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Autism in Girls: Signs, Symptoms, and Diagnosis

November 7, 2023

In a bustling playground filled with laughter and chatter, Mia stood apart, her eyes fixated on the spinning leaves. At first glance, it might seem like she was lost in her world, but to those who knew her well, it was a subtle sign of something more profound. Mia’s story is just one of many, shedding light on the often overlooked signs of autism in girls.

This article explores girls’ unique manifestations and challenges on the autism spectrum, offering a deeper understanding of this diverse and complex condition.

Autism in Girls: Signs, Symptoms, and Diagnosis

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What Are the Signs of Autism in Girls – Is Asperger’s in Girls Overlooked?

How Common is Autism in Girls?

Information from the Centers for Disease Control and Prevention (CDC) suggests autism spectrum disorder (ASD) affects 1 in 36 children in the United States across all ethnic groups and is four times as prevalent in boys than in girls. Various evidence now suggests this is inaccurate, and more girls are living with ASD than people realize. 

Autism Spectrum Disorder (ASD) is characterized by social communication and social interaction difficulties, according to the DSM-5 classification system. However, recent research published by the Journal of Autism and Developmental Disorders suggests that the criteria for diagnosis are based on scientific evidence of autism in boys. As a result, diagnosing girls with autism usually occurs later in their development than 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 lives. Depending on the extent and severity, these challenges can cause psychological strain for young girls and their families.

To help girls on the spectrum receive an autism diagnosis quicker, parents need to be aware of the possible signs of autism. So, how does autism appear in girls?

Signs of Autism in Girls

Autism spectrum disorder is sometimes described as a “boy” thing, as more boys are diagnosed than girls. This could be because the diagnostic criteria for autism are fundamentally based on research on 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, compared to boys, to interact in social settings, and they can often 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, and 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 the different manifestations of autism on the spectrum, some of 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.

Social Skills and Communication Challenges

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.

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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 a 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 ASD, sensory inputs increase the need for self-regulation through stimming, meltdowns, or, in more extreme cases, self-injurious behaviors.

Behavioral Challenges

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

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, Ph.D., was nonverbal for the first three and a half years of her life. She developed her social skills and attained 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 tend to develop special interests and obsessions. The classic stereotypes 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 why girls are missed for diagnosis is that their special interests are often more “socially acceptable” than boys on the spectrum. For example, a teenage girl might develop an intense interest in boys or celebrities. This could be because they highly desire to “fit in” with their peers.

Is Masking the Reason Why Girls Are Missed for ASD Diagnosis?

Some research suggests the reason girls are typically underdiagnosed for autism spectrum disorder is that the current diagnostic criteria do not meet the expression of autism in girls.

A recent study published by Springer cited 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 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 can often “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 can hide and blend in. This is known as camouflaging or masking. The occurrence of masking in girls is due to the cultural pressure to display the “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 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 hands or giving scripted responses to questions, are additional methods of masking based on current studies and clinician experiences.

Typically, girls take on these masking strategies to “fit in” or avoid standing out by adapting to school environments. The ability to mask autistic traits is often learned 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 suggest that girls may be autistic.

Consequences of Masking

According to a 2020 study published by Springer, masking or camouflaging has detrimental mental, physical, and emotional effects. 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.

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What Are the Signs of Autism in Girls – Is Asperger’s in Girls Overlooked?

The Psychological Impact of Late Autism Diagnosis in Girls

Studies published by Springer and SageJournals reported personal experiences of older autistic girls and women who obtained a diagnosis of ASD later in adulthood.

It was reported that some participants stated that 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 girls at a younger age with autism. They did not meet those criteria because they showed capacity for socialization with others.

The act of forging a different identity brought a lot of emotional reactions. They felt anger and regret for all the time spent trying to be different or “be good.” All of that was 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 had experienced one or more mental health difficulties. The most common were anxiety, depression, and eating disorders. Concerning 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.

Benefits of Diagnosis and Recognizing Signs of Autism in Girls

Like 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.

According to Dr. Susan F. Epstein, a clinical neuropsychologist, girls with autism can often end up wondering what’s “wrong” with them, suffer from poor self-esteem and depression, and can become vulnerable to bullying.

Young and adult women 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.

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How to Support Girls with Autism

Many services have been implemented for families and parents with children with special needs. Some of these aim to cater to girls with autism and those with undiagnosed autism who may not understand their symptoms. Let’s explore some suggestions for girls looking for support.

Support Groups or Communities

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.

Reading Books and Articles about the Female Experience of Autism

Many books are written by individuals with special needs or, more specifically, with ASD. One great suggestion is The Spectrum Girl’s Survival Guide – How to Grow Up Awesome and Autistic. It 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 worldwide.

Speaking to 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.

Taking Social Skills Classes

Here, autistic girls learn to cope with 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.

Attending Therapy

Some people believe Applied Behavioral Analysis (ABA) is particularly helpful for young girls (under five), but older girls can also benefit. A method called talk therapy is said to help autistic girls. During psychotherapy, the therapist will present problems to the child and work together to develop 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 them at home, school, or in the workplace.

Girls with co-occurring disorders, such as OCD and anorexia or trauma survivors, may need more specialists on their team. As more girls receive 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.


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 to feel “socially acceptable.”

If parents 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.

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What Are the Signs of Autism in Girls – Is Asperger’s in Girls Overlooked?


Q: What are the early signs of autism in girls?

A: Early signs may include social challenges, communication differences, and sensory sensitivities. These signs often become apparent in early childhood.

Q: How can I seek a diagnosis for my autistic daughter?

A: It’s essential to consult a healthcare professional specializing in autism spectrum disorders. They will conduct assessments and evaluations to determine a diagnosis.

Q: What educational support is available for autistic girls?

A: Autistic girls can benefit from special education services, including Individualized Education Plans (IEPs) tailored to their specific needs.

Q: What are some effective coping strategies for parents of autistic girls?

A: Don’t forget to care for yourself, seek support, and advocate for your child. These are essential coping strategies for parents and caregivers.

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