NORFOLK, Va. (WVEC) -- Every day in America, about 100 people are diagnosed with autism spectrum disorder. Boys are diagnosed about four times more than girls, suggesting there might be a gender gap in the diagnosis process.
One of those girls is 4-year-old Holly who, like any child, is playful, smart, and social.
“She has a lot of interests like ballet. She likes to play outside,” said Holly’s mom, Jennifer Malia.
If you watch Holly's interactions closely, however, you’ll find something different about her.
“She was having some language difficulties. That was kind of the first thing that I noticed,” said Malia, who told 13News Now that Holly has other challenges. Malia said Holly had meltdowns every 45 minutes that included screaming and crying. Holly did not like changes in routines.
Malia said she spotted the signs two years ago.
”She put together hundred piece puzzles when she was two years old,” Malia explained. “When I started taking her to doctor’s appointments, a lot of them, they acknowledged that, yes, she seemed to have a language delay, but there were a lot of other behaviors going on that led me to believe there was something else.”
Malia suspected her daughter had autism but found it tough to get a doctor to agree.
“What I had to do was find a clinical psychologist who was aware of the gender differences with autism,” said Malia.
Research shows girls with autism are good at mimicking behavior. They want to socialize and usually have less repetitive behavior than boys with autism. Regardless of gender, children with autism tend to feel overwhelmed by group activities and stay away from socializing with kids their own age.
Children's Hospital of The King's Daughters (CHKD) developmental pediatrician Dr. Amy Newmyer said without extreme disabilities, autism is tough to diagnose.
“I think even in the medical community people think about autism spectrum disorder more related to boys than girls,” stated Newymer. She said, “It’s a challenge, because when you look at the diagnostic criteria that we all learn and everyone’s using, when they’re evaluating children with autism, they’re mainly based on studies of boys.”
CHKD clinical psychologist Dr. Janice Keener said girls can camouflage their symptoms easily.
“I worry about these little girls that are just like: 'Oh, look. They’re so good. They’re so quiet.' I actually don’t like hearing that,” said Keener.
Boys with autism tend to be shy which most people see as unusual behavior in boys. They see the same shyness in girls as ordinary, feeding a stereotype about girls.
Keener said misperceptions are leading to misdiagnosis.
“You might have a girl who you think is typically developing and she seems to be okay socially,” said Keener.
Sometimes autism in girls is mislabeled as another issue such as anorexia or obsessive-compulsive disorder (OCD).
“Half the girls who end up being diagnosed have been overlooked and given A.D.H.D or anxiety," said Keener, referring to some misdiagnoses.
Keener also said it takes someone outside the hospital noticing the disorder first, explaining, "Unless you really get in there and start asking these probing questions that we typically don’t in a clinical setting or in a school setting, really.”
Girls and Autism
Malia trusted her feelings as a 39-year-old mom, Norfolk State University English teacher, and journalist. She said, “I started writing for Glamour. I wrote a piece for New York Times, the Washington Post, New York Magazine.”
During her research to diagnose Holly, Malia found out something else.
“That led me to realize that not only was she autistic, but I was autistic, too," said Malia. “Describes a lot of what I did through my life. I was very studious, as a child though I was selectively mute,” said Malia.
Her diagnosis hasn’t held her back, and she believes research on autism in females eventually will catch up.
Malia said, “There does need to be a lot more awareness and acceptance of autism and the wide spectrum that it includes.”
Mallia plans to write a memoir about living with autism in the form of a children’s book.
Pediatricians at CHKD said the ratio of diagnosing girls to boys will not break even; however, new studies show diagnostic rates for girls are increasing.