Autism in boys: identifying signs and navigating the diagnostic process

Exploring autism signs in boys, helping families to navigate diagnosis and support.

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Page medically reviewed by Mahul Trivedi, Integrative therapist at Priory Hospital North London, in May 2024.

Autism is diagnosed more often in boys than in girls, with current figures showing that boys are around three times more likely to be diagnosed with autism than girls.

Being aware of the signs of autism in both boys and girls, and understanding the differences between them is essential. It’s the first step towards getting a timely and effective support system for autistic young people, paving the way for better developmental outcomes.

Recognising the signs of autism in boys

Autism presents differently as children grow and develop. Being able to recognise the signs of autism in boys is important so they can receive a diagnosis and any additional support they might need.

Below, we explore what autistic characteristics look like for boys at different ages, from young childhood through to adolescence. We also highlight how these signs might differ between boys and girls. You can read more about autism in girls here.

In young boys, early signs of autism can be mistaken for typical ‘boyish’ behaviour, which can sometimes make early diagnosis challenging. However, it’s important to recognise that these behaviours might not just be preferences or stubbornness, but could be early signs of autism. 
Key indicators include:

  • Difficulties with verbal communication – autistic boys of this age might struggle to form words or sentences compared to their peers, or might not speak at all
  • Repetitive behaviours - such as spinning around in a circle, flapping their hands, lining up toys or insisting on ‘sameness’
  • Intense interests in specific topics - which could take over their play activities. These might include things like trains, space, dinosaurs and maps
  • Limited interest in other children – your child may prefer solitary play, or prefers not to participate in simple group games that are typical for his age
  • Emotional responses – they might show extreme fear over everyday situations that don't usually upset other children. On the other hand, they might not seem afraid in situations that are actually dangerous

In contrast to these, girls may engage in repetitive behaviours that are more ‘socially acceptable’, like arranging dolls. Their intense interests may not seem out of the ordinary, as they often revolve around animals or fictional characters. Also, girls might develop language at a more typical pace but they might use it in a repetitive or scripted way.

As boys reach school age, the social demands of their environments increase, which can highlight challenges that might have been less obvious before. 

Signs of autism in school-age boys can include:

  • Difficulties in social interactions – your child might find it challenging to pick up on social cues, like when to speak or listen during conversations. They might also struggle with taking turns, playing in groups, or forming and keeping friendships
  • Sensory sensitivities - your child might be unusually sensitive to sensory inputs. For example, they might find certain noises too loud, bright lights overwhelming, or the texture of clothing, like their school uniform, uncomfortable or irritating
  • A strong preference for routines - they may become very upset if their usual routine changes unexpectedly, like going a different way to school or having a new teacher. They often feel safest when things happen in a predictable and consistent way
  • Communication challenges – they might take things that are said to them very literally and could struggle to understand jokes, sayings or phrases that mean something different from the actual words used. This can make typical conversations difficult
  • Motor skills - they might seem awkward or clumsy and could have difficulty with activities that need careful movements, such as writing neatly or tying shoelaces

In girls, these challenges may be less visible. This is because girls are more able to mimic social interactions effectively, hiding any difficulties they might have when it comes to understanding social nuances and behaving in ‘expected’ ways.

During adolescence, the characteristics of autism can evolve and present new challenges as young people face increasing social expectations. 
Signs of autism in teenage boys include:

  • Social isolation - as social situations become more complex, you might notice your teenager spending more time alone. They may have trouble keeping up with the latest slang, understanding jokes, or knowing what's expected in relationships and dating
  • Behavioural issues - your teen might react strongly, either by getting upset quickly or pulling away from others, especially when things get too overwhelming for them
  • Emotional regulation - managing feelings in social settings can be hard for them. This might lead to sudden outbursts of emotion, such as anger, that seem out of place or unexpected
  • Self-awareness - as they grow older, your teenager might start to notice how they’re different from their friends. This can sometimes make them feel upset or frustrated
  • Executive functioning - you might see that your teenager struggles with staying organised, planning ahead for schoolwork, or keeping track of time. These challenges can become more noticeable as school becomes more demanding

Girls, on the other hand, might be able to internalise their difficulties more than boys. This is also known as ‘masking’. Masking how they’re truly feeling in response to the world around them can lead autistic girls to develop conditions like anxiety or depression, which can be less obvious to other people, and can mean that their autism goes unnoticed into adulthood.

It’s important for families and teachers to understand the signs of autism in children and adolescents, and how these might change over time, so they can get appropriate support for the young person’s learning and social development. 

Diagnosis and support

If you think your child might be showing the signs of autism, getting a diagnosis is the best way to make sure they receive the tailored support they need for their development and wellbeing.

First steps

If your son is showing certain behaviours or traits that could be characteristic of autism, a useful first step may be to talk to your GP. They won’t diagnose autism themselves, but they can point you in the right direction for getting a diagnosis and support. 

You could also take an online autism test for your son, which acts as a screening tool that indicates whether he might benefit from receiving a diagnostic assessment for autism. One such tool is the AQ-10, and there are different versions available, depending on how old your son is.

Take an online test

This quick questionnaire can be completed on behalf of a child/young adult. The questionnaire is a simple screening tool that indicates whether someone might have autism.

Diagnostic assessment

You could also reach out for a private autism assessment – this is where professionals carry out a detailed evaluation of your son’s behaviours and traits. They’ll be able to combine information from you with their own clinical observations to make a diagnosis.

During an assessment, specialists use lots of different diagnostic tools but one of the most important is the Autism Diagnostic Observation Schedule (ADOS). This tool is designed to help clinicians observe and interact with your child in ways that bring out behaviours that are typical of autism, which can sometimes be more noticeable in boys. These behaviours could be specific ways of playing, interacting and communicating, and the ADOS helps to identify them clearly and objectively.

For a detailed and personalised evaluation, consider booking a private autism assessment with Priory. Our experienced professionals are available across the UK to provide you with the support and clarity you need.

Diagnostic criteria

The official criteria for diagnosing autism, as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), focus on two main areas:

  1. Social communication issues
  2. Repetitive behaviours

These are the key areas that will be observed during the ADOS. Boys often show these signs more clearly than girls, which is one of the potential reasons why boys tend to be diagnosed with autism earlier than girls within the current diagnostic framework.

Our autism assessment pathways

Watch our video explainer detailing Priory's autism assessment pathways for adults and children - and how you can get started.

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Challenges in diagnosis

Diagnosing autism in boys comes with its own set of challenges. The signs of autism can vary from one child to another, which sometimes makes it difficult to pin down a clear diagnosis. 

One of the significant challenges in diagnosing autism in boys is the potential for over-diagnosis. This risk arises partly because certain behaviours that are associated with autism, such as difficulties in social interaction or specific repetitive behaviours, can be misinterpreted or overemphasised. There’s a fine line between identifying genuine signs of autism and misinterpreting natural variances in personality or interests that aren’t a result of an underlying condition.

In boys, parents and teachers might view typical energetic or disruptive behaviours through the lens of autism. This could lead to a diagnosis that might not fully account for other possible explanations, like attention deficit hyperactivity disorder (ADHD) or even normal developmental variations.

Importance of accurate diagnosis

The importance of an accurate diagnosis of autism can’t be underestimated. It lays the foundation for all the support and interventions that will follow, tailored to address each child’s unique challenges and strengths. A thorough and comprehensive diagnostic process is crucial in order to ensure that every aspect of the child’s behaviour is considered, helping to avoid misdiagnosis and unnecessary treatments. 

For boys, where the risk of over-diagnosis and misinterpretation of symptoms is higher, the precision of this process becomes even more vital. This ensures that each boy is given the best possible opportunity to reach his full potential.

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