6 Reasons Autistic Girls and Women Go Under Our Radar

Autism (often referred to as Autism Spectrum Disorder (ASD), although let's leave that for another blog post!) has traditionally been viewed as a condition that affects boys (those assigned a male gender at birth, again another blog post) more frequently than girls (those assigned female at birth). For years, diagnostic criteria and public perceptions have been shaped by research primarily focused on male presentations of autism. As a result, many autistic girls and women go undiagnosed or are misdiagnosed with other conditions. In recent years, however, experts have started to recognize that autism in females often looks different and can be much more subtle than in males, leading to significant underdiagnosis. Let's explore why this happens and what we can do to better identify and support autistic girls and women.

1. Gender Bias in Diagnostic Criteria

One of the primary reasons autistic girls and women go undiagnosed is because the diagnostic criteria for autism have historically been based on studies involving mostly boys. Early research into autism focused predominantly on young boys, which has resulted in a set of diagnostic characteristics that align more closely with how autism presents in those assigned a male gender at birth.

Male Presentation:

• Boys are more likely to display externalized behaviors, such as hyperactivity or aggressive outbursts.

• Common signs include intense fixations on specific interests (e.g., trains, numbers), repetitive behaviors, and difficulty with social interactions.

Female Presentation:

• Girls (and I'd like to clarify not exclusively) may have different or more internalized traits, such as social withdrawal, anxiety, or perfectionism, which can be overlooked as typical behavior.

• They are often more adept at masking their symptoms, mimicking social behaviors, and engaging in "camouflaging," making it difficult for parents, teachers, and even healthcare professionals to detect the signs.

2. The Art of Masking and Camouflaging

Autistic girls and women often develop advanced coping mechanisms known as masking or camouflaging, where they consciously or unconsciously imitate neurotypical behaviors to fit in socially. This might include mimicking facial expressions, copying phrases, or forcing eye contact, which can make their autism less visible to others.

Why Masking Happens:

• Girls may feel greater societal pressure to conform to social norms and expectations, which are often stricter for females.

• They might be acutely aware of their differences and put extra effort into hiding them to avoid bullying, exclusion, or negative attention.

Consequences of Masking:

• While masking can help autistic girls navigate social situations, it comes at a high cost. It often leads to exhaustion, anxiety, depression, and a diminished sense of self.

• The stress of constantly masking symptoms can result in a delayed diagnosis and can prevent them from accessing the support and accommodations they need.

3. Different Interests and Social Behaviors

Another reason why autistic girls are often overlooked is because their special interests and social behaviors might not align with the stereotypical presentations seen in boys. While boys might have intense interests in niche topics like trains, numbers, or video games, girls might develop interests that appear more typical or socially acceptable.

Examples:

• Autistic girls might be deeply interested in topics like animals, books, celebrities, or fictional characters. These interests might seem intense, but they align more closely with what neurotypical girls enjoy, making them less likely to raise red flags.

• Socially, autistic girls may appear shy, quiet, or "people-pleasing," characteristics that are often overlooked or even viewed as positive in girls rather than potential signs of autism.

Challenges in Recognition:

• Because these interests and behaviors fit subjectively into the expected social norms for girls, they often don't trigger concern, leading to missed or delayed diagnosis.

4. High Rates of Co-occurring Conditions

Autistic girls and women are more likely to be diagnosed with co-occurring mental health conditions such as anxiety, depression, obsessive-compulsive disorder (OCD), and eating disorders before receiving an autism diagnosis. These conditions can mask the underlying autism, causing clinicians to focus on treating the visible symptoms without recognizing the root cause.

Examples of Misdiagnosis:

• Anxiety and social withdrawal in autistic girls might be misinterpreted as social anxiety disorder or dismissed as shyness.

• Perfectionism and rigid routines may be seen as signs of OCD rather than manifestations of autism.

• Eating disorders, particularly anorexia nervosa and ARFID, have been found to have higher prevalence rates in autistic women, as restrictive eating can be a way of coping with sensory sensitivities or a need for control.

5. Cultural and Societal Expectations

Cultural norms and societal expectations play a significant role in shaping how autism is perceived in girls versus boys. From an early age, girls are often socialized to be more nurturing, empathetic, and socially engaged. These expectations can lead autistic girls to push themselves harder to meet these societal standards, even when it is uncomfortable or draining.

Impact on Diagnosis:

• Because society expects girls to be more socially competent and emotionally aware, deviations from this norm are often attributed to shyness, introversion, or even typical "female" emotional variability rather than autism.

• Parents, teachers, and clinicians may not suspect autism because the behaviors of autistic girls are often interpreted through the lens of gendered expectations.

6. Later Diagnosis and the 'Missed Generation'

Many autistic girls are not diagnosed until adolescence or adulthood, if at all. This late diagnosis, often referred to as the "missed generation," has significant implications for their mental health and well-being.

Reasons for Late Diagnosis:

• As girls grow older, social expectations increase, and it becomes harder to mask symptoms. This often leads to a crisis point in adolescence or adulthood when the effort to fit in and cope with environmental factors becomes unsustainable.

• Many women report being misdiagnosed with conditions like borderline personality disorder, eating disorders, depression, or generalized anxiety before their autism is identified.

Consequences of Delayed Diagnosis:

• Without an early diagnosis, many girls miss out on vital support and interventions that could help them navigate school, social relationships, and daily life more effectively.

• Delayed diagnosis can lead to a higher risk of developing mental health issues due to years of misunderstanding, invalidation, and lack of appropriate support.

What Can We Do to Improve Recognition?

The first step to better recognizing autism in girls and women is increasing awareness among parents, educators, and healthcare professionals about the differences in presentation. Here are some steps we can take:

1. Update Diagnostic Criteria: Incorporate traits and behaviors that are more commonly seen in autistic females into diagnostic guidelines.

2. Train Clinicians: Provide specialized training for clinicians to recognize the less obvious, more internalized signs of autism in females (and some males).

3. Educate Parents and Teachers: Increase awareness about the unique ways autism can present in females, so they can advocate for earlier assessment and support.

4. Encourage Open Communication: Create safe spaces where children and adolescents can express their experiences without fear of judgment, making it easier to identify symptoms that might otherwise be masked.

Final Thoughts

Autistic girls and women have been underdiagnosed and misunderstood for too long. By expanding our understanding of autism and challenging the traditional, male-centric models of diagnosis, we can help ensure that more autistic people receive the support and recognition they deserve, regardless of their gender. Early identification and intervention are crucial for empowering autistic individuals to lead fulfilling and successful lives, free from the burden of undiagnosed challenges. The more we learn about the diverse presentations of autism, the better we can support everyone on the autistic spectrum.

If you would like any further information or guidance on supporting your young person to reach their full potential contact me for a confidential consultation here. 

Jilly xxx