The Overlooked Signs of Autism in Girls: What Parents and Teachers Should Know

Last week I hit you with a personal insight into my Autism as a woman and what that journey has been like, which was terrifying but wonderful. You guys hit me right back with a (surprisingly) huge response from women all over the world who said they felt heard, and wondered whether they may be autistic too, but were unsure of what the ‘characteristics’ were and whether they fit this mould. This week I am going to offer more research based information and practical tips for spotting the more nuanced traits that often fly under the autism radar with us girls, in the hope that out there somewhere is a girl or woman that gets access to support, because she is finally seen. Don’t worry, I’m throwing in some personal examples to contextualise things and help you to see how these things translate ‘off the page’. 

Autism presents uniquely in each individual, I strongly believe that if you’ve met one autistic person - then you’ve met one autistic person… but the differences between how boys and girls present are particularly striking. In fact, Autism is more commonly diagnosed in boys than girls, with a ratio of approximately 4:1 (Centers for Disease Control and Prevention, 2020). For every 4 boys, there is 1 girl diagnosed with autism. Studies suggest that autism in girls, especially those without intellectual disabilities, is often underdiagnosed or diagnosed later in life (Kirkovski, Enticott, & Fitzgerald, 2013). Is this because autism is more prevalent in boys than girls? The answer is a resounding no, but it always surprises me as to how many people think that this is the case. Many girls go undiagnosed because they exhibit different symptoms or develop more effective coping mechanisms to mask their condition. On average, girls are diagnosed with autism around age 7.5, while boys are typically diagnosed around or before the age of 5 (Gould & Ashton-Smith, 2011).

Recognising the signs of autism in girls is crucial for ensuring they receive the support and resources they need to thrive. In this blog, we’ll explore the key signs to watch out for, how they might differ from more well-known presentations, and practical steps you can take if you suspect a girl in your care may be on the spectrum.

Understanding Autism in Girls  

Autism is a natural variation in human neurodevelopment, where individuals experience the world in unique ways, including how they process sensory information, communicate, and socially interact. Autistic individuals may have distinct strengths, such as deep focus, attention to detail, creativity, and innovative problem-solving, alongside their own set of challenges in navigating a society designed for neurotypical ways of thinking and being.

Autism is not a disorder, but rather a different way of experiencing and interacting with the world, with each autistic person having their own blend of traits, abilities, and perspectives. I think there is something to be said here for the ‘toxic positivity’ community who would pressure us autists into referring to our neurology as a ‘superpower’ and smile through our difficulties. No. Stop that. I have some wonderful strengths - I notice details that allistics (non-autistic) individuals take ages to notice, I see solutions to problems that they may not consider, I am incredibly creative and I can smell if you have picked up a virus - even if you show no symptoms yet (seriously, I have never been wrong. Freaks my husband right out). BUT, this is not a superpower. I can be completely crippled by my autism and lose the ability to take care of my own basic needs like showering, brushing my teeth or remembering to eat. I have shed an ocean of tears over social problems, misunderstandings, failed job interviews and lost relationships due to my struggles with social communication. I can be so disabled by my sensory differences that I am unable to part-take in meals, outings, events, and interactions with others. It doesn’t mean that I would take a magic pill to not be autistic anymore, but it also doesn’t mean that we need to glamourise our neurology and place it on a pedestal above everyone else’s. It’s just different.

Social and Communication Differences  

Research suggests that many girls develop strategies to mask their autism, consciously or unconsciously mimicking socially appropriate behaviours. Girls and women with autism frequently experience difficulties in social situations, though they may work hard to hide these struggles. Unlike boys and men, who might display more overt social challenges, girls may seem to blend in by mimicking their peers or using "scripted" behaviours they’ve observed. I can personally confirm that I am an expert at masking and social camouflage strategies and have mastered this successfully for 35 years WITHOUT knowing I was doing it. As a result, the signs are often subtle and can be mistaken for shyness or anxiety, even by the autist themselves, which delays or prevents an accurate diagnosis. 

There is a lady I worked with, let’s call her Steph, who is the most sophisticated social butterfly I have ever seen. It comes so easy to her, everyone loves her. She is funny, intelligent, kind, empathetic, professional and friendly. I have never seen her create conflict but I have seen her manage conflict in others like a samurai. I have studied her closely for years, using her scripts, facial expressions, mannerisms and jokes. I can’t master it. Why? Why can’t I do ‘social’ like she can? - I interrogated myself over this for years. Now I know why and it is starting to sting less.

I’ve come across criticism from others who have told me that I ‘must have known’ I’m autistic and how can I ‘suddenly’ be autistic, almost finding the idea funny. But let’s address that elephant in the room. Why are many adult women ‘suddenly’ realising that they are neurodiverse and finding themselves suddenly disabled by their neurology? Let’s talk about everyday demands through a lived experience example…

When I was in my 20s I lived at my parents house, my wonderful Latino mother took care of my washing, she cooked all of the family meals, took over the majority of the housework and created a calm and safe home for us all. I lived in a cute wooden cabin under a beautiful tree at the end of the garden, with my cat. I did yoga, I wrote poetry, I worked as a teacher in an excellent and supportive school which trusted us to do a good job and I wasn’t micro-managed. I completed a Masters. I became rather good at pole-fit. I was hugely privileged to live this life and have my family around for support if I needed them. Due to having so few responsibilities and so much time for self-regulation (the demand level on me being so low) I coped remarkably well. I used masking and social camouflage to get through interactions with others and had the energy to do so. To the outside world, I was completely neurotypical almost my whole life. 

Fast forward to now, I am 35 years old and here are how my everyday demands have changed: I am 22 weeks pregnant with a high risk pregnancy (uterine rupture) and am in pain or at least discomfort most of the time with that and SPD in my pelvis and carpel tunnel in my wrists. I am experiencing symptoms in line with POTS (Postural Orthostatic Tachycardia Syndrome) which I am undergoing tests for. My husband and I have three children under 5, one is a baby and the other two are being assessed for (between them) possible autism, PDA, sensory processing disorder, ADHD, dyspraxia and gestalt language processing. I have quit the career that I love (which is hard) to be their carer and spend 24 hours a day caring for their complex and varied needs. 

My husband works for the Police so does shift work and long hours, which means I am the main carer for the children, there are no days off. We have moved to a town where I don’t know anyone outside of my husband’s family who all work full time, so I don’t have a ‘village’. I don’t drive so all of the school runs are lengthy trails of fire through public transport with three small children prone to meltdowns and a weighty double buggy with no breaks. 

There is the bloody housework which needs a mention - my washing pile is as tall as me at all times, there is ALWAYS washing up to do as we don’t have a dishwasher and I have to cook so many separate meals to meet each child’s access needs for food (as well as main meals for us), my best friend is a hoover and I am outnumbered by toys by a ratio of 400:1. I am working through my own assessment and diagnosis process for an elaborate salad of things that affect my ability to fulfil my responsibilities through affecting my energy levels, concentration, executive functioning skills, physical ability, sensory needs, processing, and communication skills. I am also trying to build my own business (SENDinMama) to support us financially as losing one whole income in the house takes its toll and it would be great to not worry about getting a take away now and again.

The level of demand in my life has meant that I am at my limit as to my ‘capacity’ and am frequently pushed to my ‘threshold of tolerance’. What do I mean by that? Capacity refers to an individual’s overall ability to manage, perform, or cope with a task or demand, while threshold of tolerance refers to the point at which that individual can no longer comfortably manage or tolerate additional stress, stimuli, or demands before feeling overwhelmed or distressed. When I reach my threshold, I can experience autistic meltdowns that completely disable me and I require support from my husband to get through it. I can hyperventilate, disassociate, find verbal communication difficult, sweat, panic, cry, and shake. Afterwards, I need recovery time, further support and feel exhausted. Because my life has changed, my ability to cope has changed. I am not suddenly autistic, but I do sometimes find myself suddenly unable to cope with this new demand level. This is what many mothers report is the trigger for a lot of the changes in themselves that they notice, such as sensory sensitivities to noise, light, clutter, touch and smell, a need to control or tidy their environment to manage anxiety, meltdowns or anxiety attacks, loss of patience and being easily triggered. 

So in our girls, what are some of the things we can look out for within social communication which may indicate autism?

Signs to look for:

- Difficulty maintaining friendships: A girl with autism may prefer solitary play or gravitate towards younger children. Her interactions might seem superficial, lacking the deeper connection typical of her peers. I actually have no idea what makes someone my ‘friend’ or when we become that thing. I don’t understand what I need to do to keep friends and any that decide to stick around I see as 100% luck on my part. 

- One-sided conversations: Girls might engage in conversations that revolve around their specific interests, which can sometimes seem intense or repetitive. This is sometimes referred to as ‘info-dumping’. I will talk to you about dinosaurs, astrophysics, neurodiversity, psycholinguistics and education until you bleed from your eyes because I need that kind of visual to make me realise that you are not having a good time.

- Challenges with social cues: Picking up on body language, facial expressions, and tone of voice can be particularly difficult. They may struggle to interpret sarcasm or subtle changes in conversation, leading to social misunderstandings. They may also be seen practising or imitating some of these things when observed in others. 

- Tendency to be a "people pleaser": Some girls with autism may go out of their way to imitate social behaviours or expressions they observe in others, trying hard to fit in. This can make them appear overly agreeable, often saying or doing things they don't fully understand just to maintain social harmony. This may also happen if they are told off for particular behaviours by adults such as stimming, being loud, correcting others, etc. They may mask their needs or behaviours to please you. 

- Difficulty initiating or sustaining conversations: Girls on the spectrum may struggle with starting conversations or keeping them going, especially in group settings. They might rely on others to guide the interaction, leading to awkward pauses or a tendency to remain silent unless directly addressed. For example, a girl might laugh when others laugh but may not fully grasp the joke or the social context behind it. 

Parents and educators might overlook these signs because they appear more subtle compared to the struggles seen in boys.

Photo by Tara Glaser on Unsplash

Behavioural and Emotional Signs  

Girls on the spectrum often display behaviours that may not immediately be seen as "autistic" because they align with societal expectations of girls. For example, an intense interest in collecting dolls, horses or reading the same book repeatedly might be seen as a typical childhood phase, when in fact it can reflect a deeper need for routine and predictability.

Signs to look for:

- Repetitive behaviours or intense interests: Girls may become deeply focused on specific hobbies, collecting items, or becoming experts on a niche subject. While this might seem typical for any child, in girls with autism, these behaviours can become all-consuming. For example, as a small child I used to group sweets and coins into colour/size/date frequency graphs, would listen to the same audiobook on repeat every night (let’s hear it for Anne of Green Gables) and copy the scripts, I collected china dolls, I would spend long periods of time ‘organising’ my toy animals into families and making them homes but then wouldn’t ‘play’ with them in the traditional sense (to me, the organisation was the play).

- Emotional regulation difficulties: Meltdowns, heightened anxiety, or being easily overwhelmed by changes to routine are common. Girls may appear emotionally volatile, prone to extreme frustration or distress over seemingly small issues.

- Perfectionism and fear of failure: Many girls with autism may develop a strong need for perfection in their work or daily tasks, fearing any form of failure or criticism. This can lead to high levels of anxiety, reluctance to try new things, or an intense focus on avoiding mistakes, which may not always be seen as linked to autism. I refused to speak Spanish to my mother in case of mistakes or even worse - praise (PDA profiles of autism can find praise challenging). I was resistant to trying new things in front of others and the idea of failure made me extremely anxious.

-Difficulty adapting to changes: Even minor changes in routine or unexpected events can be highly distressing. Girls may react with heightened anxiety or frustration when things don't go as planned, showing an intense need for predictability and structure in their environment.

- Sensory sensitivities: Loud noises, certain textures, or bright lights might be unbearable. These sensory challenges can lead to avoidance behaviours, such as refusing to wear certain fabrics or becoming distressed in crowded spaces. I was gifted the kind of autism which means that if I feel crumbs in the bed or floor with my bare feet I fold into myself like one of those ‘pick a number, pick a colour’ things… Unexpected noises are not my friend so my phone is always on silent. Sorry I missed your call. 

My own sensory sensitivities surrounding textures of non ‘safe’ foods (foods that I felt comfortable eating, were predictably the same every time and had a texture I could tolerate) meant that I would frequently feel hungry. The approach at the time of ‘she’ll eat it if she’s hungry!’ obviously didn’t work. I would rather feel hungry than go through the sensory ‘pain’ of attempting a food outside of my comfort zone. If made to eat these foods I would gag and sometimes be sick.

The Journal of Autism and Developmental Disorders (2023) discusses how these behaviours can be internalised, with girls more likely to suppress their feelings until they are in a safe space, like at home. This can make these signs harder to spot in school environments.

Academic and Cognitive Signs  

Girls with autism often perform well academically, but school can still be a source of great stress. They might excel in structured, predictable environments but struggle with the unspoken social dynamics of the classroom. If they have a PDA profile of autism there may be additional struggles in attendance and ability to access learning due to teaching strategies and behaviour management strategies from the past. As Bandit, Bluey’s Dad would say… “This isn’t the 80s, Pat”.

Signs to look for:

- Perfectionism and anxiety: Girls may become fixated on getting things "just right," often putting immense pressure on themselves to succeed. This can lead to anxiety, especially around schoolwork or tests. This affected my ability to finish my work because it took me so long to make sure it was correct and consistent in presentation.

- Executive functioning challenges: Difficulties with organising tasks, time management, following multi-step instructions, or keeping track of assignments may be apparent, though teachers might attribute this to forgetfulness or a lack of focus. It took me three attempts to complete my Masters Dissertation - not because I didn’t understand the content, I understood it deeply - but because of the executive functioning skills involved in putting something like that together and how you are basically left to do it independently at that level.

- Shyness or quietness: Instead of being disruptive or outwardly struggling, many girls retreat into themselves. This can lead to them being overlooked or mischaracterised as merely shy, further delaying diagnosis. 

- Difficulty with abstract concepts: Girls with autism may find it challenging to grasp abstract ideas or concepts, preferring concrete, tangible information. This can impact their performance in subjects like mathematics or literature, where understanding underlying themes or complex problem-solving is essential. They might excel in rote memorisation but struggle with deeper comprehension.

- Reluctance to participate in group work: Many girls on the spectrum may feel uncomfortable or anxious in group settings, preferring to work independently. They might avoid collaborative projects or struggle to contribute ideas during discussions, leading teachers to misinterpret this as a lack of interest or engagement rather than a reflection of their social challenges. The idea of working in a group makes me want to disappear into myself. I understand that some great ideas are born of collaboration, but so are really crap ones that are based on inaccuracies or misconceptions and quite frankly I am not good at sitting and smiling through that detritus without correcting you.

As the Child Mind Institute (2023) points out, these challenges are often internalised, making it easy for educators to miss or misunderstand the signs of autism in girls. 

Next Steps if You Suspect Autism  

If you’re noticing these signs in a girl you care for, it’s important to take action. Early diagnosis and intervention can make a significant difference in her long-term well-being. A few people came forward asking me what to do next as they felt that their daughter/child in their care appeared to fit this mould. 

Steps to take:

- Keep a record: Documenting your observations of her behaviours and social challenges can be helpful when discussing concerns with professionals. Additionally, asking school to do this too (if they attend) can be very helpful as it allows you to build a holistic picture of your child. School may say that there are no signs or behaviours to note, but this tells you a bit about masking behaviours and may go some way to explain any restraint collapse (this is when a child, who has been holding in their emotions or sensory overload during the school day, experiences an emotional outburst or shutdown after being picked up, as they release the built-up stress in the safety of a trusted environment.)

- Seek professional advice: A visit to a GP, paediatrician, or educational psychologist is the first step. If the child is under 5 you can also speak with your Health Visitor. Waiting times can be lengthy for assessments and can vary from local authority to local authority. It is worth bearing in mind the option called ‘right to choose’ as a means of speeding the process up, and is definitely worth looking into. If the initial evaluation isn’t conclusive, consider seeking a specialist with experience in female autism.

- Prepare her for the process: Let her know what to expect during evaluations, using clear, reassuring language to reduce anxiety. Be mindful that she is most likely already aware of her differences, even if she hasn’t expressed them.

Support during this stage is essential, both for the girl and her family. Understanding and validation from professionals can greatly ease the process of seeking a diagnosis and moving forward with a plan for support.

Conclusion 

Recognising the signs of autism in girls is a vital step toward helping them receive the resources and care they deserve. By understanding the subtle, often overlooked traits of autism in females, parents and educators can support early diagnosis and intervention, which can make a world of difference in a girl’s life. I have no idea what my life might have looked like with support. I do mourn it, which is weird because I can’t imagine it. But if you suspect a girl may be on the autism spectrum, trust your instincts and seek professional guidance. Early support can help her navigate the challenges she faces and empower her to reach her full potential. It can also help her to avoid unnecessary pain and isolation.

Please feel free to like this post and I would love to hear your thoughts and experiences with autism in girls and women in the comments section below, so please reach out!

For more information, resources and also our courses on SEND and neurodiversity, please take a peek at our courses right here on our website. Keep your eyes peeled for our course on Autism in Girls - COMING SOON!

References and useful reading:

Begeer, S., Mandell, D., Wijnker-Holmes, B., Venderbosch, S., Rem, D., Stekelenburg, F., Koot, H. M., & Begeer, S. (2013). Sex differences in the timing of identification among children and adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43 (5), 1151-1156.

Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2014). Risk of suicidal behaviour in autistic adults: A systematic review and meta-analysis. The Lancet Psychiatry, 1 (2), 142-150.

Centers for Disease Control and Prevention (2020). Data and statistics on autism spectrum disorder. Available at: https://www.cdc.gov/ncbddd/autism/data.html [Accessed 23 Sept 2024].

Cridland, E. K., Jones, S. C., Caputi, P., & Magee, C. A. (2014). Being a girl in a boys’ world: Investigating the experiences of girls with autism spectrum disorders during adolescence. Journal of Autism and Developmental Disorders, 44 (6), 1261-1274.

Dean, M., Harwood, R., & Kasari, C. (2017). The art of camouflage: Gender differences in the social behaviours of girls and boys with autism spectrum disorder. Autism, 21 (5), 678-689.

Dworzynski, K., Ronald, A., Bolton, P., & Happé, F. (2012). How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? Journal of the American Academy of Child and Adolescent Psychiatry, 51 (8), 788-797.

Giarelli, E., Wiggins, L. D., Rice, C. E., Levy, S. E., Kirby, R. S., Baio, J., & Pinto-Martin, J. (2010). Sex differences in the evaluation and diagnosis of autism spectrum disorders among children. Disability and Health Journal, 3 (2), 107-116.

Gould, J., & Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice, 12 (1), 34-41.

Hiller, R. M., Young, R. L., & Weber, N. (2016). Sex differences in autism spectrum disorder based on DSM-5 criteria: Evidence from clinician and teacher reporting. Journal of Abnormal Child Psychology, 44 (6), 1305-1316.

Kirkovski, M., Enticott, P. G., & Fitzgerald, P. B. (2013). A review of the role of female gender in autism spectrum disorders. Journal of Autism and Developmental Disorders, 43 (11), 2584-2603.

Lai, M. C., & Baron-Cohen, S. (2015). Identifying the female phenotype of autism spectrum disorder. Autism, 19 (5), 491-493.

Lai, M. C., Lombardo, M. V., Suckling, J., Chakrabarti, B., & Baron-Cohen, S. (2013). Biological sex affects the neurobiology of autism. Brain, 136 (9), 2799-2815.

Mandy, W., Chilvers, R., Chowdhury, U., Salter, G., Seigal, A., & Skuse, D. (2012). Sex differences in autism spectrum disorder: Evidence from a large sample of children and adolescents. Journal of Autism and Developmental Disorders, 42 (7), 1304-1313.