Autism tends to be thought of as a male condition, even being described as “extreme male brain.”1 Autism has always been present in girls and women as well, but has often gone undiagnosed, or misdiagnosed, instead. Autism presents differently in girls and there are forms of therapy and medication to help autistic girls function in society.
Signs & Traits of Autism in Girls
Diagnostic criteria for autism was created with boys in mind, which means that girls on the autism spectrum often go unidentified until adolescence and even well into adulthood.2 Presently, the ratio of diagnosis of boys to girls is 4:1, but if more girls were correctly diagnosed, it is thought that this ratio would be closer to 2:1.3 Instead of being given the correct diagnosis, autistic girls are often misdiagnosed with social anxiety, anxiety, borderline personality disorder, or a comorbid eating disorder.3
Some characteristics of autism in girls include:3,4,5,7,8
- Appearing shy or quiet
- Seeming either younger for her age, or an “old soul”
- Skilled in music, ability to sing with perfect pitch
- Ability to adapt and blend into varying social situations
- Might be able to form friendships, but then difficulty keeping friends
- Might imitate or copy another person as a way of coping or fitting in
- Scripting, “cutting and pasting” lines from TV, movies, or other people
- Being the model student at school and then having meltdowns at home
- Strong empathy for others. Might enjoy caring for people or animals
- Special interests include topics like music, pop stars, or other elements of popular culture that are more common, or more “socially acceptable” interests than autistic boys might display
- Might prefer, or have an easier time socializing and forming friendships with boys than girls
- Might “flit” from one social group or situation to the next
- Might prefer to have one or two close friends as opposed to a large social group
- May prefer to socialize with either younger or older children
- May struggle with executive functioning
- Style of dressing includes clothing that is comfortable and functional
A girl on the autism spectrum might have a speech or language impairment, or instead might be hyperverbal, displaying a vocabulary and verbal ability beyond her years. She might also use echolalia in conversation or exhibit idiosyncratic speech. The autistic girl might be learning words and developing language faster than her neurotypical peers. She might also be hyperlexic, reading early or learning to read on her own.
It should be noted that all of these traits can also apply to boys, men, and gender diverse individuals as well. They are characteristics of autism that fall outside of the generally accepted stereotype, and so those with such characteristics are likely to go unnoticed and undiagnosed, no matter their gender.
How Is Autism Different in Girls vs. Boys?
Female autism often presents differently because girls tend to be more skilled at camouflaging their autistic traits and blending in with others. Autistic girls often use imitation of others to cope with social differences and fit in, or go unnoticed.2 Girls are also often socialized to be more polite, and to present in a way that aligns with what is considered socially acceptable.
Autistic girls can be skilled imitators, and often fly under the diagnostic radar due to their imitation of others that they use as a coping strategy. If an autistic girl doesn’t know what to do in a social situation, she may look to someone who she perceives to be socially successful, and may copy that person in use of language, style and mannerisms. It’s not uncommon for a girl on the autism spectrum to imitate favorite characters from television, movies or books.
In addition to imitating peers, a girl on the autism spectrum might also imitate a teacher or other adult. Autistic girls and women can often manage in social situations due to an ability to observe, analyze and imitate.2
Autism in girls is so often overlooked because of pervasive stereotypes about what autism “looks” like. These stereotypes are so prevalent that even professionals often don’t know what to look for when assessing girls and women for autism. Autistic girls may appear more social, and may simply be labeled as “quirky.”
It is also important to recognize people who fall outside of the cis-gender binary, who may be trans, non-binary, or gender fluid whose autistic traits may also present as different from the assumed stereotypes. It is known that people on the autism spectrum frequently have a different relationship to gender and sexual orientation.
Some express that their perception of gender is heavily influenced by autism itself, identifying as “autigender.” It is important to honor the identities of everyone on the autism spectrum, and the rich variations of presentations within the autistic community.
Are There Tests for Female Autism?
Autism assessment for children generally includes gathering information from the parent, meeting with the child and engaging with them in a way that allows the clinician to make observations of that child’s characteristics. The clinician will note things like eye contact, how the person engages in conversation, facial expressions, gestures, and imaginative play.
During an autism assessment, the autism diagnostic observation schedule (ADOS) test is often used to facilitate situations in which these traits can be observed. Although the ADOS is frequently referred to as the “gold standard” of autism testing, the ADOS can easily miss autism in girls unless the assessor knows exactly what to look for, and has a thorough understanding of how girls and women tend to mask or camouflage their autistic traits.
Assessment of autism in adult women typically includes a meeting and interview with the client during which the assessor asks questions and gathers information about present and past traits and life experiences. Sometimes the clinician will also meet with the client’s parent or other close relative present during the client’s childhood to gather additional history and information. Assessment often also includes testing such as the ADOS, diagnostic interview for social and communication disorders (DISCO), Rivito autism and asperger diagnostic scale (RAADS), or other psychometric tests.
Assessment and diagnosis have long revolved around the male model of autism, and can be rooted in outdated stereotypes based on how boys were thought to commonly present. Because autism can appear so differently in girls, women, and gender diverse populations, accurate diagnosis can be much more difficult to obtain. Although access to proper diagnosis remains a challenge, the increase in autistic clinicians and researchers in the field of autism may be shifting the tide toward a greater understanding of the nuances and diversity of presentations within the autism spectrum.
How Do Traits of Autism in Girls Change as They Grow Older?
As girls get older, social relationships become more complicated and can become increasingly challenging to navigate. An autistic girl may find herself struggling socially in middle school or high school. Over time, autistic individuals may learn strategies to manage social difficulty, or to mask struggles, but during periods of stress or overwhelm, they may find they are no longer able to camouflage their difficulties or cope with these challenges.9
Puberty can be an incredibly difficult time for girls on the autism spectrum due to physical and hormonal changes, as well as the growing complexity of social relationships. Autistic traits that might have previously gone unnoticed might suddenly become more pronounced during the middle school and high school years due to life becoming more complicated or overwhelming. Emotionality may become stronger and an individual might also be more easily overwhelmed.
Also, as one gets older, sensory issues may feel more pronounced or difficult to manage. And the cost of masking or camouflaging autistic traits can add up over the years, leading to autistic burnout, which is sometimes also referred to as “regression.”
It is not uncommon for women to receive an autism diagnosis in adulthood, often during an autistic burnout. Late diagnosis of women often occurs when stressors in life increase, and there is no longer the time, energy, or rest to cope with these struggles and difficulties as there previously might have been.
Also frequently, women who have children on the autism spectrum, or who are otherwise neurodivergent, may notice traits and characteristics their children possess with which they also identify. It is becoming more common for mothers to become diagnosed with autism, themselves, after their child receives an autism diagnosis.
Getting the Best Support
When seeking to support girls on the autism spectrum, know that autism is not a disease that needs to be cured, or something “wrong” that needs to be corrected. To support a girl on the autism spectrum, love, accept, and encourage her for exactly who she is. Understand that the social environment of school may feel confusing, exhausting or unpleasant, and be sure to provide her with a space that is welcoming, understanding, and sensory friendly. Seek out an IEP or 504 plan if your child needs additional supports or accommodations in the school environment.
Drama, theater, and the arts can be helpful to facilitate self-expression and communication. People on the autism spectrum may be gifted in the area of music, and may write songs or compose music as a means of self-expression. Drawing, painting, and the visual arts can be a wonderful means of expression as well. Art may be a more comfortable and preferred method of communication to the spoken word. Allow and encourage the individual to communicate in whichever way makes the most sense for them (speech, sign language, art, or music).
Facilitate connection to peers who may also be autistic or neurodivergent, if the child is interested, as people within the neurodiverse community often find it easier to understand, communicate and forge friendships with each other.
Supporting and encouraging special interests, can be a great source of joy and can pave the way for potential career paths and opportunities in adulthood. Women on the autism spectrum often excel in careers in the arts, psychology, and the helping professions. Autistic women can be brilliant psychologists and psychotherapists due to having deep empathy, and the ability to recognize patterns and systems.10 Autistic women can also be found in other areas of the caring professions such as nursing, medicine, and teaching.
It is important to remember that autism does not automatically require any therapy at all. There are individuals on the autism spectrum who thrive without any type of therapy or intervention, if simply allowed to be who they are and follow their interests.
Therapy can be helpful if a child is struggling with any particular area. Occupational therapy can be extremely helpful for management of sensory differences, challenges with emotional regulation, or activities of daily living.
Speech therapy can be helpful if there are any challenges related to speech and communication. The goal is always communication, and supporting whatever that looks like for each individual person (spoken speech, sign language, typing).
Psychotherapy and counseling can provide support for management of stress, anxiety or depression, pathological demand avoidance, or coping with complex feelings. As communicating feelings through words can often be challenging for those on the autism spectrum, play therapy or creative arts therapy involving music, visual art, and movement can be helpful modalities.
As alexithymia, or the difficulty identifying and verbalizing emotions, can be common to the autistic population, psychotherapy can often help with identifying emotions, and answer the question of “What am I feeling?”
The best therapy offers non-judgmental support, understanding, and unconditional positive regard. Therapists who are themselves autistic or neurodivergent can often offer the most helpful insight and understanding when working with autistic clients.
Autism is not an illness and does not require treatment with medication. However, there are common comorbid conditions that coexist with autism that might be treated with medication. Some of these conditions may include autism and a sleep disorder, anxiety, depression, or ADHD.
Medication is prescribed by a medical doctor, such as a psychiatrist, neurologist, or developmental pediatrician. Medication can also be prescribed by other providers including psychiatric nurse practitioners or physician assistants.
When supporting girls on the autism spectrum, one of the most important elements of support is unconditional acceptance. Support the individual as they are without attempting to change them to appear more neurotypical.
Some additional helpful supports may include:
- Time for Solitude: Many autistic people require solitude to recharge their energy and recover from school or social situations. Follow her lead if she needs time alone. Understand if she may not want to socialize as much as her neurotypical peers and allow her time and space for solitude and decompression.
- Support Groups: For mutual support, connection, and understanding with other autistic or neurodivergent peers.
- Equine Therapy: Horses are a common special interest for girls on the autism spectrum. Often riding horses, helping to care for horses, or simply being around horses can be incredibly therapeutic.
- A Safe and Affirming Environment: Girls tend to be experts in masking, or camouflaging their autistic traits. Masking is extremely taxing and exhausting, so be sure to provide a space where she can feel free of the perceived need to mask, where she can be 100% accepted for who she is.
Final Thoughts on Autism in Girls
If you’re concerned about autism, the most important thing to remember is that autism is simply a different neurotype that comes with its own unique strengths and challenges. The best way to move forward is by accepting each child for exactly who they are, supporting them in any areas where they may struggle, and fostering the gifts, talents and abilities that are uniquely their own.
Autism in Girls Infographics