What to Know About Autism in Boys

Rear view of autistic boy with headphones at home

Maskot / Getty Images

Language note: Although individual preferences exist, surveys of the autistic community consistently show that autistic people prefer identity-first language rather than person-first language (i.e., “autistic person” rather than “person with autism”). This article reflects that community language preference.

Autism Prevalence in Boys

Autism, known in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as autism spectrum disorder, is a neurodevelopmental difference that impacts functioning, social skills, and behavior.

Previous research has suggested that autism is more prevalent in boys than other genders, but more recent research suggests that the existing diagnostic criteria highlight how boys tend to present. As such, boys are more likely to exhibit behaviors and mannerisms that are recognized as autistic.

Diagnosis of Autism in Boys

Psychologists and psychiatrists often use psychological assessments to diagnose autism. Developmental specialists can also assess for autism in young children. Autism assessments may include a diagnostic interview during which the client (or in young children, the parent or caregiver) provides history and background information. The evaluator may also administer structured interviews, behavioral rating scales, and direct assessments to determine whether ran individual’s presentation and symptoms meet the diagnostic criteria for autism.

It can be challenging to identify autistic traits if an individual is masking (camouflaging or hiding) their autistic traits. Boys engage in less masking behavior than other genders, which can make the diagnostic process easier.

Many existing measures to test for autism have higher validity for boys than for girls and other genders, contributing to autistic boys being identified at an earlier age compared to other genders. Specifically, the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is often referred to as the “gold standard” of autism assessment but is most accurate in evaluating cisgender boys.

Diagnostic Criteria for Autism

Deficits or problems related to communication and social interactions, manifesting in multiple contexts and including:

  • Difficulty with social-emotional reciprocity, which can include “abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.”
  • Difficulty interpreting nonverbal communication or expressing nonverbal cues in a way that others can comprehend.
  • Difficulty understanding, developing, and maintaining relationships, which can manifest as lower interest in these relationships.

Restrictive or repetitive behaviors, language, interests, or activities, including:

  • Repetitive movements or speech (sometimes known as “stimming”).
  • Strong need for consistent routines, structures, or behavior.
  • Specific, intense interests (sometimes known as “special interests”).
  • Atypical responses to sensory input, such as over or under-responding to lights, sounds, smells, et cetera.
  • Symptom onset must occur in the early developmental period, though they may not fully manifest until later in life when demands exceed one’s ability to mask symptoms.
  • Symptoms must cause clinical impairment in multiple areas.
  • Symptoms must not be better explained by another diagnosis.

Typically, an autism diagnosis includes information about whether an individual requires “support,” “substantial support,” or “very substantial support” based on the individual’s level. This refers to how much support the individual needs in order to function and thrive.

What the DSM Says

The newest edition of the DSM, the DSM-5-TR (text revision), modified the diagnostic criteria for autism slightly. In the DSM-5, individuals only needed to meet two out of the three social-communication criteria. However, in the 5-TR, all three social-communication criteria must be met for an individual to meet the criteria for autism.

How Presentation Differs in Boys

The diagnostic criteria for autism does not differentiate by gender. However, much research that went into developing this criteria focuses on how autistic cisgender boys tend to present. Boys are more likely than girls and other genders to be accurately identified as autistic and tend to be diagnosed at a younger age.

A 2022 study of autistic boys and girls found neurological differences related to motor, language, and visual-spatial systems, suggesting that distinct diagnostic criteria for autism based on gender may be appropriate. These brain differences support the idea that autism does in fact look different in boys than in girls.

Because research has historically focused on symptom presentation in boys, the current diagnostic criteria is likely to manifest in boys.

What Causes Autism?

Researchers do not fully understand what causes autism and cannot accurately predict who will or will not be autistic. However, because autistic people are born this way, it is highly likely that autism has a strong genetic component. Here are some other factors that may contribute to autism:

  • Siblings of autistic children have a 20% chance of being autistic, and twin studies have shown that, if one twin is autistic, the other twin has between a 64% to 91% chance of also being autistic. Recent research has shown that autism has one of the strongest genetic components of any DSM diagnosis.
  • Some genetic disorders, including Fragile X Syndrome, Down Syndrome, and muscular disrophy are more common for autistic people than for non-autistic populations. This could indicate that the genes that cause these disorders are also part of the genetic combinations that cause autism.
  • Parent age has also been linked to a higher probability that an individual will be autistic. Older parents are more likely to have autistic children. It is widely known that parental age can increase the likelihood of various genetic disorders, so this correlation could have a similar cause.

While we are still learning about the specific genetic factors that contribute to whether or not someone will be autistic, researchers can confidently say that autism is not caused by environmental factors such as parenting choices or vaccines.

How Is Autism Treated?

Since autism is a neurodivergence and not a mental illness, treatment looks different than it would for an issue like depression, anxiety, psychotic disorders, personality disorders, et cetera. However, autistic people can develop mental health issues and are at higher risk for many diagnoses than non-autistic people, and they are at higher risk for trauma and abuse than non-autistic people.

Autistic people may benefit from psychotherapy services to treat any mental health diagnoses they have. Neurodiverse-affirming therapy can help with self-acceptance and identifying coping skills that work for them. This can additionally help in identifying masking behaviors, which can be stressful and lead to burnout.

Many providers will recommend applied behavioral analysis (ABA) for autism, especially in children. However, many autistic people report that their experience with ABA was traumatic. This can occur when an ABA therapist teaches masking behavior with the goal of making the individual appear less autistic rather than meeting the autistic person’s underlying needs.

Boys do not engage in as much masking behavior as other genders, and they are more likely to externalize their emotional responses. This can manifest as sensory meltdowns and behavioral outbursts. Supporting autistic boys in identifying effective, safe skills to meet their communication and sensory needs can help them process and express these feelings in a healthier way.

Autistic people who struggle with communication can benefit from speech therapy services to help them express their needs in a way that those around them can understand. They may also benefit from occupational therapy to address sensory issues that cause distress or interfere with daily life.

11 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lai MC, Szatmari P. Sex and gender impacts on the behavioural presentation and recognition of autismCurrent Opinion in Psychiatry. 2020;33(2):117-123.

  2. Wood-Downie H, Wong B, Kovshoff H, Mandy W, Hull L, Hadwin JA. Sex/gender differences in camouflaging in children and adolescents with autismJ Autism Dev Disord. 2021;51(4):1353-1364.

  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. American Psychiatric Publishing.

  4. van ’t Hof M, Tisseur C, van Berckelear-Onnes I, et al. Age at autism spectrum disorder diagnosis: A systematic review and meta-analysis from 2012 to 2019Autism. 2021;25(4):862-873.

  5. Supekar K, Angeles C de los, Ryali S, Cao K, Ma T, Menon V. Deep learning identifies robust gender differences in functional brain organization and their dissociable links to clinical symptoms in autism.The British Journal of Psychiatry. 2022;220(4):202-209.

  6. Cleveland Clinic. Autism spectrum disorder (Asd): Causes, symptoms, treatment & outlook.

  7. Tick B, Bolton P, Happé F, Rutter M, Rijsdijk F. Heritability of autism spectrum disorders: a meta-analysis of twin studies. J Child Psychol Psychiatry. 2016;57(5):585-95. doi:10.1111/jcpp.12499

  8. Thapar, A., Rutter, M. Genetic Advances in Autism. J Autism Dev Disord 51, 4321–4332 (2021). https://doi.org/10.1007/s10803-020-04685-z

  9. Al-Beltagi M. Autism medical comorbiditiesWJCP. 2021;10(3):15-28.

  10. Lyall K, Song L, Botteron K, et al. The association between parental age and autism‐related outcomes in children at high familial risk for autismAutism Research. 2020;13(6):998-1010.

  11. Sandoval-Norton AH, Shkedy G. How much compliance is too much compliance: Is long-term ABA therapy abuse? Rushby JA, ed. Cogent Psychology. 2019;6(1):1641258.

By Amy Marschall, PsyD
Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.