Autism & Girls

Autism in Girls: signs, symptoms and under-identification

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.

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 behaviour at school may lead to detentions or even suspension.
Have different behaviour at home and school: Some neurodivergent children 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 neurodivergent children may thrive on a routine at home and then have difficulty functioning at school.5
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 behaviour 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 unidentified

Some girls have clear traits of autism, like self-stimulating behaviours (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” behaviour.

Similarly, a girl who often seems lost in thought may be called a “dreamer” in a positive way, but the same behaviours 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.

https://www.verywellhealth.com/signs-of-autism-in-girls-260304

Autistic female friendships

– Published on 13 February 2018- Author: Felicity Sedgewick

Felicity Sedgewick, a researcher at the BEACON Project King’s College London, discusses her own and others research into the friendship and relationship experiences of autistic girls and women, highlighting the benefits of an early diagnosis on feelings of self-assurance.

Autistic female friendships: what we know, and what we can do

Most of us have friends. Generally, we like to form close relationships with other people, to build trust, to have fun together, to rely on each other when life is difficult, and to share our joy when life is great.

In early autism research however, there was an assumption that the above statement was not true for autistic people. ‘Autism’ came from ‘auto’, meaning self, and the implication was that autistic people were more interested in their own world, did not particularly want friends, and may even be incapable of doing so.

Thankfully we have moved far past these assumptions, and there is a wealth of work examining the friendships and social lives of autistic young people (Bauminger et al, 2008; Locke et al, 2010; Petrina et al, 2014). We know that autistic adolescents do want friends, usually have them, and are generally satisfied with the friendships they have – even if they don’t look exactly like the friendships of their neurotypical peers.

This research has generally been carried out with male participants though, due to a long-standing under-recognition of autism in girls and women. We know that in neurotypical people there are notable gender differences in friendship: women talk more; are more emotionally supportive; have fewer, closer friends than men; and engage in socially subtle aggression.

Are these gender differences also true for autistic people?

What do we know?

Autistic girls are usually more socially motivated than their male counterparts – they tend to be more interested in making and maintaining friendships (Calder, Hill, & Pellicano, 2012; Sedgewick et al, 2016). They are likely to have more friends than autistic boys, and be more included in the classroom (Dean et al, 2014). They tend to talk with their friends, rather than focussing on shared activities, something which both autistic and neurotypical boys do (Kuo et al., 2011).

For my PhD, I carried out three studies which examined friendship and relationship experiences of autistic girls and women. In my adolescent study with secondary school students, autistic and neurotypical boys and girls completed questionnaires about their friendships and about bullying, and they took part in an interview about these things too.

I then carried out a similar study with autistic and neurotypical women, including questions about their friendships when they were teenagers and how things had changed. Finally, I interviewed the parents of autistic girls to learn what they thought about their daughters’ friendships, and what their concerns were for the future, if any.

My research (awaiting publication) showed that teenage autistic girls have best-friendships which they rate as just as close as those of neurotypical girls. Autistic girls tended to have one or two best friends rather than a larger group, which is different to neurotypical girls, but their friendships were distinctive from the friendships of autistic boys.

For all these positives though, one difficulty was clear – autistic girls were more often the target of relational conflict (being gossiped about, or left out) than neurotypical girls. They found it difficult both to understand this, and to know how to respond to it effectively.

What about autistic women?

Many of the similarities between autistic and neurotypical girls continue to be present in adulthood, according to women in my research. Autistic women are similarly likely to be:

in romantic relationships
to be mothers
to be employed
to have friends.

The patterns of these relationships are like those of autistic girls – autistic women tend to have one or two close, intense friendships. Their romantic partner is often their main relationship, sometimes acting as a ‘social gatekeeper’, meaning that they socialise mainly with their partner’s friends. Autistic women were happier and more secure in their friendships and relationships than they had been as teenagers. They attributed this increased self-assurance to receiving an autism diagnosis in adulthood, providing an explanation for their differences.

Unfortunately, some of the difficult aspects of relationships in adolescence continue into adulthood too. Autistic women described struggling with office or school-gate politics, finding the tactics other women use to ‘get ahead’ both baffling and pointless (as they may well be!).

More worryingly, most autistic women I spoke to had experienced sexual assault or domestic abuse in the past, although all were in good relationships now. They themselves often attributed this to difficulties understanding other people’s motivations towards them, and an assumption that people would ‘play by the rules’.

So, what next?

Reassuringly, assault and abuse weren’t problems among the adolescent autistic girls I worked with, and many parents (who I also interviewed) were actively trying to talk about safe relationships with their daughters. Hopefully, as the current generation grow into adult women, they will face fewer challenges because they know they are autistic and are learning what they need from their relationships.

Despite some of the worrying findings of my research, my take-away message would be this: some autistic girls and women have friendships and relationships which are in many (but not all) ways like those of neurotypical girls and women, and which are different to those of autistic boys.

The Curly Hair Project

https://thegirlwiththecurlyhair.co.uk/
https://thegirlwiththecurlyhair.co.uk/resources/e-learning/

Clarke, H (2022) Supporting spectacular girls. A practical guide to developing autistic girls’ wellbeing and self-esteem. Jessica Kingsley Publishers

Autism and Masking – How and why people do it, and the impact it can have’. Dr Felicity Sedgewick, Dr Laura Hull and Helen Ellis – 2022.

The Secret Life of Rose: inside an autistic head Paperback – 16 Feb. 2021 by Rose Smitten

Autistic Girls Network Reasonable adjustments
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The Bridge- ASD Communication and girls
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