Autism in Girls and Women

Aspiring trainee psychologist Phoebe Lawes (pictured here) writes about autism in girls and women:

Who do you think of when you hear the word autism? Most commonly, Autism Spectrum Condition is associated with boys and men, thought of as a predominantly male condition. But is this the reality? Recent research suggests that more females are living with autism than we might think, they are just better at hiding it…

What is autism/ASC?

Autism, or autism spectrum condition (ASC) is a lifelong neurodevelopmental condition caused by differences in the brain. Whilst is comes with both strengths and challenges, it is often characterised by difficulties in social communication and social interaction, repetitive and restricted behaviours and extremely focused, specific interests. Despite misconceptions, autism is not an illness to be cured with treatments; instead, people with autism can benefit from support in various areas of difficulty to help live happy fulfilled lives. Because autism exists on a spectrum, the levels and type of support required looks different for every individual.

Prevalence of Autism: Males versus Females

According to the National Autistic Society, more than 1 in 100 individuals in the UK are on the autism spectrum, meaning roughly 700,000 individuals in the country have the condition. Diagnoses of autism have been on the rise in the UK with a recent study reporting a 787% exponential increase in the number of people diagnosed between 1998 and 2018 and a recent telegraph article highlighting the surge in diagnoses post-pandemic.
Stereotypically, autism has long been thought of as a predominantly male condition; this common belief is backed up by research finding that the male to female ratio of those diagnosed in the UK is roughly 3:1. Whilst it has been proposed that this figure reflects a higher prevalence of autism in males, recent research suggests instead that women with autism are simply diagnosed less often, misdiagnosed or are receiving a diagnosis much later in life.

Although current evidence is not fully conclusive, there are a few widely accepted explanations for this diagnostic disparity:

1. Autism can present differently in females compared to males, with women and girls not always displaying the ‘classic’ traits associated with the condition.
This is particularly true for high-functioning girls and women and has been discussed within the literature as a ‘unique female phenotype’.

2. Current diagnostic criteria and autism assessments are more tailored to identifying ASC in males, as they are based largely on research using men and boys.
They might therefore be less sensitive to the traits more commonly seen in females.

3. Masking or camouflaging is more common in females compared to males.
Masking refers to an individual’s ability to mimic the behaviours of others in social interactions in order to blend in. This camouflaging can make autistic traits more difficult to spot. Examples of masking behaviours can include copying facial expressions or consciously maintaining eye contact despite feeling uncomfortable. These behaviours can be learnt through observing peers or social interactions on TV shows. Masking can be extremely mentally, physically and emotionally fatiguing for people with autism.

4. Cultural norms/gender stereotypes might also help explain the delay in diagnosis for females.
Even in today’s society with a focus on moving away from strict gender norms, girls are still often expected to be more reserved and less assertive than their male counterparts. This means that whilst being shy is often a red flag for ASC in boys (because it goes against male gender expectations), it is less likely to be picked up on as a sign for autism in girls. This might help explain why teachers under-report autistic traits in girls.
5. The specific interests and repetitive behaviours of autistic girls might be more likely to go unnoticed in girls compared to boys.
Research suggests that the special interests of girls with ASC are less likely to be those traditionally associated with autism in males. Boys often focus on transportation, computers and astronomy whereas girls might be drawn to literature, the arts, cosmetics, fashion, medicine, and animals. These interests might initially seem similar to those of their typically developing peers and so might not be picked up on as an autistic trait.
Similarly, the repetitive behaviours associated with autism in boys such as rocking backwards, and forwards are not always seen in girls. Repetitive behaviours in females might include activities such as excessive hair twirling, which are not picked up on as easily by teachers and parents.

Awareness of autism in women and girls has increased in recent years: non-fictional, fictional and autobiographical books have been published; an abundance of informative websites have been set up, many of which include first-hand accounts from women diagnosed with autism; there are countless videos on platforms such as YouTube and even supportive, informative communities for autistic women and girls have been formed on platforms such as TikTok!

Despite this increasing awareness of the realities of autism for women and girls, until the sex and gender bias is further reduced in research and diagnostic practice, and the stereotypes of what autism can look like are abandoned within the wider population, issues surrounding diagnosis and support for women will still exist. With this in mind, it is important to be aware of the typical signs of autism in girls specifically, and how these might differ to boys.

Here is a brief list of signs of autism in women and girls. Although these are the most common it is important to note that autism can look different for every individual.

Signs of autism in Girls:
– Hiding the challenges faced through copying the behaviours and play of other children
– Relying on others to guide them and speak for them
– Withdrawing in difficult situations
– Not seeking out/avoiding social interaction
– Being perceived by others as particularly shy
– Are able to keep emotions under control in social situations (such as at school), but are prone to becoming upset/having meltdowns or shutdowns when out of those situations (when they get home)
– Having a limited number of close friends
– Becoming possessive in friendships
– A strong enjoyment of fiction and pretend play due to a well-developed imagination
– Displaying one-sided/ strictly controlled play
– Intense but limited interests which can be focused on art, music, animals etc.
– Having interests perceived as advanced for their age
– Repetitive behaviours such as hair twirling
– Being seen as a very fussy eater
– Being particularly sensitive to sensory challenges
– Having symptoms of anxiety or another mental health conditions
– A history of epileptic seizures

Signs of autism in women:
– Having the ability to mask their autistic traits
– Mimicking the gestures and expressions of other people
– Forced eye contact in social interactions
– Preparing phrases to use in conversations with others in the future

Whilst a diagnosis at any age can be helpful, earlier diagnosis and intervention is extremely beneficial as it means girls with autism can gain access to support and resources sooner. Research has found that autism in females Is associated with higher rates of comorbidities including anxiety, depression and eating disorders during adolescence compared with males with ASC and typically developing females of the same age, however an earlier diagnosis can greatly reduce the challenges and difficulties faced.

This article only presents a short summary of the challenges faced by women and girls with autism as well as a simple list of potential signs to look out for. If you think you or your child might have ASC, the first step to gaining support is meeting with a trained healthcare professional who can provide a diagnosis. Contact us here at the Blue Tree Clinic, where we have a range of expert psychiatrists, psychologists and therapists who can help.

An important note: In this article we focus heavily on ASC in boys, men, women and girls. We are very aware that diagnoses of autism exist across all genders (including non-binary and transgender).