Autism in Girls: Signs, Symptoms and Underdiagnosis

Autism in girls may look different than in boys. Sometimes, caregivers and even healthcare providers may doubt that a female child is autistic because they do not show traits typically associated with autism. This is because these traits were largely based on research focused on boys.

Autism traits common in females, particularly those with low support needs, include:

• Relying on other people to guide or speak for them
• Having unusual sensitivity to sensory challenges
• Having passionate but limited interests
• Challenges in making and keeping friends
• Having conversations limited to their own topics of interest
• Differences with social communication (which increases with age)
• Choosing behaviors that seem to be shy, quiet, or unusually passive
• Having symptoms of anxiety or another co-occurring mental health condition
• Challenges with controlling emotion
• A history of epileptic seizures

It's true that autism traits in girls and women are not always the same as those identified in boys and men. This means that females may not get an autism diagnosis until much later in life—if ever.

This article will go over how autism is different in girls. You'll learn about autism traits in girls and women, as well as how the differences in autism between girls and boys can delay diagnosis.

Autism Traits in Girls

No single trait can define an autism diagnosis, regardless of a person's sex at birth or gender identity. Yet there are some characteristics of autism that can help providers make the diagnosis.

That said, autistic girls may not show some of the "classic" traits that are more often seen in boys. Sometimes, girls learn how to mask autistic traits or overcompensate for them, in order to appear more neurotypical (or seemingly "normal") to others.

Whether you are female and think you might be autistic or you are caring for a child who may be living with an autism spectrum disorder (ASD) there are some experiences that are shared and resonate with many autistic girls and women.

An autistic girl may:

• Rely on other children to guide and speak for her during the school day.
• Have passionate but limited interests. The list of things that interest her is narrowed. For example, an autistic child may talk endlessly about a TV show's characters, locations, props, or actors, but know little or nothing about the show itself (e.g., the plot).
• Have conversations that are limited to her topics of interest. She may share her focus on a specific interest with you but remain disinterested in another person's response. This may interfere with her ability to join groups or make friends.
• Be unusually sensitive to sensory challenges such as loud noises, bright lights, and strong smells (a common trait in autistic people regardless of sex).
• Have a low frustration level and find it hard to manage feelings when she is frustrated. She may have inappropriate outbursts of temper for her age—sometimes called autistic meltdowns. Disruptive behavior at school may lead to detentions or even suspension.
• Have different behavior at home and school: Some autistic kids may spend so much energy trying to cope and trying to follow what is expected of them at school and then may release it with meltdowns at home. Other kids may thrive on a routine at home and then have difficulty functioning at school.
• Have depression, anxiety, or other mental health symptoms. Autistic people of all ages often have co-occurring mental health conditions, including obsessive-compulsive disorder (OCD) and eating disorders.

Some autism traits can be perceived as being part of a young girl's personality, or just "quirks" in how she connects with others.

In fact, these can be subtle but missed traits in autistic girls:

• She has a hard time making or keeping friends. She may seem to miss nonverbal social cues or demonstrate a disconnect on how the girls around her behave.
• She is called "quiet" or "shy" in school and other social situations. Autistic people have varied language skills, but some challenges can make it harder for a child to jump into talks with friends, raise their hand in class, or respond quickly in social settings.
  
• She is unusually passive. Being passive can be a sign that she's unsure what to do or say in a situation and has decided the safest option is to do nothing. Some autistic people are actually quite assertive, but young girls may learn that being passive is more likely to be accepted or rewarded, especially at school.

• She developed typically as a child but starts to find social communication increasingly difficult as she enters her teen years. Autistic girls often find ways to mask and cope with their differences early on. However, once social expectations become more complex in the early teenage years, her challenges with neurotypical behavior can become a lot more clear and harder to manage (or hide).
• She has epileptic seizures. Some research has suggested that epilepsy could be more common in autistic girls than boys.
  

There is also some research to suggest that autistic girls may not identify as readily with conventional gender norms and have higher rates of gender variance. For example, they may not identify as female or may be more likely to feel negatively about their assigned gender group. However, more research is needed.

Why Autistic Girls Go Undiagnosed

Some girls have clear traits of autism, like self-stimulating behaviors (stims) or extreme speech and language difficulty.

If challenges with social communication or cognitive tasks are obvious, girls are usually referred for help and diagnosed at a young age. However, for girls with subtle traits and those who have learned to mask, autism may not be diagnosed—or even discussed—until they are pre-teens, teens, or adults.

Cultural beliefs (and misbeliefs) also contribute to missed autism diagnoses. Many girls are expected to behave in quieter and less assertive ways than boys. A girl who seems shy and withdrawn might be seen as "feminine," while a boy with the same characteristics would get intervention because they are not exhibiting more outward "boy" behavior.

Similarly, a girl who often seems lost in thought may be called a "dreamer" in a positive way, but the same behaviors might be viewed as disruptive in boys and, again, would lead to intervention.

Healthcare providers and mental health professionals can miss autism in girls, too. The diagnostic criteria for ASD were put together based on available research, which has long been primarily focused on boys and men.

Strides are being made to help make the criteria more inclusive for autistic people who are not male, but there is still a long way to go.

Summary

Autistic girls and women may not get diagnosed as early as boys and men—if they are diagnosed at all. The "classic" autism traits do not always show up in girls, and some girls learn how to cover up their autistic traits at a young age.

There are many factors that contribute to the missed and misdiagnosed autism in girls, and some of them have to do with cultural expectations. Not only does this make it harder for autistic girls to get diagnosed, but it also means they go longer without the support they need to thrive.

A Word From Verywell

Gender stereotypes and a predominance of research on male patients have given females a disadvantage when it comes to readily diagnosing autism. This can be improved by knowing the signs and symptoms and advocating for yourself or your child if you have a suspicion of autism.

— NICHOLAS R. METRUS, MD, MEDICAL EXPERT BOARD