For a long time, people thought that autism was an exclusively male condition. Although studies have varied, experts believe the ratio of autistic males to autistic females is 3:1¹. This doesn’t necessarily mean that autism is less common in girls. In fact, it is much more likely that fewer girls are being diagnosed because their autistic traits are different and are more difficult to spot. Late diagnosis for girls can cause problems later on, including mental health issues and even eating disorders, so what should parents and teachers be looking for?

Social interaction

Autistic children often find social situations difficult or even distressing. In girls this appears to be less of an issue, but that doesn’t mean they aren’t affected. Because they are raised to place greater importance on friendships than boys, autistic girls are more driven to try and fit in. They can go to enormous lengths to mask their difference, adopting elaborate strategies such as practicing pre-prepared greetings or faking eye contact. They often enjoy watching programmes with predictable social interaction over and over again, learning these ‘scripts’ to use within social situations. Many of them will do this so effectively that their internal discomfort can be difficult to detect.²

Special interests

One of the better known traits on the autistic spectrum is the single-minded pursuit of a specific interest, often to the exclusion of much else. Where autistic males are often fascinated by stereotypically boyish interests such as trains or gaming, girls are equally likely to focus their attention on more feminine pursuits³. Whether it’s Disney films, fantasy stories or drama their level of interest is no less intense than boys, but the fact that these are seen as ‘normal’ for girls sometimes means that the unusual depth of their fascination can be overlooked.

Social touch

One area where you might spot the signs of ASD in girls more easily than boys is their reaction to touch. Younger girls are often quite ‘touchy, feely’ with their friends. An aversion to hugging or stroking hair can make them stand out from their neurotypical peers. Similarly, an unusually strong aversion to certain textures can be a clue that a child of either gender might be on the autistic spectrum. Trusting Autistic girls will often be very trusting and tend to take people at face value. This can put them at risk of manipulation by their peers or adults that might take advantage of this vulnerability.

Trusting

Amy Gravino, a certified autism specialist and consultant who was diagnosed at age 11 says, "In my experience I’m a lot more trusting than my neurotypical peers, and this leads me to not always see when someone has duplicitous intentions. I believe what people say up front, because I’m very up front. That leads to a lot of women on the spectrum being taken advantage of."

Teaching autistic girls how to keep themselves safe, especially as they become old enough to have sex or be encouraged to try dangerous or illegal activities, is vital.⁴

Eating disorders

The relationship between children and food is always a complicated one but for autistic children eating can have a much deeper significance⁵. Issues about texture, colour and routine all combine to make mealtimes a particular flashpoint. For some autistic girls, controlling food can be the beginning of a pattern that leads to anorexia. In fact, studies of females with anorexia show that they have elevated austic traits. Diagnosis of both disorders are often made quite later when anorexia takes a different shape to that of neurotypical children. An early diagnosis of ASD means you can access expert support for your child’s food issues and a greater chance of helping them avoid developing an eating disorder.

Misdiagnosis

Because of the difficulties in detecting autism in girls there is a risk that their symptoms may be misdiagnosed. Depression, anxiety and personality disorders are more common diagnoses. Time is often wasted treating the wrong condition. It is vital that schools and medical professionals are educated to raise awareness of gender specific autistic traits⁶.

¹Halladay, A. K., Bishop, S., Constantino, J. N., Daniels, A. M., Koenig, K., Palmer, K., ... & Taylor, J. L. (2015). Sex and gender differences in autism spectrum disorder: summarizing evidence gaps and identifying emerging areas of priority. Molecular autism, 6(1), 36.

²Dean, M., Harwood, R., & Kasari, C. (2017). The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder. Autism, 21(6), 678-689.

³Milner, V., McIntosh, H., Colvert, E., & Happé, F. (2019). A qualitative exploration of the female experience of autism spectrum disorder (ASD). Journal of autism and developmental disorders, 1-14.

⁴Yi L, Pan J, Fan Y, Zou X, Wang X, and Lee K (2013). Children with autism spectrum disorder are more trusting than typically developing children. Journal of experimental child psychology, 116 (3), 755-61

⁵Baron-Cohen, S., Jaffa, T., Davies, S., Auyeung, B., Allison, C., & Wheelwright, S. (2013). Do girls with anorexia nervosa have elevated autistic traits?. Molecular Autism, 4(1), 24.

⁶Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281-3294.