'Underdiagnosed' Girls With Autism Struggle to Fit In

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At first glance, 8-year-old Kaede Sakai is a typical first grader. She's a smart student, and most of the time she is kind and cordial in class. But recess is an exercise in frustration for her because no matter how hard she tries to fit in, she just doesn't click with the other kids.

It's heartbreaking to see, especially for her mom.

"[She's] been very sad lately, because a lot of the kids have their play as a set group," said her mother, Kristi Sakai.

There's something about how Kaede approaches play that turns off a lot of kids. "She's inflexible and has difficulty engaging properly with other peers," said her mom. "She needs them to do things her way, period. And kids aren't able to do that."

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And while Kaede might appear like nothing more than a little girl having a bad day, it takes someone who has seen a lot of autistic children to recognize that Kaede has autism.

Brenda Myles, one of the lead researchers specializing in the quite narrow field of girls with autism, said autism can be more difficult to detect in girls.

Difficulty of Diagnosis

"Almost all the research is on boys," said Myles. "Well, first of all there are more boys than girls with autism spectrum disorders, but second of all, girls are underdiagnosed."

For a while, the Sakais dealt with the consequences of this narrow field. Kristi Sakai sensed something was wrong when Kaede was very young, but she struggled with a diagnosis.

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"I had a really hard time getting her diagnosed," she said. "The early intervention people would not recognize the things that I was seeing even though they were identical behaviors as the boys."

The Sakais also have two sons touched by autism. The family lives in a rural area of Oregon, not far from Eugene. It's the kind of place where everybody tends to watch out for everybody else. And in Kaede's family, that's important.

Kaede's brothers, Tom and Kito, have many issues, including an inability to give and take in conversation, and intolerance of various physical stimuli, like certain kinds of clothing.

"[Kito] would pull at the feet of his pajamas and scream until we would take them off," said Kristi Sakai.

The boys also have nearly uncontrollable fits of fury that can last for hours and be set off by being given the wrong shirt or because a familiar routine was changed at the last minute. The boys, however, were more easily diagnosed with autism.

The Need to Please

Kaede's autism was harder to detect. She exhibited some of the symptoms her brothers did, but she was able to control others, leading many to believe that she did not have autism.

"So she had the sensory issues," said her mom. "That was the first thing I noticed. But she wasn't having the big meltdowns though, which is what other people were saying: 'Well, she doesn't have what the boys have.'"

Kristi Sakai believes that those differences disguised her daughter's symptoms when she took Kaede to be evaluated.

"She wanted to please them, so whatever they asked her to do, she would throw her whole heart into it and do what the adults wanted," she said.

It is exactly this desire to please that Myles believes may explain how a girl with autism could fool the experts, so to speak.

"We overtly teach social skills to girls," Myles said. "They are told not to get angry, they are told to be nice, they are told to share -- all of those behaviors."

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