On Tuesday, Dr. Paul Lipkin, director of medical informatics at Kennedy Krieger Institute in Baltimore, presented new findings on nearly 10,000 children with autism, using data from the Interactive Autism Network registry. On average, boys were diagnosed with Asperger's syndrome, an autism spectrum disorder, at about 7.1 years old, while girls were diagnosed at 7.6 years. Digging deeper, the researchers also compared types of symptoms for about 5,100 of these children. Girls were more likely to have problems with social cognition -- the ability to recognize and interpret social cues, says Lipkin, the director of IAN. What other kids learn by experience doesn't come as naturally to them. Boys were more likely to exhibit obvious mannerisms, such as hand flapping and other repetitive behaviors, and to have narrowly restricted interests. Autism is much more common in boys. In the IAN registry, the ratio of enrolled boys to girls was about 4.5 to 1. The gender gap only held for higher-functioning children, with a slightly narrower gap for pervasive developmental disorder, a moderate diagnosis on the autism spectrum. However, "in those with frank autistic disorder, there was no difference in age of diagnosis" Lipkin says. "Those children's problems are quite overt and easily recognizable, even to the general public. So when girls are having those severe problems, they probably aren't looking much different than the boys." The new findings come as no surprise to clinical psychologist Shana Nichols, owner of the Aspire Center for Learning and Development in Melville, New York. Nichols says many girls arrive at the Center between ages 10 and 12. Until then, they've been able to get by with their peers. But even earlier, she says, "parents often say they've noticed their daughters aren't quite as attuned to the social nuances -- although they're good at faking it." By sharing common activities and nodding and smiling during conversations, girls with autism may look like they're participating well, Nichols says. But in reality, she continues, there's "a more surface-level, almost an intellectual understanding of the social interaction." Amy Keefer, a clinical psychologist with Kennedy Krieger's Center for Autism and Related Disorders, starts seeing patients around age 8. With autism, she says, "boys' interests tend to stand out more." For example, boys may have a deep fascination with city sewer systems, while girls may be really into the movie "Frozen." Intense focus on their area of interest is what sets girls with autism apart, Nichols says. Being a girl who "really, really loves horses" is not the same as "being a girl who really loves horses and also knows a million different facts about all the different breeds, and that becomes an exclusive interest." Keefer says when kids with autism play with others, it's different. "Maybe the girl tells her friends what to do," she says. "It has to fit her rules and be exactly her way."
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