Autism spectrum disorder (ASD) is widely recognized as a condition with diverse presentations. However, one of the most significant disparities in our understanding of autism lies in how it arises in girls compared to boys (1:4). Historically, diagnostic tools, research studies, and even cultural perceptions have focused disproportionately on males. This has led to underdiagnosis and misdiagnosis of autism in girls, leaving many to struggle without appropriate support.
As a school Nationally Certified School Psychologist (NCSP) & School Neuropsychologist (ABSNP) working closely with neurodivergent individuals, I have seen how these differences shape but also delay the lives of girls on the spectrum. It is essential to explore these nuances, educate families and schools, to advocate for tailored interventions that allow autistic girls to thrive.
Why Is Autism Often Missed in Girls?
Research indicates that autism is diagnosed four times more often in boys than in girls. However, this does not mean autism is inherently less prevalent in girls. Instead, it points to gender biases in how autism is understood and identified.
Historically, the diagnostic criteria for autism have been based on behaviors more commonly observed in boys. Traits like repetitive movements, fixation on niche interests, and overt social withdrawal may be less pronounced or differently expressed in girls, leading clinicians to overlook their needs.
Additionally, autistic girls often exhibit higher social motivation and masking behaviors. Masking involves mimicking neurotypical behaviors to blend in socially, which can obscure their struggles from teachers, parents, and even professionals. This ability to “fly under the radar” means many autistic girls are not diagnosed until adolescence or adulthood, often after years of struggling with anxiety, depression, or other mental health challenges.
Key Signs of Autism in Girls
While the core features of autism remain consistent across genders—challenges with social communication, restricted and repetitive behaviors, and sensory sensitivities—these traits often look different in girls.
Social Motivation and Masking
Autistic girls often display a strong desire to fit in socially, which may contrast with the more overt social withdrawal seen in some autistic boys. They may:
• Study social interactions in detail and mimic them, often to perfection.
• Engage in conversations or play but struggle to maintain balance in relationships, frequently feeling excluded despite their efforts.
• Internalize rejection deeply, leading to heightened sensitivity and anxiety around social situations.
Masking is particularly prevalent among autistic girls. While this strategy can help them navigate social settings, it often comes at a significant cost. Constantly suppressing their natural behaviors can lead to exhaustion, identity confusion, and difficulty understanding their emotions and needs.
Restricted and Repetitive Behaviors
The restricted interests and repetitive behaviors associated with autism also manifest differently in girls. For example:
• Instead of stereotypical movements like hand flapping or spinning, girls might engage in subtler behaviors, such as twirling their hair or tapping their fingers.
• Their special interests often focus on socially accepted topics, such as animals, fictional characters, or celebrities, which may not raise flags in the same way as more niche or technical obsessions.
Sensory Sensitivities
Autistic girls may display heightened sensitivities to sensory input, such as bright lights, loud noises, or certain textures. However, these experiences may be internalized or expressed through emotional dysregulation rather than overt complaints.
The Challenges of Masking
Masking, while often seen as a coping mechanism, poses significant risks for autistic girls. It can:
• Be mentally and emotionally draining, leading to burnout and chronic stress.
• Hinder their ability to understand themselves, as masking forces them to suppress their authentic identities.
• Complicate diagnostic evaluations, as clinicians may not observe the behaviors typically associated with autism during assessments.
As clinicians and caregivers, it’s vital to peel back the layers and consider the toll of masking when evaluating girls for autism. Asking thoughtful questions about their social experiences, friendships, and self-perception can provide valuable insights.
Supporting Autistic Girls
Identifying autism in girls is just the first step. Ensuring they receive the right support is equally important. Here are some key ways to help autistic girls thrive:
Early Intervention
Early diagnosis and intervention can make a profound difference in the lives of autistic girls. Comprehensive evaluations that account for gender differences in autism are crucial. Schools, clinicians, and parents should work together to secure necessary services, such as speech therapy, occupational therapy, or individualized education plans (IEPs).
Addressing Mental Health
Many autistic girls experience anxiety, depression, and emotional dysregulation, often as a result of years of masking or social rejection. Teaching healthy coping strategies—such as mindfulness, relaxation techniques, and emotional awareness—can help them manage these challenges.
Supporting Executive Functioning
Executive function difficulties, such as challenges with planning, organization, and time management, are common among autistic individuals. Providing structure, scaffolding, and tools like visual schedules can help autistic girls navigate daily tasks more effectively.
Fostering Self-Acceptance
One of the most empowering things we can do for autistic girls is to teach them to embrace their neurodivergence. A strengths-based, neurodiversity-affirming perspective can help them see their unique traits as valuable rather than something to hide. Encouraging open conversations about autism and celebrating their individuality can foster confidence and resilience.
Educating Clinicians and Families
Raising awareness about autism in girls is an ongoing effort. Clinicians must actively seek training and stay informed about the latest research on gender differences in autism. Families should feel empowered to advocate for their daughters, ask questions, and seek second opinions when necessary.
It’s also essential to challenge common myths about autism, such as the notion that autistic individuals lack empathy or social interest. Many autistic girls are deeply empathetic and crave connection—they simply express it in ways that may not align with neurotypical expectations.
Conclusion
Recognizing and supporting autism in girls requires a shift in how we approach diagnosis, education, and treatment. By acknowledging the unique ways autism manifests in girls and addressing their specific needs, we can ensure that they receive the understanding and resources they deserve.
As an educator, I am committed to helping families and schools navigate this journey. Together, we can create a more inclusive world where autistic girls are seen, heard, and celebrated for who they are.
Dr. Smith is a Nationally Certified School Psychologist (NCSP) & School Neuropsychologist (ABSNP) at the Arizona Speech and Psychological Institute, specializing in neurodivergence and childhood development.
