Autism in children is more and more frequently detected. Why boys are more affected and the warning signs
The number of children diagnosed with autism spectrum disorder is increasing, amid expanded screening and closer monitoring of development from the earliest years of life. At the same time, statistics consistently show that boys receive this diagnosis several times more often than girls. The connection between the two realities is not accidental: the way the signs of autism are defined and looked for influences both how many children end up being diagnosed and why boys appear more frequently in the statistics.
In recent decades, autism spectrum disorder (ASD) has become increasingly visible in child health, with increasing diagnosis rates in many countries, including Romania. This increase does not necessarily signify an autism “epidemic,” but rather a health and education system more attentive to early signs of atypical development and better structured toward early intervention.
Why are more and more children being identified as autistic?
Beyond increased awareness among families and expanded pediatric screening, part of the increase in diagnoses can also be explained by changes in diagnostic criteria. Over the past two decades, the definition of autism spectrum disorder has been broadened, and subtypes that were previously diagnosed separately—such as Asperger syndrome or pervasive developmental disorder not otherwise specified—have been integrated into a single spectrum.
The researchers also talk about the phenomenon of “diagnostic substitution”, i.e. the situation in which children who in the past would have received other labels (for example, global developmental delay or certain communication disorders) are today included in the autistic spectrum, based on better defined criteria.
It is important to note that learning disability itself was not “included” in the spectrum, but the overlaps between language, communication and social functioning difficulties led to the re-evaluation of some cases that, in the past, received other diagnoses. This recalibration of criteria contributes to the apparent increase in prevalence without necessarily implying that the biological incidence of autism has increased to the same extent.
Official data from the US Centers for Disease Control and Prevention estimates that approximately 1 in 31 8-year-olds will be diagnosed with autism in 2022 – an increase from 1 in 36 in 2020. In the same report, autism is reported to be more than 3.4 times more common in boys than girls. On average, 1 in 27 boys are diagnosed compared to 1 in 116 girls.
Why are more boys diagnosed than girls?
There are several explanations for this discrepancy. Part of the difference lies in how the signs of autism manifest in each gender. Boys tend to display autistic behaviors – such as repetition of actions, highly focused interests, or obvious difficulties in social communication – in a manner that is more visible and easily recognized by parents and professionals.
In contrast, girls may exhibit autistic characteristics in a more subtle or less stereotypical way. For example, they may have intense interests that seem socially acceptable for their age and may learn to imitate the behaviors of peers so that interaction difficulties are less apparent at first glance. This social adaptability can cause signs to be noticed later or interpreted differently.
An analysis of more than 2.7 million people born in Sweden between 1985 and 2020, published in The BMJshows that although boys are diagnosed with autism 3-4 times more often than girls in childhood, this difference narrows significantly by the age of 20, when the proportions diagnosed are almost equal.
The difference between boys and girls in the current statistics does not necessarily mean that autism is biologically three times more common in boys. Part of this discrepancy may reflect the way screening tools are constructed, the way children's behaviors are interpreted, and different social expectations of girls and boys. As the criteria become more nuanced and professionals are more attentive to the less visible forms of the manifestation, it is possible that the differences in the statistics will decrease. The increase in diagnoses shows, however, that medical and educational systems are identifying children who need support earlier, which can make a difference in their long-term development.
Signs parents should watch for
As a rule, the early signs of autism spectrum disorders appear in the first two years of life. The lack of direct visual contact with other people, the lack of reaction to the parent's voice, to his presence, to environmental stimuli and the absence of crying are just some of the early signs of autism. Some children have many early signs of autism, while others only a few. Early diagnosis and initiation of recovery therapies are very important, experts warn.
Therefore, the following manifestations should be observed:
- avoiding eye contact,
- lack of response when called by name,
- they don't smile when they are smiled at
- get very upset when they don't like a certain smell, taste or sound,
- have repetitive movements,
- I don't talk as much as other children,
- no imaginative games are played,
- repeats the same sentences and phrases very often.
Older children do not seem to understand what others are thinking or feeling, they speak in an unusual way, imitating others, they have a strict daily routine and get nervous when it is not followed, they have an increased interest in certain activities and subjects, they get angry when they are asked to do something, they prefer to be alone than in the company of other children, it is difficult for them to say what they feel.
Autism spectrum disorders are lifelong and have a significant impact on the lives of children and their families. Early diagnosis, made with the help of a psychiatrist specializing in child care, and the initiation of intensive therapies can lead to good long-term results.
