As our understanding of Autism Spectrum Disorder (ASD) evolves, it’s becoming increasingly clear that ASD in women and girls often presents differently than in males. This discrepancy has led to significant underdiagnosis and misunderstanding of autism in females. As a psychologist who works with a lot of neurodivergent individuals, I’ve seen firsthand how this impacts the lives of many women and girls on the spectrum. As with males, females on the spectrum often have many strengths and significant potential that is not being optimised by the mainstream schooling and work environments to the detriment of everyone.
The Male-Centric Diagnostic Criteria
Historically, the diagnostic criteria for ASD were primarily based on studies of boys and men. This male-centric approach has inadvertently created a bias in how we identify and diagnose autism. The classic presentation of ASD often includes:
- Obvious social difficulties
- Restricted interests, often in “stereotypically male” topics like trains or computers
- More visible stimming behaviours
- Tendency towards literal interpretation of language
However, ASD in women and girls often looks quite different.
Masking: The Hidden Face of ASD in Women and Girls
One of the most significant factors in the underdiagnosis of ASD in women and girls is their tendency to”mask” or camouflage their autistic traits. This masking can be so effective that it often fools even experienced clinicians who aren’t specifically trained in identifying ASD in females.
Women and girls with ASD often display:
- Better surface-level social skills
- More subtle or internalized stimming behaviours
- Interests that align more closely with societal expectations (e.g., animals, literature, art)
- Higher emotional intelligence, despite struggling with social interaction
This list is not exhaustive, and is likely to grow over time. Interestingly, many women and girls with ASD seem to be more skilled at masking than their male counterparts. This could be due to societal expectations placed on females to be more socially adept, leading to increased pressure to conform and “fit in”. The highly sensitive person (HSP) construct is a term given to a list of factors very similar to ASD in women and girls. The book Divergent Minds discusses ASD, HSP and ADHD as related form of neurodivergence, which aligns with our clinical experience at Redman Gall Psychologists. This book is a great resource for women considering whether ASD may be a part of their wiring.
The Consequences of Masking
While masking can help women and girls with ASD navigate social situations more smoothly, it comes at a significant cost. The constant effort to appear “normal” can lead to:
- Extreme fatigue & burnout
- Anxiety and depression
- Loss of identity
- Delayed diagnosis, often not until adulthood
- Missed opportunities for early intervention and support
- Relationship difficulties
- Difficulties in work or study
- Difficulties with complex health conditions (medical gaslighting and awful experiences navigating the health system)
Recognising ASD in Women and Girls
To better identify ASD in women and girls, it’s crucial to look beyond the surface. Some signs that might indicate ASD in females include:
- Exhaustion after social interactions
- Intense focus on maintaining friendships, often with detailed “rules” or scripts
- Perfectionism and high anxiety
- Passionate, often all-consuming special interests
- Sensory sensitivities that may be internalized
- Meltdowns or shutdowns that occur in private
- Eating Disorders (both typical and atypical in nature)
- Difficulties in executive functioning that are hidden by working harder or longer
The Importance of Awareness
Increasing awareness about how ASD presents in women and girls is crucial. As a psychologist, I’ve seen many women find immense relief in finally understanding themselves after a lifetime of feeling “different” but not knowing why.
A proper diagnosis can open doors to appropriate support, self-understanding, and community. It can also help explain lifelong struggles and provide strategies for managing challenges associated with ASD. Diagnosis is often a game-changer when treating other conditions, as what is going to be helpful for a neurotypical may not be best for a woman with ASD (e.g. socialising more as part of addressing depression, or requiring a person to eat a large variety of foods when addressing an eating disorder).
Moving Forward
The field of autism research and diagnostics is gradually recognising the need for a more inclusive understanding of ASD. However, there’s still much work to be done. We need:
- More research focusing specifically on ASD in women and girls
- Updated diagnostic criteria that account for gender differences
- Increased training for healthcare professionals in recognising ASD in females
- Greater public awareness to reduce stigma and promote early identification
- Proper accommodations and support in schools and workplaces
- More research on physical health conditions more frequently experienced by people with ASD
- Better accommodations within the health system
- A greater focus on optimising individual develop to help girls and women with ASD to thrive
ASD in women and girls is often a hidden condition, masked by learned behaviours and societal expectations. By increasing awareness and understanding of how autism presents in females, we can ensure that more women and girls receive the diagnosis and support they need to thrive.
If you’re a woman or girl who has always felt different, or if you’re a parent concerned about your daughter, don’t hesitate to seek an evaluation from an ASD psychologist experienced in working with females on the spectrum. Understanding yourself or your child is the first step towards embracing neurodiversity and finding the right support.
Book an appointment with our ASD specialist team at Redman Gall Psychologists on the Gold Coast for a comprehensive autism assessment tailored to women and girls.
Further Reading
There are a growing number of great books which discuss ASD in girls and women. Some examples include:
Different not Less by Chloe Hayden
Divergent Mind by Jenara Nerenberg
Late Bloomer by Clem Bastow
