Autism in Women: Signs, Causes, & Support

What Is Autism?

Autism is a condition in which a person’s perception and relation to the world around them are influenced by the wiring of their brain. Autism occurs on a wide spectrum due to how vastly different the disorder can present in different individuals.

Autism is typically diagnosed in childhood; however, more recently, we are finding adults have been misdiagnosed or have flown under the radar and are being diagnosed into their 50s. While autism can be diagnosed in men and women, women are typically underdiagnosed. Signs of autism are generally seen in the early years of life, with an official diagnosis occurring as early as three years of age.¹

While symptoms of autism can look different for each individual, common autism symptoms include:²

• Social differences
• Sensory issues
• Repetitive motor movements or sounds
• Social withdrawal or distancing
• Special interests
• Rigidity
• Overwhelm
• Difficulty maintaining social relationships

Signs of Autism in Women

While signs of autism can vary widely from person to person, they can also differ from gender to gender. These symptoms can impact both their relationships and their behaviors. The societal expectations of women differ from those of men, causing relationships to be impacted by the behaviors exhibited.

Common signs of autism in women include:

1. Special Interests

Women with autism may show signs of special interest in topics such as movies, celebrities, makeup, hair, etc. A lot of the special interests of women with autism can be seen as more “socially acceptable” than those of men with autism. This can present a challenge when needing to engage in conversations with others that do not surround the topic of the special interest.

2. Increased Empathy

Increased empathy, also known as hyper-empathy, can also be a sign of autism in women. Hyper-empathy is when we allow ourselves to feel what others are feeling in a particular situation which results in emotional reactivity. This can look like feeling tired after socializing with others, difficulty saying “no,” accepting unkind treatment for others because of their life circumstance, disproportionate emotional responses, physiological responses to other’s feelings, being stuck in emotional pain for an extended period of time, and overwhelm resulting in a reduction in your life functioning.

Having increased empathy can impact a woman’s career choices as they are more likely to be attracted to “helping” careers (i.e. social work, therapy, nursing). This can also impact relationships with others, as women with hyper-empathy may avoid social situations due to the exhaustion it can cause.³

3. People Pleasing

As a result of increased empathy, women with autism are more likely to engage in people-pleasing behaviors. Signs of people pleasing include:¹

• Difficulty saying “no”
• Concerns with what others think of you
• Never having time for yourself
• Guilt surrounding setting boundaries
• Apologizing when you haven’t done anything wrong
• Seeking approval from others
• Keeping your own feelings to yourself
• Low self-esteem
• Always agreeing for approval
• Fear of being seen as selfish

4. Scripting

Autistic scripting, also known as mirroring or echolalia, is a repetition of pop culture lines from movies, television, books, podcasts, etc. Scripting aims to regulate, communicate, socialize, mask, and stim. Scripting can be used by women with autism to “fit in” with peers.⁴

5. Social Withdrawal

Social withdrawal is common in women diagnosed with autism. This can result from difficulty with socializing, increased anxiety in social situations, hyper-empathy, people-pleasing, and avoidance of the pain of being misunderstood.

How Do Autism Symptoms Differ in Women & Men?

While the actual symptoms of autism don’t necessarily differ between men and women, research has shown that women are more likely to mask their symptoms than men. The ability to mask symptoms may be the underlying cause of why women are underdiagnosed with autism. Women may be better at masking due to a higher level of Emotional Intelligence (EQ) than men.⁵

What Causes Autism in Women?

The causes of autism are not entirely known or understood. However, many researchers have found that there are factors related to both genetics and environment. One possibility is that women are raised to be more socially aware of their surroundings and to engage in “socially appropriate” ways to manage their ASD symptoms better than their male counterparts. While this is one theory, there is a need for much more research on the topic.⁶

How Is Autism Diagnosed in Women?

While there is no set way to diagnose ASD in adult women, there are tests that can be utilized to give you an idea of your diagnosis. It is important to seek an accurate assessment from psychological testing to receive the necessary diagnosis and treatment. You can seek a referral for an assessment through your primary care doctor, psychiatrist, or therapist.

It can be challenging to get an accurate diagnosis as an adult woman due to the ability to mask, lack of research on adult diagnosis, and lack of research on autism in females in general.

According to the DSM-5, to receive an autism diagnosis, a person must experience:

• Rigidity
• Sensory issues
• Difficulty maintaining social relationships
• Social withdrawal or distancing
• Special interests
• Social differences
• Repetitive motor movements or sounds
• Overwhelm
• Have symptoms present in childhood

Does Autism in Women Require Treatment?

Having an autism diagnosis does not necessarily require treatment unless the symptoms are negatively impacting a person in their everyday life. Medication management, cognitive behavioral therapy, social skills, art therapy, speech and language, and occupational therapy can all benefit a person with an autism diagnosis. Some of the benefits of therapy include: improve mood and regulation, improve social skills and communication, increase sensory regulation, developing coping strategies, etc. It can also be helpful to find a neurodiversity-affirming therapist that is familiar with living with autism.

Therapy options to consider include:

• Occupational therapy: Occupational therapy can be helpful when dealing with sensory processing issues that are commonly associated with an autism diagnosis.
• Cognitive behavioral therapy: CBT can help with managing the anxiety commonly associated with autism. It can help with understanding our thoughts and feelings surrounding our lives and how it impacts our behaviors.
• Art therapy: Art therapy can help women better articulate themselves or express emotions through a creative outlet.
• Speech and language therapy: This can help women that are struggling with particular speech and language difficulties (i.e. echolalia)
• Music therapy: Music therapy, similar to art therapy can be helpful to process emotions through a creative outlet.
• Medications: Medication management can be helpful for symptoms associated with autism, even though there are no specific medications to treat autism. Common comorbid disorders that can be treated are depression, anxiety, OCD, and ADHD.
• Social Skills Therapy: Social skills therapy can help women with autism learn to engage in social situations in a more confident way to reduce masking and social withdrawal

Final Thoughts

Receiving an autism diagnosis may seem scary initially, but support is available for women with autism to help you better understand your new identity. Start with asking questions and finding a provider willing to hear your concerns and connect you with resources is a great way to start. Start here to find a neurodiversity-affirming therapist.