The Hidden Struggle: Understanding Autism in Girls

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent challenges with social interaction and communication, repetitive behaviors, and restricted interests. While it was once thought that ASD primarily affects boys and men, we know now that many girls and women with ASD have historically gone undiagnosed or misdiagnosed. 

Lack of diagnosis can mean that girls and women with ASD don't have the critical skills they need to navigate the world and social situations as they get older. It could impact self-esteem and mental health, too. Learning about Autism in girls can be empowering, leading to a greater chance of diagnosis and appropriate accommodations, self-care, and support.

This article will cover information parents should have about ASD in girls, starting with the current landscape of ASD diagnosis and the unique challenges faced by girls with ASD. We'll also talk about gender differences in support and intervention, as well as strategies to improve diagnosis and support for autistic women and girls in the future. 

The Current Landscape of Autism Diagnosis

If you look at current ASD statistics, you'll notice that more boys and men are diagnosed than girls and women. Right now, the Centers for Disease Control (CDC) suggests that about 1% of girls and 4% of boys have ASD. Recent Autism research indicates that ASD is likely underdiagnosed in women and girls. This suggests that the gender gap in ASD diagnosis could be due to misdiagnosis and lack of awareness of ASD in women in girls rather than a higher prevalence of autistic boys and men. 

Challenges in identifying Autism in girls

Why have so many women and girls gone undiagnosed up until this point? Differences in symptom presentation are one possible reason. For example, special interests are common in autistic people and can refer to an intense, fixed, or obsessive interest in any subject. Girls with ASD might be fixated on a subject aligned with gender norms, such as a favorite singer, actor, or animal. Differences in presentation paired with other challenges regarding diagnosis could lead girls to go undetected. 

Other possible challenges of identifying Autism in girls may include but aren’t limited to the following: 

• "Masking" or hiding symptoms to fit in. Autistic girls and women are more likely to camouflage ASD symptoms by mimicking the behavior they see in other people. 
• Gender stereotypes and bias. While ASD symptoms can differ among girls, some of the same symptoms may be perceived differently in autistic boys due to gender stereotypes. For example, if a girl is highly emotional due to sensory discomfort, she could be called "dramatic," whereas the same label may not be used for a boy.
• Misdiagnosis of other disorders. Many autistic girls and women have been wrongly diagnosed with another disorder, such as a mental health condition. Alternatively, women and girls may have co-occurring mental health conditions, and their symptoms may be chalked up entirely to a mental health condition, even if ASD is also present.

Girls with ASD may face unique challenges both in the diagnostic process and in daily life. Being aware of potential hardships and obstacles matters for anyone supporting autistic children and adults. 

Unique Challenges Faced by Girls with Autism

Autism is a spectrum not in "how autistic" someone is but in the diverse range of ways a person with ASD may fit the criteria for the disorder. Parents may need to look for symptoms closely. For those with teenage girls, it may be essential to consider what she was like at a young age.

Social communication difficulties

Early social development differences mean that autistic girls often learn to mask social and communication-related symptoms of ASD well, so not all social and communication difficulties will exist on the surface. All autistic people show symptoms in a different way. However, here are some examples of what you may notice:

• She takes things literally.
• She has a preference for alone time or favors one or two close friends.
• Her own facial expressions are either atypically intense (she is very emotionally expressive) or less expressive than others.
• She uses scripted responses, possibly copying movie, TV, and book characters, parents and siblings, or other kids.
• She has difficulty picking up on social cues, including non-verbal cues like gestures and facial expressions.
• She talks excessively about a special interest or goes on tangents.
• She speaks more loudly or softly than others.
• She is often "in her own world."

Autistic girls may become attached to some people and are sometimes called “shy.” A girl with ASD might make social blunders, not understanding what she did wrong. Early signs of ASD sometimes include poor eye contact and either limited speech or advanced language skills. Not all autistic people experience these symptoms, potentially making the diagnostic process even more challenging. Additionally, some people experience these symptoms but do not have ASD.

Sensory sensitivities

Around 90% of autistic people have atypical sensory experiences. What many people don't know is that this can refer to hypo (under) or hyper (over) sensitivity. Autistic people may experience sensory sensitivities in the form of an aversion to certain fabrics, tastes, food textures, scents, noises, or physical touch. 

However, one could also experience under-sensitivity to some stimuli. For example, some autistic people have a high pain tolerance or may not pick up on certain bodily needs, like needing to eat or being too hot or too cold.

Repetitive behaviors and restricted interests

Repetitive behaviors are extremely common Autism traits, and they can manifest in different ways. Examples of repetitive behaviors include but aren't limited to:

• Hair twirling.
• Rocking or swaying.
• Biting nails or tapping hands.
• Singing or humming.
• Repeating words or phrases.
• Flapping hands or shaking arms.
• Jumping or bouncing. 
• Pacing. 

Other possible signs of Autism include inflexible adherence to routines or insistence on sameness. Your child could have routines she is insistent on adhering to, where she may have a hard time with change and transitions.

Masking and camouflaging behaviors

We’ve talked a little bit about what masking can look like—for example, repeating words and phrases others have said. Sometimes, this could serve a girl with ASD well. That said, even if rarely, there are also times when she may use those words and phrases out of context, leading to confusion from others. 

Another example of autistic masking is using eye contact or facial expressions well because she knows she is supposed to. Especially as she gets older, she might learn not to use repetitive behaviors that are less socially accepted, or she may stop talking about special interests as a form of masking. Sometimes, this can be due to bullying, which is imperative for parents and teachers to look out for and address. 

Gender Differences in Support and Intervention

While autistic girls may have different challenges, it doesn't mean that they have less. Differences in symptom presentation could mean that typical intervention strategies aren’t the right fit for some girls, leading to a need for tailored support. Additionally, if female children and teenage girls have ASD, it may impact their other mental health needs and the way parents can best address social issues that could affect them now and in the future.

Importance of tailored support for girls with Autism

Since autistic traits can present differently from person to person and there’s no singular treatment path for people with ASD, it's important that girls get support catered to their whole-person needs. Help with communication and social skills, executive functioning, and day-to-day tasks, for example, can be crucial for girls with ASD. Treatments like occupational therapy, speech therapy, social skills training, and applied behavior analysis (ABA) can be targeted to fit the needs of an individual.

Providers versed in working with autistic females can better support women and girls with ASD. If you have an autistic female child, it may be helpful to look for a therapy provider who has experience in working with female autistic children. If your child may have ASD but does not yet have a diagnosis, look for a provider who is versed in diagnosing females with ASD.

Treating co-occurring disorders and addressing social issues affecting girls

Many people with ASD have multiple diagnoses, including mental health conditions. However, if a girl with ASD doesn't get diagnosed, she may not get the right support both for ASD and any other co-occurring conditions she has. In mental health therapy, for example, an individual must be understood as a whole person. If ASD is missed, challenges like alexithymia, difficulty with social cues, and sensory issues that lead to certain behaviors may never be addressed appropriately, so the girl might not get the help she needs.

Understanding social issues that disproportionately affect women and how to address or prevent them in autistic girls is crucial. For example, research suggests that about 9 in 10 autistic females experience sexual violence. Accordingly, it’s vital that autistic girls are taught how they should be treated, behavior they should not accept from others, and how to speak up about sexual violence if they encounter it. 

Strategies for Improving Diagnosis and Support for Girls with Autism

Early intervention can be vital for people with ASD, leading to outcomes like greater self-understanding, social and communication skills, functioning, and quality of life. Many autistic women and girls who go undiagnosed develop serious mental health problems after spending their lives attempting to fit in, wondering why they are different, or not having the skills necessary to navigate daily life as an autistic person. Here are some things we can do to improve diagnosis and support for girls with ASD.

Increasing awareness and education about Autism in girls

Increased awareness in the general population means that parents can better detect Autism symptoms in girls at a young age. Caregivers who suspect ASD in a female child can benefit from learning about all of the unique ways ASD can present. Many late-diagnosed women are now advocates for the condition, talking about autistic traits adults missed when they were a child, life experiences, hardships, and ways to support girls with ASD.

Training healthcare professionals to recognize and diagnose Autism in girls

Unfortunately, many parents of autistic females find that they have to do intense advocacy work to get their child diagnosed. Adequate training for healthcare providers that details common gender differences in ASD presentation, masking behaviors, and the impact of undiagnosed ASD is vital for higher rates of accurate autism diagnosis.

Targeted interventions and support services for girls with Autism

Now that we know more about the gender gap in neurological and developmental disorders like ASD and ADHD, the hope is that female autistic children, teens, and adults are considered in future intervention and support services. Organizations and support groups for autistic females and their loved ones can be an advantageous space for sharing or finding helpful information and resources.

Conclusion

Autistic girls and women with Autism Spectrum Disorder (ASD) often go undiagnosed or undetected. This can lead to problems like lower access to important support services, increased mental health issues, challenges in social situations and interpersonal relationships, and a lower quality of life. Thankfully, this disparity is starting to change due to increased awareness surrounding Autism in girls.

Moving forward, it's imperative that we see improved diagnosis and treatment outcomes for women and girls. Catering diagnostic and intervention services to the individual needs of female autistic children can help them get necessary support and avoid the possible challenges of misdiagnosis or lack of diagnosis.