Autism In Girls: Signs, Diagnosis & Support

Autism often presents differently in girls than in boys, which can lead to a higher chance of underdiagnosis. Historically, autism spectrum disorder (ASD) and its manifestation has not been as extensively studied in females, as it has with males, largely because most clinical research has been male-focused.[1]

In recent years, increasing attention has been directed toward understanding how autism presents in girls, as their experiences often differ from the traditionally male-centred perspective of the condition.

2015 Study (source: ABS)

Understanding these differences will lead to better identification, assessment and treatment approaches, ultimately enhancing healthcare for both males and females with ASD.

Why Are Girls Underdiagnosed?

Let’s explore in a bit more detail, why girls are underdiagnosed:

• Autism has traditionally been seen as a condition that mostly affects males.
• Females with autism are often under-recognised, partly due to gender stereotypes that assume autism is primarily a male condition.
• Some autistic girls and women may not be diagnosed because they display a “female autism phenotype,” which doesn’t align with the male-focused view of autism.
• Educators, who often play a key role in referring children for autism assessments, may contribute to this under-recognition due to potential biases.
• A study tested whether educators are more likely to identify boys as autistic compared to girls with the same symptoms, and whether children showing a “male” presentation of autism are more likely to be recognised than those with a “female” presentation.[3]
• Results showed that primary school educators are more likely to identify boys and those with a male-type presentation as autistic.
• Girls with ASD often have a stronger desire to form friendships and fit in socially. This can make their symptoms less apparent, as they might work hard to be socially successful (e.g., masking), even if it’s challenging for them.
• Passivity may be perceived as shyness in girls rather than avoidance. They may also mimic others by masking their behaviour and develop strategies to compensate for social deficits.

What are the Signs Of Autism In Girls?

When it comes to ASD in girls, the signs can often be more subtle and different from those typically observed in boys.
Girls with ASD may exhibit traits that are less obvious, such as:

Camouflaging or Masking

Girls often mask their autistic traits by mimicking social behaviours, practising facial expressions, and using behaviours that mimic eye contact (looking at the other person’s face or ears etc). This behaviour can make their symptoms less noticeable, leading to underdiagnosis.

For instance, they might imitate their peers’ social interactions, which helps them blend in but conceals their difficulties. However social difficulties tend to become more pronounced in girls over time, particularly during teenage years.

Maintaining this over time can become exhausting and distressing. Long-term camouflaging is linked to poor mental health outcomes for individuals with ASD.

Detecting camouflaging in childhood may create opportunities for early intervention and better long-term outcomes.[5]

 

Internalising Difficulties

Girls with ASD are more likely to develop internalising issues such as anxiety, depression, or eating disorders. These conditions are often overlooked or misinterpreted, which can delay an autism diagnosis.

Unlike boys, who might display aggression or hyperactivity, girls may internalise their struggles, making their symptoms harder to detect.

Girls may also struggle with explaining their emotional states verbally, and as they can be so good at hiding their difficulties others around them may not realise that they are in need of support.

Restricted Interests

Girls with ASD often have intense but socially acceptable interests, such as a deep fascination with animals, celebrities, or fiction.

These interests differ from the more mechanical or mathematical obsessions typically seen in boys, making them less likely to be flagged as signs of autism.

For example, it would be more likely that a girl’s restricted interests revolved around horses, Taylor Swift or Sam Kerr. These can manifest by fascination with listening to Tay Tay non-stop, or taking up soccer herself.

Restricted and Repetitive Behaviours (RRBIs)

The Restricted and Repetitive behaviours shown by girls are very similar to those experienced by their male peers, however, they can be expressed or viewed differently.

They may have a need for sameness or routine (not uncommon for boys or girls), but this is more likely to be viewed as a personality type as opposed to a behavioural preference.

Behavioural Issues

Girls are equally as likely to experience behavioural difficulties as boys. However, these are less likely to be problematic and interfere with those around them.

For example, girls may be more chatty in the classroom as opposed to hyperactive or physical behaviours involving other people.
These behaviours can vary, and in some cases, girls may need additional behavioural issues to be present for their ASD to be recognised and diagnosed.

A study found that parents were especially concerned about emotional and behavioural problems in girls. It showed that girls were more likely to get a diagnosis if these issues were severe. [5]

Language

Girls with ASD may have lower verbal cognitive abilities, which can affect their communication skills. This can lead to a delay in diagnosis, particularly if they are verbally capable but struggle with more nuanced aspects of language, such as understanding social cues or engaging in conversations.

Conversely, girls may have an excellent vocabulary but struggle with receptive language and instruction. They are very likely to appear highly capable with verbal communication, however, they may have memorised phrases to use in certain situations, or they may struggle to comprehend what is being told to or asked of them.

They are likely to get lost in the words. Instructions with more than one step can lead to confusion as they may be digesting the initial step, comprehending what is being asked of them, but therefore whilst doing this internally they have missed the subsequent steps in the request.

Relationships

Socially, girls with ASD may exhibit behaviours similar to neurotypical boys, which can mask their condition. It is likely they are considered to be a “tom boy” or, they might be perceived as shy or passive, rather than recognising these behaviours as potential signs of autism.

More recently parents and teachers are seeing more signs of anxiety in girls, this could also be a side effect of Autism and confusion in school or social situations leading to the child becoming anxious.

Girls may camouflage to make a good first impression with peers, but over time, they might struggle to maintain this or meet social expectations. This can lead to social distancing and rejection, which may result in internalising issues.[5]

This can also offer explanation why girls are seen to function really well through out the day at school, but fall apart once they get home at the end of the day.

Adhering to social norms to the best of their abilities, internalising sensory difficulties (because that’s how the other children behave) and remaining alert and vigilant to their peer’s behaviour leads to exhaustion and by the time they return home they can no longer keep up the façade.

 

Sensory Sensitivities

Girls with ASD can have sensory sensitivities, but these are often less recognised. These might include heightened sensitivity to light, sound, or textures, which can contribute to their overall difficulties but may not be immediately linked to autism by observers. [4]

For example, they may engage in challenging behaviour when asked to put on a certain piece of clothing due sensory sensitivities and it being extremely uncomfortable for them. They may also refuse to wear certain clothing dues to sensory issues, which is easy to apply to the idea that “they just love wearing dresses like Elsa”.

Seeking A Diagnosis

If you already have a paediatrician, the best thing to do would be to book in with them to start the process. Explain your reasons and provide any evidence prior to booking an appointment so they can suggest the best type of appointment for your child.

For those who are not working with a paediatrician yet, here are some suggested steps to follow:

• You can start by discussing this with your GP, or you may prefer to secure a paediatrician’s appointment first and then request a referral from your GP.
• Additionally, you may like to ask your child’s daycare or school teacher for a letter outlining any behaviours or challenges they’ve noticed—this will be helpful when discussing your child’s needs with the specialist.
• Throughout the process, keep communication open with the school and healthcare professionals to ensure everyone is working together to support your child.

Advocating for your child through this process will give you greater clarity and help you access the support services your child may need.

At Mosaic Early Intervention our in-house psychologist can provide an ASD assessment that may result in a diagnosis, you can learn more about what an autism assessment involves here.

Supporting Girls With ASD

After receiving a diagnosis, various support services may be recommended to help your daughter develop important skills. These could include applied behaviour therapy, psychology sessions, speech therapy, or other specialised therapies. These interventions aim to build social and learning skills that are crucial for success both in school and in everyday life.

Additionally, families may be eligible for NDIS (National Disability Insurance Scheme) funding, which can assist in covering the costs of these essential services, ensuring your daughter gets the support she needs to thrive.

While your child’s school may offer additional support—such as access to a counsellor or extra time for tasks—it’s important to discuss and confirm what specific accommodations can be provided.

 

We would like to acknowledge Hannah Wise-Mann, Psychologist, for her valuable contribution to this article.

 

 

Sources:

1. Sex/gender differences in children with autism spectrum disorder: A brief overview on epidemiology, symptom profile, and neuroanatomy
2. ABS – Disability, Ageing and Carers, Australia: Summary of Findings, 2015 
3. Recognition of Girls on the Autism Spectrum by Primary School Educators: An Experimental Study
4. Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review
5. Sex differences in the first impressions made by girls and boys with autism