{"id":367747,"date":"2024-12-04T16:45:03","date_gmt":"2024-12-04T21:45:03","guid":{"rendered":"https:\/\/www.additudemag.com\/?p=367747"},"modified":"2025-01-14T17:16:25","modified_gmt":"2025-01-14T22:16:25","slug":"autism-in-girls","status":"publish","type":"post","link":"https:\/\/www.additudemag.com\/autism-in-girls\/","title":{"rendered":"Autism in Girls: Why Signs of Neurodivergence are Overlooked"},"content":{"rendered":"<div style=\"background-color: #e2edf6; padding: 10px; border-radius: 8px;\">\n<h2>Autism in Girls: Key Takeaways<\/h2>\n<ul>\n<li>Autism in girls is overlooked because symptoms manifest differently across genders, and because of persistent gender bias in clinical and research settings.<\/li>\n<li>Compared to boys, autistic girls are more socially motivated, which may make their social challenges less apparent and thus more likely to be missed by clinicians.<\/li>\n<li>Autistic girls seldom demonstrate repetitive movements, and their special interests are more likely to be seen as typical.<\/li>\n<li>In-depth evaluations are often necessary to identify or rule out autism in girls. Other supports \u2014 from therapy to emotional regulation skill-building \u2014 can significantly help.<\/li>\n<\/ul>\n<\/div>\n<h2>Autism in Girls Looks Different<\/h2>\n<p><a href=\"http:\/\/additu.de\/subscribe\/\" target=\"_blank\" rel=\"noopener\"><img decoding=\"async\" class=\"alignright\" title=\"wrap\" vspace=\"0\" hspace=\"24px\" src=\"\/wp-content\/uploads\/2025\/01\/from-issue-banner-320x60-x2-winter-2024.png\" width=\"336\"><\/a> About one in 36 children in the U.S. is autistic, a diagnosis that is four times more common in boys than in girls.<sup><a href=\"#footnote1\">1<\/a><\/sup> What explains this gender gap?<\/p>\n<p>Science is working to determine factors that may explain autism\u2019s diagnostic prevalence in males, but many clinicians who specialize in <a href=\"https:\/\/www.additudemag.com\/what-is-autism-spectrum-disorder-asd\/\">autism<\/a> in girls and individuals assigned female at birth clearly see that gender bias \u2014 in referrals, diagnostic criteria, and tests \u2014 plays a role in diagnostic outcomes.<\/p>\n<p>Autism is more readily identified in boys than in girls because, historically, the clinical and research focus has been on boys almost exclusively. Many clinicians who are trained in diagnosing autism are unaware how its traits can uniquely manifest in girls. Failing to realize that girls and women don\u2019t always demonstrate the more stereotypical signs of autism, many clinicians end up overlooking behaviors that are indicative of autism. This is part of why girls and women are often diagnosed as autistic later in life than boys.<\/p>\n<h2>Signs of Autism in Girls<\/h2>\n<h3>Social Motivation<\/h3>\n<p>Autism is characterized, in part, by difficulties and differences with social communication and interaction. Some autistic children may have trouble initiating or engaging in social interactions, which can result in them feeling left out or different. Some children, meanwhile, may prefer solitary activities.<\/p>\n<p>Some children may struggle to understand when and how to join a conversation. An autistic child may follow up to a peer\u2019s question with a brief response or with nothing at all, bringing the interaction to an end. Sometimes, conversations and interactions can become one-sided; an autistic child, for example, may not realize that others want to play differently and will continue to insist that everyone play a game according to very fixed rules. Autistic children may also show differences in use of eye contact, gestures, and facial expressions or misinterpret these cues from others.<\/p>\n<p><em>[<a href=\"https:\/\/www.additudemag.com\/signs-of-autism-in-girls-test\/?src=embed_link\">Take This Free Screening Test: Autism in Girls<\/a>]<\/em><\/p>\n<p>Autistic girls may experience all of the above. However, many demonstrate more social motivation \u2014 the drive to understand, connect, and enter relationships with others \u2014 than do autistic boys, which may make their <a href=\"https:\/\/www.additudemag.com\/autism-and-adhd\/\">social challenges<\/a> less apparent and thus more likely to be overlooked.<\/p>\n<ul>\n<li><strong>Autistic girls are more likely to want to fit in.<\/strong> As such, they are more likely to mask (i.e., hide or compensate for autistic traits) and mimic neurotypical behaviors.<\/li>\n<li><strong>Autistic girls are more socially observant,<\/strong> which helps them pick up on details that allow them to better fit in and mask. It\u2019s common for autistic girls to painstakingly study patterns in how people interact to reverse engineer \u201cnormal\u201d behavior.<\/li>\n<li><strong>Autistic girls are often <a href=\"https:\/\/www.additudemag.com\/perfectionism-adhd-not-good-enough-anxiety\/\">perfectionists<\/a>.<\/strong> The urge to fit in and flawlessly mask drives<br \/>\nperfectionistic tendencies. <a href=\"https:\/\/www.additudemag.com\/how-to-deal-with-rejection-rsd-adhd\/\">Sensitivity to rejection<\/a> is also common; when autistic girls stumble and experience social exclusion \u2014 despite their best efforts and desires to make and maintain<br \/>\nfriendships \u2014 the pain of rejection is profound.<\/li>\n<\/ul>\n<h3>Autism in Girls: The Consequences of Masking<\/h3>\n<p>We can\u2019t talk about autism in girls without talking about <a href=\"https:\/\/www.additudemag.com\/adhd-masking-signs-consequences-solutions\/\">masking<\/a>. While masking often emerges as a coping strategy for socializing, especially for autistic girls without intellectual development disorder or who may not have observable behavioral or academic needs, it can create lots of issues, too.<\/p>\n<ul>\n<li><strong>Masking is mentally taxing.<\/strong> Constantly trying to figure out others, understand unspoken<br \/>\nsocial rules, and fit in with changing circumstances is highly exhausting.<\/li>\n<li><strong>Masking interferes with self-understanding.<\/strong> Autistic girls often have trouble tuning into their own needs and emotions because masking has long forced them to suppress their authentic selves. Identity and self-esteem issues are common; some girls don\u2019t even realize when they are masking. Masking can also interfere with friendships, as girls are unable to bring their full selves to these relationships or know what they want in a friend.<\/li>\n<li><strong>Masking can impact clinical evaluations.<\/strong> Autistic girls who have become accustomed to hiding their traits may struggle to express and make sense of their behaviors and experiences, which can interfere with autism evaluations and lead to underdiagnosis or misdiagnosis. (This compounds the gender bias that causes girls\u2019 autistic behaviors to be downplayed.)<\/li>\n<li><strong>Masking can cause health issues.<\/strong> Constantly worrying about blending in with societal norms can turn into <a href=\"https:\/\/www.additudemag.com\/what-is-anxiety-disorder\/\">anxiety<\/a> and other internalizing and physical issues. Many autistic girls tend to suppress their feelings, which causes more mental health challenges.<\/li>\n<\/ul>\n<p><em>[<a href=\"https:\/\/www.additudemag.com\/autism-spectrum-disorder-in-children\/?src=embed_link\">Read: What Does Autism Spectrum Disorder Look Like in Children?<\/a>]<\/em><\/p>\n<h4>Differences in Restricted and Repetitive Behaviors<\/h4>\n<p>Autism is characterized by restrictive, repetitive patterns of behavior, interests, or activities as demonstrated by the following signs:<\/p>\n<ul>\n<li>hand flapping, finger flicking, rocking, and other stereotyped behaviors (or \u201cstims\u201d)<\/li>\n<li>lining up, stacking, spinning, sorting and\/or categorizing toys and objects<\/li>\n<li>echolalia and other forms of repetitive speech<\/li>\n<li>a strong preference for routine; resistance to change<\/li>\n<li>rigid, perseverative thinking; insistence on adherence to rules<\/li>\n<li>highly restricted, fixated interests (i.e., special interests)<\/li>\n<li>hyper- or hyporeactivity to sensory input<\/li>\n<\/ul>\n<p>While autistic girls can show the above signs, these behaviors may manifest differently.<\/p>\n<ul>\n<li><strong>Autistic girls are less likely to demonstrate repetitive movements.<\/strong> When they do, they are more likely to demonstrate different types of repetitive movements than boys, like tapping their fingers or twirling their hair, which can be easily overlooked.<\/li>\n<li><strong>Autistic girls\u2019 special interests are more likely to center on animals, celebrities, or <\/strong><strong>fictional characters<\/strong>, which can seem more socially acceptable and thus less likely to be flagged as a sign of autism.<\/li>\n<\/ul>\n<h2>Autism in Girls: How to Support Neurodivergent Youth<\/h2>\n<h3>Know the Signs \u2014 and Myths<\/h3>\n<p>Early detection is key for autistic girls to receive the support they need so they can develop self-<br \/>\nunderstanding without shame. Parents, educators, and clinicians should be aware of the above signs of<br \/>\nautism in girls and these common <a href=\"https:\/\/www.additudemag.com\/autism-myths-dispelled\/\">autism myths<\/a>:<\/p>\n<table style=\"width: 100%; border-collapse: collapse; margin: 20px 0; font-family: Arial, sans-serif;\">\n<thead>\n<tr style=\"background-color: #f4f4f4;\">\n<th style=\"border: 1px solid #ddd; padding: 8px; text-align: left;\">Autism Myth<\/th>\n<th style=\"border: 1px solid #ddd; padding: 8px; text-align: left;\">The Truth<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"border: 1px solid #ddd; padding: 8px;\">Autistic individuals lack empathy or compassion.<\/td>\n<td style=\"border: 1px solid #ddd; padding: 8px;\">The range of emotional functioning is wide in any population, and autistic individuals can feel deeply.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ddd; padding: 8px;\">Autistic individuals are antisocial. They have no friends (and online friends don\u2019t count).<\/td>\n<td style=\"border: 1px solid #ddd; padding: 8px;\">Autistic individuals, especially girls, are often desperate for friendship but don\u2019t know how to connect or maintain relationships. Online friends should not be disregarded; real and genuine connections exist over the Internet.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ddd; padding: 8px;\">Autistic people lack a sense of humor.<\/td>\n<td style=\"border: 1px solid #ddd; padding: 8px;\">We all appreciate humor differently, and it\u2019s no different for autistic individuals, who have the capacity to be funny and see the funny side of things.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ddd; padding: 8px;\">Autistic individuals can\u2019t make eye contact.<\/td>\n<td style=\"border: 1px solid #ddd; padding: 8px;\">Some individuals don\u2019t struggle at all with eye contact or have trained themselves to keep eye contact. Eye contact can feel intense and stressful for some autistic individuals, and forcing eye contact is never okay.<\/td>\n<\/tr>\n<tr>\n<td style=\"border: 1px solid #ddd; padding: 8px;\">Autistic people aren\u2019t smart and can\u2019t achieve in school.<\/td>\n<td style=\"border: 1px solid #ddd; padding: 8px;\">Autistic individuals have a wide range of intellectual abilities. Some may have intellectual disabilities, while others may be gifted. Many autistic people achieve highly in school, particularly in subjects that align with their interests and strengths. Appropriate support and accommodations can help autistic children succeed.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>Clinicians: Peel Back the Layers<\/h2>\n<p>Clinicians overlook autism in girls, especially in those without intellectual or language disorders, because these girls can be adept at camouflaging. Their symptoms tend to be more internalizing, and they may have trouble verbalizing their experiences and what they need. Even when girls do show signs of autism, to the untrained eye, these girls can appear \u201cnot autistic enough.\u201d<\/p>\n<ul>\n<li><strong>Dig deep.<\/strong> Ask about relationships when evaluating girls for autism. How does your patient experience friendships and connecting with others? How does your patient feel about their ability to make friends and maintain them? How does this experience connect to her self-esteem? What is the toll of social interactions on your patient? Watch for cues that your patient finds social interactions exhausting and effortful. You may need to carry out longer assessments and observe your female patients over time so you can dive deep into their experiences. If they do not show signs of or report impairment across settings, watch for signs of subjective distress.<\/li>\n<li><strong>Screen for comorbid conditions.<\/strong> <a href=\"https:\/\/www.additudemag.com\/adult-autism-symptoms-adhd\/\">Autism and ADHD<\/a> co-occur at high rates, and the symptom overlap cannot be overstated. Anxiety and <a href=\"https:\/\/www.additudemag.com\/slideshows\/types-of-learning-disabilities-overview\/\">specific learning disorders<\/a> are also common.<\/li>\n<li><strong>Actively educate yourself on autism in girls.<\/strong> Seek out training and review the latest literature. Listen and learn from patients with lived experience.<\/li>\n<\/ul>\n<h3>More Ways to Support Autistic Girls<\/h3>\n<ul>\n<li><strong>Seek interventions and supports.<\/strong> From speech, physical, and occupational therapy to <a href=\"https:\/\/www.additudemag.com\/iep-vs-504-plan-adhd-differences\/\">IEPs or 504 plans<\/a>, secure the services that support your child\u2019s individual needs. Medications are available to help support mood and reactivity. Talk to an autism specialist about the best interventions for your child and seek a second opinion if your provider makes you feel disrespected or unheard.<\/li>\n<li><strong>Provide structure and <a href=\"https:\/\/www.additudemag.com\/sample-schedule-adhd-morning-after-school-bedtime\/\">routine<\/a>.<\/strong> Stability and predictability reduce anxiety, stress, and overwhelm in autistic children, who often struggle with rigidity, inflexibility, and stress during transitions.<\/li>\n<li><strong>Support <a href=\"https:\/\/www.additudemag.com\/how-to-improve-executive-function-adhd\/\">executive functions<\/a>.<\/strong> The cognitive skills that allow us to plan, prioritize, organize, manage time, start tasks, and self-regulate are often impaired in autistic individuals and can significantly impact daily functioning. Scaffolding in the classroom and at home can help.<\/li>\n<li><strong>Teach healthy coping skills.<\/strong> <a href=\"https:\/\/www.additudemag.com\/emotional-dysregulation-adhd-video\/\">Emotional dysregulation<\/a> is very much a part of autism. What\u2019s more, girls are socialized to suppress their emotions, which can accumulate and lead to intense emotional outbursts. Autistic girls must be taught emotional awareness, including how to monitor, label, and understand their emotions. Breathing exercises, mindfulness, muscle relaxation techniques, and other strategies can help improve emotional regulation.<\/li>\n<li><strong>Talk about autism from a neurodiversity-affirming standpoint.<\/strong> Viewing autism from a strengths-based perspective can help young girls accept themselves, refrain from masking, and gain the confidence to advocate for themselves throughout their lives.<\/li>\n<\/ul>\n<h2>Autism in Girls: Next Steps<\/h2>\n<ul>\n<li><strong>Get This Free Download: <\/strong><a href=\"https:\/\/www.additudemag.com\/download\/adhd-autism-link\/?src=embed_link\">The ADHD-Autism Link in Children<\/a><\/li>\n<li><strong>Read: <\/strong><a href=\"https:\/\/www.additudemag.com\/understanding-neurodiversity-adhd-and-autism-overlap\/?src=embed_link\">ADHD, Autism, and Neurodivergence Are Coming Into Focus<\/a><\/li>\n<li><strong>Read: <\/strong><a href=\"https:\/\/www.additudemag.com\/autism-myths-dispelled\/?src=embed_link\">4 Autism Myths \u2014 Dispelled<\/a><strong><br \/>\n<\/strong><\/li>\n<\/ul>\n<p><i><span style=\"font-weight: 400;\">The content for this article was derived from the ADDitude ADHD Experts webinar titled, \u201c<\/span><\/i><a href=\"https:\/\/www.additudemag.com\/webinar\/audhd-adhd-autism-women-girls\/\"><i><span style=\"font-weight: 400;\">AuDHD Guidance: Why Autism is So Difficult to Diagnose in Women and Girls with ADHD<\/span><\/i><\/a><i><span style=\"font-weight: 400;\">\u201d [Video Replay &amp; Podcast #511] with Karen Saporito, Ph.D., which was broadcast on June 27, 2024.<\/span><\/i><\/p>\n<hr \/>\n<p><span style=\"color: #c3320b; font-style: Source Sans Pro,sans-serif; size: 9pt;\"><b>SUPPORT ADDITUDE<\/b><\/span><br \/>\nThank you for reading ADDitude. To support our mission of providing ADHD education and support, <a href=\"http:\/\/additu.de\/subscribe\/\" target=\"_blank\" rel=\"noopener noreferrer\">please consider subscribing<\/a>. Your readership and support help make our content and outreach possible. Thank you.<\/p>\n<h3>Sources<\/h3>\n<p><a name=\"footnote1\"><\/a><small><sup>1 <\/sup>Maenner, M. J., Warren, Z., Williams, A. R., Amoakohene, E., Bakian, A. V., Bilder, D. A., Durkin, M. S., Fitzgerald, R. T., Furnier, S. M., Hughes, M. M., Ladd-Acosta, C. M., McArthur, D., Pas, E. T., Salinas, A., Vehorn, A., Williams, S., Esler, A., Grzybowski, A., Hall-Lande, J., Nguyen, R. H. N., \u2026 Shaw, K. A. (2023). Prevalence and characteristics of autism spectrum disorder among children aged 8 years &#8211; autism and developmental disabilities monitoring network, 11 sites, United States, 2020. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C. : 2002), 72(2), 1\u201314. https:\/\/doi.org\/10.15585\/mmwr.ss7202a1<\/small><\/p>\n<button class=\"simplefavorite-button\" data-postid=\"367747\" data-siteid=\"1\" data-groupid=\"1\" data-favoritecount=\"15\" style=\"\"><span class=\"label\">Removed<\/i><\/button>","protected":false},"excerpt":{"rendered":"<p>Autism in girls looks different. Here, learn about the distinct signs of autism in girls and how families and clinicians can support neurodivergent youth.<\/p>\n","protected":false},"author":328890,"featured_media":367798,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[628,919,702],"tags":[1241,703,345410],"coauthors":[345382],"class_list":["post-367747","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-adhd-add","category-autism-spectrum-disorder","category-related-conditions","tag-diagnosing-kids","tag-treating-kids","tag-winter-2024"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/i0.wp.com\/www.additudemag.com\/wp-content\/uploads\/2024\/12\/pexels-karolina-grabowska-8003527.jpg?w=1920&crop=0%2C0px%2C100%2C1280px&ssl=1","amp_enabled":true,"_links":{"self":[{"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/posts\/367747"}],"collection":[{"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/users\/328890"}],"replies":[{"embeddable":true,"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/comments?post=367747"}],"version-history":[{"count":14,"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/posts\/367747\/revisions"}],"predecessor-version":[{"id":369925,"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/posts\/367747\/revisions\/369925"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/media\/367798"}],"wp:attachment":[{"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/media?parent=367747"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/categories?post=367747"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/tags?post=367747"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.additudemag.com\/wp-json\/wp\/v2\/coauthors?post=367747"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}