WHY ARE GIRLS MISDIAGNOSED? LITTLE MISS, DIAGNOSED!

     Does your daughter have tantrums? Do those tantrums seem to be more than a tantrum? We call that a meltdown.
How about friends? Does she seem to struggle with friendships? Maybe she claims she would rather be alone?
     If your child cannot pull herself together, or is maddeningly defiant, or can’t move on to the next thing (get ready for school, do homework, put down the tablet), or she chronically struggles with her relationships with others, then maybe there is more to the story. ​

     Maybe these ‘behaviors’ are becoming a problem and interfering with daily life? Or others tell you she needs more discipline, or a rewards chart to help her understand what’s expected, but when you try these things, the problems only get worse.
     You know something isn’t quite right, but when you look for help they tell you she has a ‘behavioral problem’, or worse, they explain it all away with a mental illness diagnosis such as Bipolar or schizophrenic (which is so unlikely that there is no criteria for anyone under the age of 12 to have these diagnosis according to the DSM5, so if your child has been so diagnosed, get a second opinion quick).
      According to the National Autistic Society (UK) in 2015 1/5 of women with Asperger’s/HFA were not diagnosed until age 11 (boys on the other hand were diagnosed on average by age 7). The numbers are even more skewed as we go back just one decade when only one in 3500 diagnosis of ASD/Asperger’s were given to females, and if you go back further, there are many who thought it didn’t exist in females at all. 
       Also, missing from these diagnosis are anxiety, phobias and attachment issues, all of which, if misdiagnosed or ignored, can result in behavior problems. 
     This is in direct contradiction to the fact that girls often display signs of Social Emotional Delay, and Sensory Processing, such as extreme discomfort in certain clothes, aversion to bright lights and covering their ears at loud sounds, and difficulty with integrated play at a very young age, often as early as infancy.
     The same is true for gifted girls who are often missed because the nature of all gifted individuals is asynchronistic development. Which basically means their intelligence is more developed then their social/emotional understanding. This asynchrony creates (debilitating) anxiety. As a result, these girls are diagnosed with an anxiety disorder, while completely missing the gifted diagnosis!
Anxiety, especially in kids, often manifests in behavioral problems, sometimes severe behavioral problems. Instead… they will give her a diagnosis of ODD (Oppositional Defiant Disorder), which according to the DSM5 is not technically a diagnosis, it’s a label used when the cause of the behavior has not yet been determined (usually severe, chronic anxiety caused by a neurological difference like HFA/Asperger’s, ADHD, Gifted or Learning Disability such as dyslexia or Auditory Processing). This all leads to the path of mental illness diagnosis, which often actually backs a kid into a mental health crisis because the basic needs and lagging skills have not yet been addressed.
An excellent book on discovering those basic needs and lagging skills is The Explosive Child, The: A New Approach For Understanding And Parenting Easily Frustrated, Chronically Inflexible Children
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     So, the real question is why don’t girls get a proper diagnosis, or worse, why are they missed, or misdiagnosed so easily?
     There are three main reasons:
 1. There is still a stereotyped view for most diagnosis.  For instance the criteria for Asperger’s/HFA (High Functioning Autism), is based entirely on how boys present with the condition. How many parents have heard “She can’t have Asperger’s/HFA because she makes eye contact”, or “because she smiled”. But we know that girls make more eye contact and are more expressive than boys in general. Thus it makes sense that they will also be this way when compared to their male spectrum peers. In addition to being naturally more social, girls also do more of something called MASKING. Masking is when girls imitate, and act like other girls while hiding their lack of social/emotional skills and awareness. Girls watch closely and “pretend” to be like other, usually more popular girls. In adolescence they often imitate young celebrities and pop stars. A Bristol University study revealed that both boys and girls who were previously identified as having autistic traits, were equally likely to make errors when identifying sad and scared faces, and more likely to mistakenly recognize faces as happy. However, when they looked at both genders separately, girls were much better at recognizing emotions in general. This revelation shows, once again, girls are often better at masking signs in typical social situations.

2.  YOU don’t want to believe that your daughter is… Autistic, ADHD, or has a Learning Disability, has severe anxiety… or all of these! Phycologist will tell you that the biggest obstacle in getting children the help they need is getting the parents to accept that there is a problem in the first place, that it is real, and it is X, Y or Z. You can’t solve a problem you refuse to acknowledge exist. But we can’t just blame the parents. Teachers and other school administrators are way behind in their awareness of how girls present and they are quick to write off behaviors and attitudes as being anything but a plain and simple discipline problem. 
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 3. The bottom line is that professionals are  still behind in their knowledge about diagnosing girls in general, and to make matters worse it is still true that most of the research on  Autism, ADHD, Processing Disorders, Learning disabilities and Giftedness has been done on boys! 
     
     This is a much under-investigated but vitally important issue, but who will address it?

     Dr. Tony Attwood, founder of the first diagnostic and treatment clinic for children and adults with Asperger’s, and author of The Complete Guide to Asperger’s Syndrome written back in 1984 says “The bottom line is that we STILL understand far too little about girls because we diagnose based on a male conceptualization of the condition. We need a complete paradigm shift”.

     He’s right. All of the research on Asperger’s/HFA was done on boys. All of it!!

You can read more about Dr. Tony Attwood and his research in his book Asperger’s and Girls: World-Renowned Experts Join Those with Asperger’s Syndrome to Resolve Issues That Girls and Women Face Every Day!
    Most of the research for ADHD and Giftedness was done on boys.
    Let that sink in.
     Girls communicate, make eye contact and play differently in general, so why wouldn’t they display symptoms differently?
     We need to draw up a female version of diagnosis that identifies girls on the basis of the way they present, and we need to do this as a matter of urgency. Undiagnosed Giftedness, ADHD, Learning Disabilities or Asperger’s/HFA can create devastatingly low self-esteem in girls, not to mention it can undermine relational success (the largest determining factor in lifetime happiness).
     Girls slip through the diagnostic net because they are so good at camouflaging or masking their symptoms.
      Just fade into the background and maybe no one will notice how much you suffer?
     We used to believe that only boys go into attack mode when frustrated, while girls would suffer in silence and become passive-aggressive.
    Although, girls learn to appease and apologize more often than boys, we are starting to see a trend of girls acting out behaviorally. Even though girls often learn to observe people from a distance and imitate them, they can only do this for so long. It is only if you look closely and ask the right questions, you see the terror in their eyes and see that their reactions are a learnt script.
     Treating these girls as behavior problems, not only misses the point, it leaves them misdiagnosed, and often leads them in other mental health struggles.

     Common missed diagnoses to consider:
     Asperger’s’/HFA
     Giftedness
     ADHD
     Learning Disabilities (Dyslexia, Dysgraphia, Dyscalculia)
     Processing Disorders
      Anxiety Disorders 
      Attachment Issues (common in adoption and step parenting)
     Keep in mind, that if you, the parent or caregiver have any of these diagnosis (male or female), the your child will likely fit the same diagnosis. These are often missed in spite of showing early signs in childhood and pre adolescence because girls are not the subject of studies and they are excellent at masking.
     Masking is a common female way of coping, and we must find a way to see through the masking so we can help these girls reach their true potential.
     If you suspect your little Miss has been miss-diagnosed, do the research yourself.
     There are women out there who are speaking out on behalf of the missed, lost and forgotten girls.
​     Don’t accept the answer that doesn’t fit.
     Little Miss-Diagnosed needs you to advocate for her.
     She’s there… behind the mask.

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