Autistic boys and girls may show signs and symptoms of autism in different ways. This can lead to delays in diagnosis in girls, and boys being diagnosed with autism more than girls.

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Autism is a neurological and developmental disorder that affects how a person interacts with others, learns, and behaves. Though it can affect anyone, it overwhelmingly affects boys compared to girls.

In part, this may be due to biological differences. But biases, as well as differences, in how each shows the classic symptoms may also play a role.

Language matters

Gendered terms like “male” and “female” are used throughout this article. But we understand gender is solely about how you identify yourself, independent of your physical body. So, when we use this language, we’re referring to all people who identify as a girl or a boy.

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Autism is more common in boys than girls.

Research from 2021 found that autism is about 4.2 times more prevalent in boys than girls. This means that for every girl with autism, there are 4 boys with autism.

A 2021 study looked at the differences in autism between males and females. Among other findings, they stated that most studies find a rough ratio of 4 boys to 1 girl. They noted that gender differences could affect diagnosis and treatment.

Many high-profile organizations, like the Centers for Disease Control and Prevention (CDC), typically report the ratio as 4 to 1 as well.

While most experts think autism is four times more prevalent in boys, there is evidence that says that the difference may be somewhat less dramatic.

A 2017 meta-analysis that reviewed over 54 studies found that the ratio may be closer to 3 boys to 1 girl. Researchers point out that the difference may be due to missed clinical symptoms in girls, which means that many may go unreported and untreated.

Future research will help clarify the role of gender and diagnosis.

Learn more about autism spectrum disorder here.

The CDC describes the signs and symptoms of autism as deficits in:

  • social communication and interaction skills, including both verbal and nonverbal communication and interactions
  • restricted or repetitive behaviors or interests

They also note that many people on the spectrum may also have additional characteristics, such as delayed speech, motor skill issues, and anxiety.

Some signs of autism that doctors and other specialists may look out for include:

  • avoiding eye contact
  • not talking as much
  • repeating the same words or phrases
  • not responding to their name
  • showing less facial expressions
  • repetitive movements (flapping hands or rocking)
  • not talking with other children

A study from 2021 has shown that boys and girls without cognitive impairment may present autism symptoms differently.

For example, studies found that boys are more likely to:

  • develop rituals and routines
  • make less eye contact when in a conversation
  • experience unusual fear or distress due to noisy, crowded spaces
  • lack interest in peer pressure
  • become distressed due to wearing particular clothing items

The differences in signs and symptoms between males and females are subtle, and can often go undetected by common screen tests.

This can lead to the underdiagnosis of girls with lower support needs, which can impact their mental health and overall well-being.

There is no medical test, like a blood sample, that a doctor can use to diagnose autism. Instead, doctors look at a child’s behaviors and developmental history to make a diagnosis.

One of the problems in diagnosing autism in females is the underdiagnosis of females.

Some studies suggest that, in addition to slightly different presentations between boys and girls, girls may be better able to camouflage their differences from “normal” child behaviors.

A 2019 study found similar results to earlier studies that suggested camouflaging or masking is more common among girls.

Camouflaging means a child hides behaviors or traits that may make them look different from others.

Girls may do better at imitating those around them, making it more difficult for caregivers, teachers, doctors, and others to recognize their differences.

Check out this resource for more information on early signs of autism in infants and young children.

Autism has the same clinical signs and criteria for both boys and girls. Many studies report a much higher incidence rate among boys than girls, but this may be skewed due to biological differences, biases, and symptom presentation.

Studies suggest that girls may present autism symptoms differently, though they experience both social issues and repetitive behaviors associated with autism.

If you suspect your child may not be developing the same as their peers, you may want to consider talking with a doctor.

A family doctor can often help connect families with local resources that can help diagnose a potential issue and find services to help.