Autism in Women and Girls

Though it is more common in boys, girls can also be autistic too.  However, the signs and symptoms of autism often present differently in girls.  That means that autism may be under-diagnosed in girls.

What does autism look like in girls?

Although autism is more frequently diagnosed in boys, girls can be diagnosed with autism too.  The signs and symptoms of autism can present differently in girls, which may cause girls with autism to go un-diagnosed.  Autistic girls may show the following symptoms:

• Social Masking/Camouflaging: Autistic girls can blend into social scenes by mimicking the social behaviors they see neurotypical people (people without autism) do. Examples of social masking/ camouflaging could be: mimicking hand gestures, postures, or mimicking vocal tone.
• Scripting: Autistic girls may sometimes make up a conversation in their heads and then rely on their memorized script in order to talk with others.  The conversation that results may not appear natural or genuine and instead feel forced, unnatural, or rigid.
• Well-Developed Linguistic Skills: In many cases, language skills (communicating verbally, non-verbally, and maintaining eye contact) are more developed in autistic girls than in their male counterparts.  As a result, a diagnosis of autism can be missed or delayed in girls with autism because they may successfully reach linguistic milestones.
• Fewer Repetitive Behaviors: While repetitive behaviors are common in autistic boys, they are less common in autistic girls.
• Selective Mutism: Selective mutism may occur in social situations when an autistic individual becomes overwhelmed.  For example, autistic girls may whisper, rarely speak, or not speak at all when at school, but have no problems communicating when at home.
• More Mainstream Interests:  Autistic people may have one specific passion, rather than a range of interests.  In autistic girls, the specific interest may a topic that most girls already enjoy, such as horses, a popular TV show, or a band. Because interests tend to be more “normal” or mainstream, they may be overlooked and contribute to delayed diagnosis of autism.
• Autistic girls may also struggle with: anxiety/depression, ADD/ ADHD, OCD or compulsive tendencies, body dysmorphia, or eating disorders.

Challenges autistic women and girls face when seeking a diagnosis

Because autistic women and girls often adopt behaviors that can down-play their autism, getting testing and treatment for girls can be more challenging.  Below, we discuss some of the challenges that women and girls face when seeking out testing.

• Girls use Compensatory Behaviors: The use of camouflaging techniques, such as social masking (see above), to hide difficulties in social situations can make autistic girls harder to spot.  Similarly, girls imitating neurotypical social behaviors during a clinical assessments can make it harder for physicians to identify autistic traits.
• Parental Concerns: Parents may be more likely to attribute unusual behaviors to autism in boys than in girls, because autism had been previously thought of as a primarily male disorder.  Girls are more likely to receive an autism diagnosis if their emotional and behavioral problems are extreme and obvious to parents.
• Lack of Information/Resources: While there is an abundance of information about boys with autism, there is a lack of helpful information available about autistic girls.  As a result, parents may be less likely to recognize signs of autism in their daughters, and therefore be less likely to seek assessment.
• Clinician Bias: Because autism is diagnosed in boys more frequently, clinicians may not consider autism as an explanation for unusual behaviors present in girls.
• Diagnostic Criteria:  The data that was used to create the diagnostic criteria for autism was mostly from male patients.  This means that to the diagnostic criteria for autism may not describe symptoms demonstrated by girls as equally as it does in boys.
• Co-existing Problems: Girls are at a greater risk for going undetected for autism because they tend to display fewer maladaptive traits, such as hyperactivity and aggression.  Autistic women and girls are thought to experience more “inward” emotional stress which may contribute to misdiagnosis.

Article by: Katie Mcgraw and The Autism ToolKit

If you would like to learn more about how autism presents in women and girls, please follow the links below:

• The costs of camouflaging autism | Spectrum
• Autism–It’s Different in Girls
• Are Girls With Autism Hiding in Plain Sight? – SPARK
• Autism in Girls and Women
• Functional Gender Differences in Autism.pdf