Are you a parent with a daughter who you think could be on the autism spectrum? Perhaps you don’t know where to start in terms of reaching a diagnosis? You’re not alone.
Information from the Centers for Disease Control and Prevention (CDC) suggests autism spectrum disorder (ASD) affects 1 in 54 children in the United States across all ethnic groups and is four times as prevalent in boys than in girls. Various evidence now suggests that this is inaccurate, and more girls are living with ASD than people realize.
ASD is characterized by social communication and social interaction difficulties, according to the DSM-5 classification system. However, research suggests that criteria for diagnosis is based on scientific evidence of autism in boys. As a result, diagnosing girls with autism usually occurs later in their development than it does for males.
Due to this, many girls on the spectrum are left to go through life without the support and help they might need, unsure how to find answers to difficulties they face in their daily living. These challenges, depending on the extent and severity, can cause psychological strain for young girls as well as their families.
To help girls on the spectrum receive an autism diagnosis quicker, it is important for parents to be aware of the possible signs of autism. So, how does autism appear in girls? Let’s have a look at this topic and, hopefully, some answers will be offered in this article.
What are the signs of autism in girls?
Autism spectrum disorder is often described as a “boy” thing as there are more boys with a diagnosis than girls; this could be because the diagnostic criteria for autism is fundamentally based on research performed in boys diagnosed with autism rather than females. As a result, many girls are not diagnosed until adolescence.
In many cases, girls with autism at a younger age show more capacity, in comparison to boys, to interact in social settings and they are often able to make and maintain friendships at a young age. This characteristic disadvantages girls with undiagnosed autism because, according to diagnostic criteria, autistic individuals lack the capacity for social interaction and communication. However, if undiagnosed, traits of autism become more evident as they reach adolescence as the need for complex social interaction capacity is heightened.
The autism diagnosis is a spectrum of different phenotypic expressions across every individual carrying the trait. It includes different types of autism, from high functioning to more severe or low functioning, types which are easier to diagnose.
Although autism is more difficult to spot in girls than boys, there are some signs you can look out for.
Here are some challenges faced by autistic girls
Remember, autism is a spectrum and presents differently in every individual. However, the list below offers some of the “common” difficulties girls with autism might face.
One of the more classic symptoms of the autism spectrum can be seen when looking at difficulties involving social interactions. This is much easier to spot in boys as girls and women tend to adapt to social situations more naturally than men.
Difficulty maintaining eye contact during social interactions or escaping difficult events through mental processing or daydreaming can provide clues that girls may be autistic.
Other examples include:
- Difficulty in forming intimate social interaction
- Lower levels of verbal cognitive ability
- A difficulty in the ability to adapt
- Literal understanding of information; struggle with sarcasm
- Communication and language problems
- Require longer time for processing to engage and interact
- Often find it difficult to communicate; conversation becomes scripted
Sensory processing issues
Sensory processing issues include difficulties processing intense lighting, sound, or touch. These are all characteristic symptoms of autism. For someone with an ASD, there are sensory inputs that increase the need for self-regulation through stimming, meltdowns or, in more extreme cases, self-injurious behaviors.
Girls with autism can sometimes act out or show aggressive behaviors. This can occur when they are trying to communicate something, or when there’s a sensory problem that they’re trying to regulate. Alternatively, it can be due to a physiological or health-related problem.
Visual thinking relates to the concept that individuals with ASD are visual learners, thinking more in pictures than language. This enables some people with autism to conceptualize patterns in their minds and solve complex problems.
One of the most famous women with autism, Temple Grandin, PhD, was nonverbal for the first three and a half years of her life. She developed her social skills and went on to attain a doctoral degree in animal science where she began to pioneer revolutionary concepts due to her ability to think in pictures.
Special interests and obsessions
Individuals on the autism spectrum often have a tendency to develop special interests and obsessions. The classic stereotypes that are used in society are special interests and obsessions with facts. Girls with autism generally have limited interest in activities and are often very specific in what they enjoy.
However, one theory for why girls are missed for diagnosis is that their special interests are often more “socially acceptable” than those of boys on the spectrum. For example, a teenage girl might develop an intense interest in boys or celebrities. This could be because they have a high desire to “fit-in” with their peers.
Masking: the reason girls are missed for ASD diagnosis?
Some research suggests the reason girls are typically under diagnosed for autism spectrum disorder is that the current diagnostic criteria does not meet the expression of autism in girls.
Current studies cite that at least three males receive an autism diagnosis for every one female. Two current arguments suggest an explanation; the first argues the reason for this occurrence is that girls have an inherent trait that “protects” them from the likelihood of developing autism. While the second argument is that more girls are likely to develop autism than current data estimates, the limiting factor is that diagnostic bias and variations in the expression of autism in girls limit the positive diagnosis.
Out of these two arguments, the second is much more favored than the other. The main issue with the current diagnostic criteria is that behavioral maskers that are used as criteria for diagnosing autism are based on pre-existing conceptions of what autism “looks like”. These are predominantly based on male population samples previously diagnosed with autism.
Girls are often able to “mask” their autism traits and the behavioral maskers used as diagnosis criteria are therefore not so apparent; but what does this mean?
How do girls mask their ASD?
Often girls with traits of autism are able to hide and blend in, this is known as camouflaging or masking. The occurrence of masking in girls is due to the cultural pressure of displaying “right behaviors” that are often expected of them
It is inherently easier for autistic girls to mimic the behaviors of others when it comes to certain interactions, at least initially. Some examples of masking or camouflaging include: the act of mimicking facial expressions, and making intentional eye contact despite the internal discomfort or anxiety-triggering emotions this can elicit. Suppressing stimming behaviors such as flapping of hands, or giving scripted responses to questions, are additional methods of masking based on current studies and clinician experiences.
Typically girls take on these making strategies in order to “fit in” or avoid standing out by adapting to school environments. The ability to mask autistic traits is often learnt through television shows, from everyday observation, or from peers to appear neurotypical at first glance.
Subtle clues such as difficulty maintaining eye contact during social interactions or escaping difficult events through mental processing or daydreaming can provide clues that girls may be autistic.
Consequences of camouflaging
Jorgenson, et. al, cited that masking or camouflaging has detrimental effects such as mental, physical and emotional drain. This is because masking is characterized by constant monitoring of what are deemed to be socially acceptable behaviors. Masking is also related to higher rates of depression and feelings of being an outcast.
The psychological impact of late autism diagnosis in girls
It was reported that some participants stated, despite years of therapy for treating symptoms of autism—unbeknownst to them, none of these health professionals could point out the possibility of an autism diagnosis. Others stated having been diagnosed with other disorders and none offered a solution to their underlying symptoms; even going as far as being diagnosed with personality disorders.
In many cases, due to the stereotype that “people with ASD all have severe and overt social and communication problems”, professionals were reluctant to diagnose the girls at a younger age with autism because they did not meet that criteria due to showing capacity for socialization with others.
The act of forging a different identity brought a lot of emotional reactions such as anger and regret for all the time spent on trying to be a different person or trying to “be good”, caused by the inability of professionals to look beyond stereotypes and focus on the symptoms from the perspective of women with undiagnosed autism.
From the response of this study, almost all older girls reported they have experienced one or more mental health difficulties. Of these, the most common were anxiety, depression, and eating disorders. In relation to mental health problems, some adult girls reported having attempted suicide or self-harm, as well as a reduced sense of self-esteem, increased doubt, and feelings of rejection.
How can an ASD diagnosis help a girl with autism?
Just as with their male counterparts, women and girls with autism benefit from early intervention. An early diagnosis can mean earlier access to therapies and resources. It can also mean more time for the girl and her family to learn how to manage an ASD diagnosis. Early intervention is key, but a diagnosis later in life is better than no diagnosis at all.
According to Dr. Susan F. Epstein, a clinical neuropsychologist, girls with autism can often end up wondering what’s “wrong” with them and suffer from poor self-esteem, depression, and can become vulnerable to bullying.
Young and adult women who are diagnosed with autism might have to play catch-up on social skills and coping mechanisms. However, after an adjustment period, most women and girls find relief from receiving their diagnosis. After a diagnosis, you and/or your child can meet with autism experts, occupational therapists, psychiatrists, or other professionals who can answer questions and help long-term.
Support services for girls with autism
A number of services have been put in place for families and parents with children with special needs. Some of these aim to cater for girls with autism as well as those with undiagnosed autism who may not understand their symptoms. Here are some suggestions for girls looking for support:
Find a support group or community
Whether you have been diagnosed with autism or not; it is always important to have a safe place with like-minded people who may be experiencing similar symptoms to yourself
Read books and articles about the female experience of autism
- There are a number of books written by individuals with special needs or more specifically with ASD. You may find the answers you’re looking for in these
- The Spectrum Girl’s Survival Guide – How to grow up Awesome and Autistic is written by Siena Castellon; a girl with autism who, at a young age, is using her platform to give a voice to autistic girls around the world
Speak to your local health professionals
It may feel like there’s no answer in sight; but an unanswered question always has an answer somewhere. Speak to your doctor, therapist, counselor, or another health professional. Giving up is not an option, keep going.
Here, autistic girls learn to cope with different challenging social situations and form interpersonal relationships. Therapists can also help girls manage co-occurring conditions with autism such as anxiety, depression, bipolar disorder, OCD, and anorexia
- Some people believe Applied Behavioral Analysis (ABA) is particularly helpful for young girls (under the age of five), but older girls can benefit as well
- A method called talk therapy is said to help autistic girls. During psychotherapy, the therapist will present problems to the child, and they both work together to come up with solutions
- Occupational therapy (OT) is another option for children who need help establishing routines and carrying out daily tasks. An occupational therapist can help autistic girls learn skills that will help her at home, school, or in the workplace
- Girls with co-occurring disorders such as OCD, anorexia, or who are trauma survivors may need more specialists on their team. As more girls are receiving an ASD diagnosis, specialists are becoming more aware of the unique way girls on the autism spectrum present and are developing new ways to help them thrive
Advice for parents
Being normal is subjective to society’s depiction of normal, and our own bias. When we take away the presumption of how one should act or behave, we learn to understand that each individual is different. Teaching your child to feel comfortable being themselves, especially in the home environment, can go a long way.
It is important as parents to listen to your child, as only your daughter will know what she is going through. Listening can also apply to looking out for nonverbal communication; for example, subtle clues in body language, such as how she responds in certain situations. It can also be verbal by being inquisitive of your child’s behaviors and talking about them. Parents have a great responsibility to protect their children and ensure their development is supported.
Most importantly, if you have a niggling feeling that your daughter could be on the spectrum, do your research and seek professional help. Trust your parental intuition and don’t give up on your search for answers.
Autism presents itself differently in each individual. In girls, autism is often missed by health professionals, because girls with autism tend to hide their autistic traits so that they feel “socially acceptable”.
If parents are able to recognize possible signs of autism in girls, intervention can happen earlier. If you are unsure where to begin, your daughter’s pediatrician or primary care doctor can connect you with autism resources in your area.
Bargiela, S., Steward, R. & Mandy, W. The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of Autism and Developmental Disorders 46, 3281–3294 (2016). https://doi.org/10.1007/s10803-016-2872-8
Cridland, E.K., Jones, S.C., Caputi, P. et al. (2014) Being a Girl in a Boys’ World: Investigating the Experiences of Girls with Autism Spectrum Disorders During Adolescence. Journal of Autism and Developmental Disorders 44, 1261–1274 . Doi: 10.1007/s10803-013-1985-6
Hull, L., Petrides, K.V. & Mandy, W. (2020) The Female Autism Phenotype and Camouflaging: a Narrative Review. Review Journal of Autism and Developmental Disorders 7, 306–317, https://doi.org/10.1007/s40489-020-00197-9
Jorgenson, C., Lewis, T., Rose, C. Kanne, S. (2020) Social Camouflaging in Autistic and Neurotypical Adolescents: A Pilot Study of Differences by Sex and Diagnosis. Journal of Autism and Developmental Disorders, 50, 4344–4355 . https://doi.org/10.1007/s10803-020-04491-7
Leedham, A., Thompson, A. R., Smith, R., Freeth, M. (2020) ‘I was exhausted trying to figure it out’: The experiences of females receiving an autism diagnosis in middle to late adulthood. Autism, 24(1),135-146, https://doi.org/10.1177/1362361319853442
Lockwood Estrin, G., Milner, V., Spain, D. et al. (2020) Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review. Review Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s40489-020-00225-8