How Autism Differs in Boys vs. Girls

Autism Spectrum Disorder, better known as Autism, is a very complex neurodevelopmental disorder that affects cognitive and executive functioning. To find out more about Autism itself, visit this page for a simplified look. Autism has been studied more and more throughout the years, and an interesting area of study has been looking at the difference between boys/males with Autism vs. girls/females. It has been suggested that Autism is diagnosed 4 times more often in males versus females (Autism Speaks, 2020), but, why? Within the research, we have determined how signs and symptoms can look different, along with how males and females may internalize Autism differently. Although there may be some differences between males and females, it is important to remember that Autism presents uniquely in every individual, regardless of sex or gender. This blog will take a look at how different components of Autism have been proposed to differ between gender populations. 

Why are boys diagnosed 4X more often than girls?

It has been suggested throughout the literature that Autism is more heavily studied in boys rather than girls. Consequently, there are a few theories as to why females present significantly lower rates of Autism than males. One theory has to do with differing levels of hormones in the body and biological sex differences. This theory ultimately suggests that females with Autism may not be diagnosed as often because they present milder symptoms due to hormone variation (Soloman, Miller, Taylor, Hinshaw & Carter, 2012). Additionally, another theory emphasizes that some girls may in fact be more impaired than boys with Autism. This theory explains that girls may either require a higher genetic or environmental load to be affected, or that males present higher rates of less severe Autism symptoms (Soloman et al., 2012). Both of these theories have been supported through journal articles, however it still remains unclear exactly why males are diagnosed more frequently than females.

How does ASD differ between males and females?

A famous quote from Stephen Shore details, “if you have met one person with Autism, you have met one person with Autism”. This amazing quote outlines how broad the spectrum is, and how every single individual has their own strengths and areas of need. Keeping this quote in mind, we know how unique each child with Autism is, but is it common for Autism to present differently in boys versus girls? Many studies have suggested sex differences for displaying characteristics of Autism, such as boys exhitbiting higher levels of repetitive behaviours and stereotypical play (Soloman et al., 2012). Girls, on the other hand, have been suggested to be at an increased risk for internalizing their symptoms (Soloman et al., 2012), meaning they keep their feelings inside their mind rather than expressing it with behaviours. Unfortunately, there are considerable gaps in the literature that fully determine significant differences between males and females with Autism. This is most definitely a topic for further research, and it will be interesting to see what is to come. 

References

Autism Statistics and Facts. (n.d.). Retrieved April 7, 2020, from http://www.autismspeaks.org/autism-statistics 

Solomon, M., Miller, M., Taylor, S., Hinshaw, S., & Carter, C. (2012). Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(1), 48–59.

Behaviour as Communication

The way that humans behave with each other often has communicative properties, even when they aren’t speaking. Even when humans are speaking, most of what they say to each other is non-verbal (tone, expression, etc.). In other words, we use our behaviour to ask others to help us with things we can’t do alone or by ourselves. 

Think of it this way. What could an infant having a tantrum in a store be communicating? It could be that they are hungry. It could be that they are ready to leave. It could even be that they don’t feel well and need comfort from someone else. This leads to one of the hard things about communicating, which is; others don’t always hear what we are trying to say.

What Are You Trying to Tell Me?

How can we tell what someone is trying to say if they can’t speak? Really, it isn’t very different from speaking, but it can be a lot harder to “hear” when others don’t speak. One trick is to look at the response that stops a person’s behaviour. 

That can be a bit confusing so let’s look at an example with speech. With typical, spoken communication, if someone calls your name and you respond, the person tends to stop calling your name, because you responded. Imagine if someone called your name and you didn’t respond. What might happen? The person might call your name more loudly, they may get nearer to you, and they may try to get your eye contact. If any of those other behaviours gets your attention, they will probably stop.

Let’s look at the same situation without speech. If someone starts to stomp and grunt they may be trying to get your attention. If you don’t respond, they may grunt and stomp more loudly, or they may get closer to you. They may try tapping you or grabbing you. If you finally look at the person and say, “What do you need?” and they stop, then they were probably trying to get your attention.

Let’s look at one more example without speech. You are talking to a friend and the person you are with starts to fidget and grab at your phone. If you just keep talking, they may become louder, more insistent, or just walk off. They probably aren’t trying to bug you, they may be bored or looking for something to do while you  talk.

A Very Brief Look at Functions

The trick to understanding what people are “saying” with their behaviour is to find out what the person is trying to get with their behaviour, what those in ABA call a “function”. In ABA, we look at what happens right after a behaviour to figure out why the behaviour happened. People have complex needs but they can all be fit into 4 broad categories of needs (or functions) and if one of these happens right after a behaviour, it might be why the behaviour happened. First, let's look at the things that can happen after a behaviour;

Accessing Items or Activities

The person is able to access something they can feel, eat, or use. An example is buying movie tickets so that you can access the activity of watching a movie. 

Accessing Social Attention

The person does something so that other people will engage with them. An example is telling a funny story or calling an old friend to chat.

Accessing a Sensation

The person does something because of the sensation it produces. An example is clicking a pen, tapping a foot, or twirling your hair

Escaping Something Unpleasant

The person does something to get out of, or avoid, something unpleasant to them. An example of this is driving the speed limit and following all traffic laws so that you do not get a ticket, which is unpleasant

When Words Fail Us

People we encounter do not always have the skills needed to communicate their needs. A person like this cannot tell you that they need to eat, or that they want some attention, or that they need help to do an activity they enjoy. So how do people that don’t speak learn to communicate? If there is no plan what often happens in cases like this is that the person does something (yells, cries, stomps, etc.) that ends with a need being met, so they become more likely to do the same thing again the next time they have that need. 

It can be confusing so here is an example. A child that cannot speak begins to stamp their foot and grunt loudly while standing in the kitchen. Their mother comes over and says “it’s okay, what is wrong?”, but the person can’t respond so they keep stomping and grunting, maybe even getting louder or more intense. The mother wants to stop the grunting and stomping so she gives the child some food and comfort. If the child was hungry, or wanted attention they would likely stop grunting and stomping when their mother gave them food and comfort, but they will be more likely to stand in the kitchen and stomp and grunt the next time they are hungry or want attention. 

So What Now?

So what do you do about it? Knowing what a person is trying to get, or “say” with their behaviour lets you make sure they get it only for doing what you want. Let’s look at it practically with our prior example. Since we see that the child grunting and stomping their feet results in food and attention, we can make a plan to teach the child how to ask for food and attention first thing in the morning and before meal times. 

This can look a lot of ways. You could have a small packet in the kitchen filled with pictures of different food items that the child can select and bring to you. You could teach the child sign language for “food” and “hug”. You could even teach the child to come and tap your arm a certain number of times to indicate food. The idea is to find out what the person wants and then teach them to ask for it in a way that they can easily do. 

Hopefully this article will give you some ideas about communication and some strategies for figuring out what others are trying to tell you. Look at what happens right after a behaviour for help in figuring out why it happens and remember that knowledge is power; the more you know about a person, their strengths, weakness, likes and dislikes, the better you can help them. 

ABA: Why the Controversy?

ABA wasn’t established as a field until 1968, much later than similar fields like medicine that have been around in some form for thousands of years. ABA has since been scientifically validated to be an effective treatment for those diagnosed with autism and its related disorders (Simmons, D., 1995). Due in part to its effectiveness in treating those with autism, news and media make it seem as though those in the ABA field can only work with individuals with autism. however; those trained in ABA have successfully worked in many different fields and on many different behaviours. Here are just some of the things that ABA has been used for;

• Reduction/cessation of smoking

• Eating Disorders

• Criminal Forensics

• Animal Training

• Training Athletes 

  • Gymnasts

  • Footballers

  • Ballet Dancers

• Addressing Addiction

• Business

So why the controversy? Beginning in the late 1960’s the field of ABA was just being established and it looked very different. While we know today that ABA is a safe and effective therapy for many behaviours, early practitioners had no guide on how to apply the principles they learned about behaviour to improving people’s lives. The use of behaviour principles in therapy was called “behaviour management” and early practitioners and programs relied too heavily on punishment strategies (meaning consequences that reduce a behaviour) due to their immediate results on reducing unwanted behaviours. Common punishers in those days included very loud noises, electric shocks, and water or food being withheld. As the field has grown so has our understanding of the principles of behaviour.

What About Punishment?

Early ABA practitioners used punishment strategies because they worked rapidly to reduce problem behaviours, so what was the problem? The problem was that they didn’t teach their client what to do instead. What often happened was a circle where a behaviour (like biting one’s self) was punished and would cease, only to be replaced by another, more intense behaviour (like banging one’s head on the floor. By the 1980’s the heavy use of punishment had reduced drastically and the field shifted toward a focus on what really changes behaviour, motivation. For a more in depth look at punishment check out our article on punishment and negative reinforcement. 

Moving Toward Rewards and Motivation

Practitioners applying new research from the field of ABA found that using rewards for appropriate behaviour was vastly more effective at creating and changing behaviour. This shift was reflected in the field of ABA as a whole as therapists and practitioners prioritized rewarding clients for appropriate behaviour while making sure that inappropriate behaviour was simply not rewarded, rather than punished. 

Is ABA Too Tough on Kids?

In the 1960’s there was a push to provide services at 40 hours per week for every client. This is no longer the norm and, while some research has shown that such high intensity of services is effective for some clients, most of those in ABA services today tend to receive from 10 to 30 hours per week of behavioural services, depending on personal need.

Research has demonstrated that humans, especially children, tend to learn best during play (Zosh et al, 2017) and ABA practitioners are typically trained to make services feel like play. ABA also focuses on training those providing direct services to be as animated and energetic as possible, so that services feel light and fun.

As an example; if I am working with a child on making eye-contact when spoken to and following directions I might tell the child that we are going to play a game of soldiers. I would let the child know that before we start the game I need to know they are listening and looking at me. The game of following directions as a soldier gives me the opportunity to have my client practice all of the directions they need to know and have fun doing it. As the client gets better and better at the game, we can start to practice in more serious ways and I can describe why it is important to follow directions by using statements like,  “Stopping when we hear the word “stop” helps keep us safe and healthy”.  

Is ABA Only For Problem Behaviours?

Some see ABA as a treatment only for “problem behaviour”; things like hitting, screaming, and running away. This is mainly due to “a few bad apples spoiling a batch”. Some practitioners fail to account for teaching their clients new, appropriate behaviours to replace the ones that were not safe or effective. This leads into a treatment cycle where the therapist is able to reduce an unwanted behavior, only to have another rise in its place. At Cayman ABA we have a 1:1 rule which is; if you are going to reduce a problem behaviour (tantruming for a cookie), you have to increase, or teach, an appropriate behaviour also (asking politely for the cookie).

Most ABA practitioners today use the science of ABA not only to reduce behaviour for their clients, but to teach all sorts of skills, from tying shoes and stating maths facts, to learning about sarcasm and how to change your tone when telling a joke. At Cayman ABA we tailor our interventions to our clients as individuals and typically have many more programs teaching or increasing a behaviour than we have for decreasing a behaviour.

Additionally, many in the field of ABA apply its principles not just for their clients, but for themselves. I used the principles of ABA to study for an important test and had a colleague use it to increase their exercise per week. ONce you know how effective rewards and motivation can be, it becomes the way you view the world. Want to increase a behaviour of your own, like studying or responding to emails? Start rewarding yourself when you study, or when you respond to an email right away.

A Message of Hope

The initial stated mission of the science of behaviour analysis was to save the world through the knowledge that the scientific study of behaviour brings. At Cayman ABA we realize that we probably can’t change the world, but we can teach kids the skills they need to thrive in the world and we can help families feel like they are not alone.

References

Simmons, D.A. The NAAEE Standards Project: Papers on the Development of Environmental Education Standards; North American Association for Environmental Education: Troy, OH, USA, 1995. [Google Scholar]

Zosh, J.M., Hopkins, E. J., Jensen, H., Liu, C., Neale, D., Hirsh-Pasek, K., Solis L.S., & Whitebread, D. (2017). Learning through play: a review of the evidence.Demark: LEGO Foundation