In the past, people thought that many more boys than girls were autistic. Diagnoses of autism spectrum disorder among girls and women were very rare and diagnostic criteria for autism tended to reflect the traits presented by men and boys. However, we now know that there are many non-binary people, girls, and women on the autistic spectrum.
Although things are slowly changing for the better, many women and girls are still often undiagnosed or misdiagnosed. There are several reasons that this might happen. While it’s understood that symptoms of autism present differently in girls than boys, the diagnostic criteria for autism remain biased towards the experiences of boys with autism. Some professionals may not have an adequate understanding of how to recognise autism in girls, leading to missed diagnoses. Others fail to see even clear signs of autism because they assume that girls are unlikely to be autistic.
In this blog, we explore the reasons that autism often goes unnoticed in girls. We also outline how autistic girls might behave differently from boys, why this can happen, and how to recognise autism in girls, women, and non-binary people.
Why Are More Men and Boys Diagnosed As Autistic?
It’s still not clear what the prevalence of autism is across the gender spectrum. Estimates of the ratio between men and women are getting closer and closer all the time. A 2017 study estimated that three men meet the criteria for autism for every one woman – but that actual diagnosis rates are lower.
The difference in diagnosis rates between men and women may partly be explained by genetic and environmental factors that mean men are more likely to be autistic. However, researchers now realise that many autistic women and girls are simply missed. Challenging this trend is important: missed diagnoses can act as a barrier for autistic girls from understanding their experience of the world and receiving the support that they need.
While experts have put forward several theories that could explain the diagnosis gap, none have been conclusively proven so far. It’s likely that multiple explanations may be at play, contributing to the reality that we see today.
Some of these theories include:
Female Autism Phenotype
The female autism phenotype is the idea that autistic women and girls have characteristics that are different from the traditional profile of an autistic person, something that is based on the experiences of boys and men. For example, women and girls may have more social skills, tend to internalise their emotional difficulties, and be more likely to camouflage autistic traits.
While most aspects of the proposed female phenotype fit into current diagnostic criteria, they may be expressed in ways that exclude them from traditional methods of diagnosing autism. Moreover, because research on autistic girls and women is still lacking, autistic females may show other traits that are not included in any criteria.
Autism Assessment Biases
Autism assessments used to diagnose men, women, non-binary people, and other gender identities may be based on implicit biases that make them less sensitive to the traits of autistic women and girls.
Camouflaging, also known as masking, is when autistic people learn to hide autistic traits from others around them. Young people may make a conscious decision to mask certain characteristics to feel more accepted by friends or other parts of society. Masking can also be subconscious, such as when a young person learns by mirroring how other people act.
Researchers think that girls and women are more likely to camouflage autistic traits than men and boys, although it can happen in all gender identities. While the mechanisms behind masking are still not clear, some theories suggest women and girls may experience greater social pressure to conform, making it more important for them to learn the ‘right’ behaviours from others. Some researchers think that genetic differences may make it easier for girls to compensate for difficulties that come from autistic traits.
Camouflaging can take many different forms. Some examples include:
- copying facial expressions of the person you’re talking to
- forcing yourself to make eye contact
- stopping talking about an interest even when you’d like to continue
Researchers think that masking can be exhausting for autistic people, causing high levels of social stress and anxiety. In many cases, these experiences are a sad consequence of a lack of acceptance for and understanding of neurodiversity in a society that often forces autistic people to hide their true selves.
What Does Autism Look Like in Women and Girls?
Autistic women and girls may have different traits from other autistic people. They may:
- Appear to have fewer social difficulties than men and boys and be more socially motivated
- Be more likely to move in and out of friendship groups like other girls their age
Autistic women and girls may also express some of the core characteristics of autism in a way that is more accepted by society or less likely to be noticed. For example, girls may show:
- Highly-focused interests, but directed towards reading books or playing with dolls, rather than stereotypes of autism such as an interest in trains
- Repetitive behaviours like twirling their hair, as opposed to the stereotype of rocking back and forth
Different autistic individuals can behave in different ways, depending on their personality, environment, and how they have been socialised. While there is great diversity in autistic traits within every gender identity, there are some traits and experiences shared by many autistic women and girls. These include:
- Relying on others to speak on their behalf
- Unusual sensitivity to sounds, light, and other sensory experiences
- Having a narrow range of passionate interests
- Difficulty maintaining friendships
- Difficulty controlling emotions
- Behaving differently at home and at school – this can may happen when an autistic person puts a lot of energy into following social norms at school and releases the built-up tension at home
- Experiencing anxiety, depression, or other mental health symptoms
Autistic girls may be missed by teachers, parents, and other adults because they control their behaviour more in public. They may smile or make a bit more eye contact, causing adults around them to overlook other signs of autism. Girls can often get by through imitating what’s going on until they enter early adolescence. They then usually begin to struggle with more complicated social rules and less accepting attitudes from peers.
Autism and Misdiagnosis
Autistic girls and young women may be misdiagnosed with ADHD or mental health conditions like anxiety and depression.
Symptoms of ADHD and autism sometimes overlap. While inattention is usually characteristic of ADHD, some children with the disorder may hyperfocus on a particular activity in a similar way to an autistic person. Young people with both ADHD and those on the autism spectrum may find it difficult to enjoy other people’s interests or react to their emotions. If a young girl is diagnosed with ADHD, symptoms of autism are often missed, even when they meet the criteria.
Autistic people often develop mental health conditions through their struggles to navigate a world that doesn’t accept or try to meet their needs. Austistic women may be diagnosed with these conditions, but the autistic traits that lie underneath their emotions and behaviours are sometimes missed. Sadly, this often means that treatment for mood and other disorders is often ineffective and fails to recognise their true needs.
The Harm of Missed Diagnoses
Undiagnosed autistic people often go through life feeling like something is wrong with them, leading to feelings of low self-esteem, anxiety, and depression. They may also continue to mask autistic symptoms, sometimes unconsciously, causing social anxiety and preventing them from embracing their true selves.
Missed diagnoses also mean that young people can’t access opportunities for skill-building that can make it easier for them to form relationships and navigate daily life. Autistic people often want to make friends but need to be explicitly taught the social skills required to interact with others successfully. While it is possible for autistic people of all ages to learn these skills, they benefit most from interventions at younger ages. When autism is missed, young people are not given the support they need to manage and experience these valuable parts of life.
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