Autism and Gender: Diagnosis and Residential Treatment

January 21, 2020

Contrary to popular belief, autism is not a single diagnosed disorder, but a spectrum of closely related disorders. These disorders share a specific core set of symptoms. This is where the phrase “autism spectrum disorder” or the statement a child who is “on the spectrum” tends to rise from.

Every individual who is diagnosed as being on the spectrum will show, at varying degrees, certain specific symptoms including problems with social interaction, difficulty showing empathy, challenges with communication, and issues with being flexible in their behavior. What is different from person to person is the level of disability and how the symptoms impact the person as an individual.

As a parent whose child has been diagnosed with an autism spectrum disorder, you may find all of the terminology confusing. Not only are there several different ways to describe the varying diagnoses; high-functioning autism, atypical autism, autism spectrum disorder, pervasive developmental disorder, etc., but doctors, therapists, counselors, and other parents may use or apply them differently.

Below we have highlighted important information about understanding an autism diagnosis, what the diagnoses mean, how a child is diagnosed, how the diagnoses differ based on gender, and how residential treatment programs can help children of all ages manage their symptoms.

Understanding Autism

How people look at and consider an autism diagnosis has changed significantly since the first diagnosis more than 75 years ago.

First diagnosed in 1943, the criteria for diagnoses and, consequently, the number of children diagnosed each year has increased over time. Autism was not classified by the DSM (the Diagnostic and Statistical Manual of Mental Disorders) until 1980.

Again, the definition of autism has increased to consider additional diagnostic criteria and allow for a broader spectrum of symptoms to be included. In the current edition of the DSM, the DSM-5 identifies various diagnostic criteria for autism. A child must present with a specific number of symptoms from three distinct categories of symptoms. It sounds a little confusing, so here is a highly simplified explanation. The full DSM criteria can be found here.  The diagnostic criteria are quoted from the DSM-5 courtesy of the Interactive Autism Network.

From category A, a child must present with six or more items.  Category A includes:

  • Symptoms or observable limitations in communication and social interaction. These are further described as
  • “Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.”
  • “Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.”
  • “Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.”
  • Limited, restricted, or repetitive patterns of behavior, interests, or activities. This category is further defined by the following four categories of symptom presentation.
  • “Stereotyped or repetitive motor movements, use of objects, or speech.”
  • “Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior.”
  • “Highly restricted, fixated interests that are abnormal in intensity or focus.”
  • “Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment.”

For an autism diagnosis to be made, again, the child must present with a specific number of the above symptoms, and these symptoms must present themselves early in the child’s developmental period. This means the symptoms will often present before the child reaches the age of three, but they may not manifest entirely until the child is older and faced with increasing social demands such as school or daycare. The symptoms must cause significant impairment in functioning for the child in social or other areas of current functioning.

How the Autism diagnosis process works

Up until the 1980’s, many people, children included, who were diagnosed with autism, were placed in institutions. This is not the case today, as awareness of autism and its associated challenges has increased across healthcare and educational settings. Unfortunately, the process of “getting” an autism diagnosis is not without its problems. It can be difficult and time-consuming; often taking more than two years from the time symptoms are noticed until an official diagnosis is made.

Unfortunately, unlike some other mental health conditions, there is no simple, single test that can determine the presence of or lack of autism symptoms. To determine if the symptoms your child is presenting with are indeed autism and not another form of developmental disorder, your clinician will look at several things. First, they will look at how your child plays and interacts, how your child communicates and behaves, and how your child responds to various stimuli. There are also several pieces to the evaluation process.

The parent interview – As the parent, you are the first line of information for the clinician: you, more than anyone, know what your child is experiencing and how their symptoms are presenting. You are also the most aware of how your child’s symptoms are impacting their day to day interactions and development.

During the phase, you will provide the clinician with relevant background information about your child. This information will include things such as medical, developmental, and behavioral history. Your doctor will also want to know about the medical and mental health history of your family or other children in the home. If you have been keeping notes about your child’s symptoms, this would be the time to share them so your clinician can get a better idea of what your child is experiencing.

Medical exam – Developmental delays can come from a variety of sources. A thorough medical evaluation, including a physical, lab testing, genetic testing, and a neurological exam will be conducted to determine if something other than autism could be causing the symptoms your child is experiencing. This exam can also help to rule out or identify the existence of any other co-existing conditions which could hinder treatment for your child.

Hearing test – The hallmark symptoms of autism relate to social and communication disorders, including language and speech delays. These same symptoms can present in a child experiencing hearing problems. Consequently, problems with hearing or hearing loss need to be ruled out before your clinician can continue to work towards an Autism Spectrum Disorder diagnosis.

Observation – Specialists who are experienced with the “typical” development patterns of children will observe your child in several different settings. During this process, they will watch how your child plays both on their own and with other people. They will also monitor how your child communicates and interacts with others. The developmental specialist will watch for specific behavior patterns that are associated with Autism Spectrum Disorder

Lead screening – The symptoms of lead poisoning in children can include developmental delays, learning difficulties, and irritability, among others.  These symptoms are nearly the same as those a child with autism will experience.

For this reason, it is recommended that lead poisoning be ruled out during the diagnostic process. This is especially important because if the child is indeed experiencing symptoms associated with lead poisoning as opposed to autism, these can be fatal if not adequately addressed.  A lead screening is valuable for eliminating this potential alternate condition.

Several other tests may be conducted depending on the results of the ones above. The symptoms your child is experiencing and the severity of those symptoms will dictate which ones and if they are needed. These tests can be beneficial for both the process of diagnosis and determining what type of treatment could be the most helpful for your child. These tests include:

Speech and language evaluation – A trained speech and language pathologist or SLP with evaluate your child’s speech and communication abilities. They will look not only for signs of autism but for other language impairments or disorders that could be occurring in addition to or as opposed to autism.

Cognitive testing – Your clinician may suggest or order a standardized intelligence test or a cognitive assessment. The information derived from this test can help to determine the extent to which your child is experiencing cognitive or developmental delays. This test may also help to rule out autism if it shows a lack of specific hallmark indicators of the disorder.

Adaptive functioning assessment – Challenges with functioning, problem-solving, and adaptation to social or life situations are part of an autism diagnosis. A test of your child’s functioning can help clinicians to observe your child’s skills in the areas of social interaction, nonverbal, and verbal communication along with daily life tasks such as dressing and feeding.

Sensory-motor evaluation – Sensory dysfunction is often a co-occurring disorder with autism. Sometimes, children will present with sensory dysfunction and be misdiagnosed with autism or vice-versa. A physical therapist or occupational therapist may wish to meet, observe, or work with your child to determine their level of ability with fine and gross motor skills as well as sensory processing abilities.

How the Autism diagnosis differs based on gender

Currently, the CDC estimates that approximately 1 in 68 children in the United States have autism.

Further, they estimate the prevalence of the disorder in boys is around 1 in 42. This rate is quite high if you consider the estimate for girls is 1 in 189. The skewed ratio in the number of boys diagnosed has been present since the 1940’s when the first autism cases were diagnosed. There are a variety of reasons for the gap in the ratio.

The first important factor to consider may be a simple diagnostic bias. Many studies point to diagnoses for girls at later stages in life and boys earlier on, which skews the number for younger children. This could also mean that symptoms are harder to spot in girls than in boys. Autism is also frequently viewed as a “boys’ condition,” so it may often be overlooked in girls. The behavior of girls often masks what are looked at as typical symptoms of autism. For instance, girls may have fewer repetitive behaviors or more socially acceptable interests. Girls are also more likely to imitate or copy their peers who may not display autism symptoms. These reasons can make autism challenging to notice in girls.

Another factor to consider is biology. Studies show the brains of people with autism show gene expression patterns that look more like those of a typical male than an average female. This could lead to missed diagnoses for girls as they do not “present” differently than their peers during assessments.

How studies are conducted is another consideration. Many autism studies include more boys than girls in their sample groups. As a result, the exact differences in gender presentation are not as well known as they should be; or need to be. Failure to diagnose or misdiagnosing a female child means they do not receive early intervention treatments that could be hugely beneficial. Also, failure to understand the differences in how boys and girls present with autism symptoms means many of the standard interventions may not be appropriate for girls.

How residential treatment programs can help Autistic children of all ages manage their symptoms

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Regardless of gender, if you believe your child is exhibiting symptoms that could be autism, it is important to talk to your clinician and start the assessment process. The earlier a diagnosis is made, the earlier treatment can begin, and your child can learn how to function to their peak potential regardless of their diagnosis. One of the biggest challenges for children with autism is the ability to communicate effectively. This often leads to frustration as they try to work their way through the challenges, friendships, and relationships thrust upon them in academic and social settings. Eventually, when a child or teen with autism feels they cannot communicate effectively, it can lead to behavior that is often misinterpreted as aggression. It can also lead to other behaviors such as self-harm or suicidal thoughts as the child or teen feels more and more isolated.

In a residential treatment setting such as Hillcrest, we will work with your child to learn other ways to communicate effectively. Focusing on non-verbal communication, such as letter writing or similar can help your child learn to communicate their needs through a medium where they can feel successful.

Your child will also have the assistance of a team of medical providers and counselors available to help them learn to identify their triggers and work with, not against, their needs so they can practice and experience positive social interaction and communication behaviors. As your child completes treatment, we will also work with other members of the family to ensure a successful transition home.

Here at Hillcrest, we have many years of experience working with children of all ages who are experiencing mental health challenges; perhaps we can help your family. Why not reach out for a callback or to set up a tour? Let us show you what we can do for you.