Autism is a neurodevelopmental disorder that affects the social interaction, communication skills, and behaviour of individuals. It is traditionally diagnosed more frequently in boys than girls, but research suggests that this may be due to a lack of understanding of how autism presents in girls. This is because the diagnostic criteria for autism has been based research mainly with men and boys, rather than women and girls. As such girls with autism often go undiagnosed or misdiagnosed due to their unique expression of the disorder, which can be in contrast to the patterns exhibited by boys.
Here are some signs that might help parents, caregivers and professionals in recognising autism in girls and women.
Girls and women with autism often struggle with language, communication, and social interaction, but in different ways than boys. Girls tend to be more socially motivated by their peers, and they may be more successful in mimicking appropriate social behaviour. However, they often struggle with social nuances like body language, tone of voice and eye contact. They may appear very competent at social interactions, but they may have rehearsed and practiced how to interact in certain situations by observing others, rather than reacting naturally based on their own thoughts and ideas. This idea of practicing how to behave in social situations by studying others is called 'camouflaging'.
Girls and women may have also learned to subdue their natural self and put on a persona of someone who is 'engaged' and 'sociable', or they may suppress certain autistic behaviours such a hand flapping or other forms of repetitive behaviour that provides comfort. This suppression is known as 'masking' and can result in mental health issues such as anxiety and depression.
When I have assessed women and girls with autism, it is common for them to be considered as sociable in public, but then they can implode and struggling mentally at home where they can be themselves. They also often intense 1.1 friendships rather than a broad group of friends, and their friend may be treated as part of special interest. Young girls I have assessed have also reported being are devastated and upset if friends plays with someone else as they can’t understand why that would happen.
Women and girls tend to have better non verbal and verbal communication skills than men and boys. They often present as being able to have good eye contact, good use of gestures, and have a wide range of facial expressions. As a result, they often perform when on assessments of autism when look at communication skills. However, these communication skills may well be very rehearsed, and require considerable effort to perform rather than being intuitive.
Girls with autism may have difficulty in tolerating sensory overload, such as sensitivity to touch, smells, noises, or light. These could manifest in the form of avoiding specific textures or fabrics or becoming upset by loud noises. On the other hand, they may gravitate towards certain smells, noises or sensations that they find pleasurable. I assessed a young girl who loved the smell of her scented pencils, and would them with her everywhere so she could smell them.
Restricted interests or repetitive behaviours
Many girls with autism develop strong, even obsessive, interests just like in men and boys. However, whereas men and boys obsessions can appear somewhat odd or unusual (e.g. an interest in pylons), the obsessions of girls and women tend to be similar to that of neurotypical people, and therefore may not appear odd. Such obsessions can be seen with things like animals (e.g. horses), people (e.g. pop stars), music, art or literature (e.g. Harry Potter). The key factor is not the nature of the obsession, but the intensity, specificity and rigidty of the assessment. As an example, I assessed a girl whose special interest was in musicals, and she knew everything about all the major musicals in London, every word to every song, and collected cds, dvds, posters and other information relating to musicals.
Women and girls tend to present with fewer obvious repetitive sensory behaviours (eg flapping, rocking) than men and boys, although this is not always the case.
Anxiety and Depression
Girls with autism are more prone to anxiety and depression than typically developing girls or boys with autism. It is common for women and girls to be misdiagnosed with anxiety and depression before being diagnosed with autism. This is because they may present with symptoms like withdrawing socially, perfectionism, and obsessive-compulsive behaviours like frequent checking, counting, organising, or cleaning as part of their autism. They are more likely to have internalising features (e.g. issues with self confidence and anxiety) whereas men and boys can have externalising features (e.g. anger, aggression and acting out).
Diagnosis of autism in girls requires a comprehensive assessment by a licensed healthcare professional. It is crucial to identify autism for girls early to receive appropriate support and services to help them achieve their full potential.
In conclusion, Autism is a complex disorder that affects individuals in a variety of ways. Recognising how autism can present differently in girls and women than in boys and men can help improve early identification and support. Referring to early intervention and support services for girls on the autism spectrum can provide them with greater opportunities for success and improve their overall quality of life.