What Are the Signs and Symptoms of Autism in Girls?

The signs and symptoms of girls with autism can be recognized in the Diagnostic Statistical Manual (the book that mental health professionals use to make psychiatric diagnoses known as DSM-5).

Even though many girls with autism may present differently from boys with autism, the symptom criteria that any child must meet to receive an autism diagnosis are the same regardless of gender.

The official diagnosis for autism is “autism spectrum disorder” (or ASD). Some of the early symptoms and signs of Autism include:

Delays in social skills, social interactions, and language, including

• Not maintaining eye contact
• Not responding to their own name
• Not showing facial expressions
• Not having shared interests with others by the time they’re a year and a half
• No pretend play by 2 years old

Restricted and/or repetitive behaviors, like:

• Flapping hands, rocking back and forth, etc.
• Lining up toys or objects
• Obsessive and narrow interests
• Having strict routines and becoming upset by any changes

But experts are now saying that this framework for understanding and diagnosing autism may be based more on boys with autism than girls.

For example, research shows that boys with autism tend to show more repetitive behaviors (like flapping their hands) than girls with autism do.

Some additional signs of autism in young girls could be:

• Depending on her classmates or being “mothered” by her classmates to show her the ropes at school
• Mirroring, or copying others’ speech and behaviors in an effort to fit in
• Having an intense and narrow set of interests, which may seem typical for a girl (like horses or princesses)
• Displaying self-stimulating behavior (aka stimming)
• Being very shy or withdrawn in social situations
• Struggling with social communication at school or with friends
• Having few to no friendships, or intense friendships that last for a short time
• Forcing themselves to show social cues like smiling or maintaining eye contact
• Keeping it together during school, only to have emotional meltdowns or tantrums when they get home
• Low self-esteem or mood issues like depression

Why girls are commonly misdiagnosed

Girls with autism often go undiagnosed (or misdiagnosed) until adolescence or even adulthood. Reports show that girls receive an autism diagnosis an average of 2 years later than boys do.

When girls with autism are misdiagnosed, they don’t get the treatment they need. Early diagnosis and intervention are essential to help people with autism learn how to live well with their symptoms into adulthood.

One reason that girls with autism seem to fall through the cracks so often is because of bias. This is similar to what happens with girls who have ADHD. Adults, including parents, psychologists, doctors, and educators, tend to think of autism as something that mostly boys live with.

Even when girls are showing autism symptoms, professionals might be more likely to explain them away. For example, they might say that a girl’s intense interest in unicorns is normal for her age. Girls could also get misdiagnosed with other mental health conditions like ADHD or anxiety.

Autism research has largely been centered on boys (especially white boys). That means that we can only say we truly understand autism as it presents in this population. Autism can show up differently in girls as we talked about above. The signs that girls present with could be overlooked or misread.

Lastly, girls also tend to be better at masking their symptoms. Because of societal gender expectations and other reasons, girls realize that their symptoms aren’t “normal.” They might try to mimic the behaviors of their neurotypical peers to try to fit in or be more accepted.

Some common ways girls with autism mask their symptoms include:

• Smiling back at others
• Forcing themselves to maintain eye contact
• Keeping their interests to themselves
• Relying on peers to guide them at school

Although these things can be coping skills in some ways, they can also get in the way of autistic girls receiving the correct diagnosis and treatment.

Types of autism

Currently, people with autism are diagnosed with an autism spectrum disorder. We now understand that autism is on a spectrum with different levels from high-functioning to low-functioning.

The level of severity (measured by the amount of support needed to function in daily life) is also noted in the diagnosis.

Before 2013, autism used to be divided into 4 subtypes.

These different "types of autism” were:

1. Asperger’s syndrome
2. Childhood disintegrative disorder
3. Pervasive developmental disorder, not otherwise specified
4. Autism (autism spectrum disorder)

However, these terms are now outdated, and healthcare professionals no longer use them. All of these subtypes are now classified under the umbrella diagnosis of autism spectrum disorder.

Causes of autism in girls

The exact causes of autism spectrum disorder are unknown, although we do know about some factors that seem to contribute to the likelihood that a child will have autism. These aren’t causes, but contributing factors. Scientists are still doing research to narrow down what causes autism in kids of any gender.

Note: The research unequivocally has found that childhood vaccines do not contribute to a higher likelihood of having autism.

Researchers say that a combination of genetic and environmental factors usually leads to autism spectrum disorder. Autism tends to run in families, and specific gene changes in the parent or the embryo can cause a child to develop autism.

Some researchers say that females could have some genetic protection against this likelihood, which might explain why so many more boys are diagnosed with autism than girls. However, it’s important to remember that many different factors, like bias, also contribute to this difference in diagnosis.

Some non-genetic factors have been linked to a higher risk of a child developing autism, such as:

• Advanced parental age
• Low birth weight or extreme prematurity
• Multiple births (twins, triplets, etc.)
• Multiple pregnancies within a short timeframe (less than a year apart)

None of these factors, on their own, cause autism directly. They are just some factors that have been linked with a higher chance.

How to seek an autism diagnosis

Talk to your child’s pediatrician for medical advice if you think they may have autism spectrum disorder. You can also talk to a mental health professional or caregiver at your child’s school, like a school psychologist, for support in setting up an evaluation.

Bottom line

Many girls with autism may not receive the proper diagnosis because of the bias that exists during evaluation and treatment. Although girls with autism sometimes present differently than boys, it’s important to monitor your child’s behaviors and traits.

This article is for informational purposes and is not a substitute for individual medical or mental health advice. Please consult with your or your child's prescribing doctor before changing, starting, or stopping a medication routine.