Aggressiveness and temper problems may be one of the reasons boys are referred for evaluation, because girls are not generally as aggressive, they are not referred for diagnosis - The squeaky wheel gets the grease, that's how the saying goes and it is just as true in AS as in cars. A child who is aggressive is more likely to see a doctor for behavioral issues than the shy little girl. This is one of the reasons more boys are diagnosed with ADHD than girls and one of the reasons more boys are diagnosed with Asperger's.
Girls are more apt to have one or two friends who help in navigating social situations and who are more likely to provide comfort when upset - One of the hallmark symptoms of AS is social difficulties. Children with AS don't understand the social nuances and have a hard time making and keeping friends. Young girls, however, are more likely to have at least one friend. This friend may help in two ways. The first is by helping her through social situations. Girls with AS have a higher ability to mimic others and can copy her friend's behavior, making it seem as if she has the same social skills. Because girls are more nurturing than boys, her friend may take on the role of "mother" guiding the child with AS in conversation and explaining social cues. The second way the friend helps is by providing a "shoulder" when upset. Boys may vent their frustration by acting out, but girls, especially those who have someone to lean on, are better able to manage their emotions.
Special interests for girls are typically more mainstream, such as animals or classic literature - Boys with AS have special interests that are as varied as the children themselves. However, research has shown that many of their special interests revolve around science and transportation. Special interests can include weather, dinosaurs, trains or trucks. For girls, special interests are more typical of what other girls are also interested in. Young girls often focus on animals, such as horses or dogs, and as they grow they may focus on classic literature, showing great interest in reading Shakespeare or poetry. Because these interests are seen as typical interests in girls, they do not draw as much notice. In AS, however, it is not necessarily the topic of interest but the intensity of the interest. Children with AS often have an intense, all-consuming interest in a specific topic.
As research into AS continues, we will undoubtedly see a more balanced approach to recognizing AS in both boys and girls. As this happens, the number of disagnoses may suddenly jump, leaving us wondering if girls were previously underdiagnosed or are now being overdiagnosed. Many researchers believe the answer is that girls are currently underdiagnosed.
Atwood, Tony, Asperger's and Girls, 2006, Future Horizons
Simone, Rudy, Aspergirls: Empowering Females with Asperger Syndrome, 2010, Jessica Kinglsey Pub
Published On: July 28, 2011