The Quiet Spectrum: Autism in Girls and the Power of Unmasking

I am a 35 year old (tired) mother of three, soon to be four, who has a kitten called Blue. I have spent over 10 years at University doing multiple undergraduate and postgraduate degrees and conducting educational research in schools. I have had the privilege of teaching hundreds of children and working with as many families in multiple settings and in a variety of roles. I am married to my best friend in the world, have a loving family and a handful of close friends. Most people would say I was doing okay, I was achieving normal things and was probably quite comfortable.

I am ALSO Autistic with a Pathologically Demand Avoidant (PDA) profile, I have Attention Deficit Hyperactivity Disorder (ADHD), Joint Hypermobility Syndrome, am being assessed for POTS and I often wonder whether I may also have Obsessive Compulsive Disorder (OCD). I have been historically diagnosed (and palmed off) with Anxiety, Depression and Suicidal Ideation and Irritable Bowel Syndrome (IBS) of all things. I have frequent autistic meltdowns, struggle with sensory overload and overstimulation, have executive functioning difficulties and still require support from those around me regularly to achieve some ‘basic’ things. There are times when I am disabled by my autism and require care from my family.

I have found living the ‘normal’ life and achieving the ‘normal’ things monumentally challenging and I had NO IDEA that no one else did, until January of this year.

Riding the tidal wave of late diagnosed and self diagnosed women and mothers my age who are seeking and fighting for assessment for their autistic children, we all took a look around and realised a few things looked pretty familiar. All plopped in front of the mirror of self reflection and looking far into the distance behind us, seeing our history play out but looking at it from a completely different perspective, many of us saw ourselves for what felt like the first time.

I cannot explain the gravity of re-evaluating the memories, events, interactions, relationships, successes and failures in your life and discovering that each of them isn’t exactly what you thought they were. Processing the ‘oh my God that’s why that happened…’ or ‘so that’s why I find that hard!’ moments almost hourly for 10 months has been life-changingly draining, not just for me but for my husband and family and led to significant hair loss through stress at the beginning of the year.

Why am I telling you this stuff? Because understanding the impact that a lack of diagnosis and support can have on girls throughout their lives is important. More important than me being worried about sharing my struggle - which I am, by the way. Why am I worried about that? Because of the wall I have hit from certain individuals in my life who refuse to accept me as I am now, working towards unmasking and with an invisible disability. One of my bridesmaids and best friends of 30 years cut me out of her life because she believed I was lying and was a danger to people who are ‘actually autistic’. 

SO… Let’s give autistic girls the airtime they deserve, recognise and see them for who they are and be ready to radically accept and accommodate them for how they present. Let’s start by trying to understand autism in girls. I am going to discuss a variety of areas and dip in and out of my life to give you real-life examples and context, as this would have really helped my parents to spot my struggles as a child.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that impacts communication, behaviour, and social interaction. However, the way autism manifests can vary significantly between the genders, which often leads to girls being overlooked or misdiagnosed. These differences can make it harder to identify the signs early in girls. Because of societal expectations and behavioral patterns, many girls mask their symptoms, blending into their social environments more effectively than boys. This masking, however, comes at a great cost - leading to late diagnoses, misdiagnoses, and a lack of the early intervention that is so crucial for long-term wellbeing.

Why Autism in Girls is Often Overlooked

The underdiagnosis of autism in girls is a well-documented issue, with research highlighting several reasons for this disparity. One key factor is social masking, a coping mechanism that many autistic girls use to blend in with their neurotypical peers. Girls tend to be more socially motivated than boys, and they may mimic the behaviours of others, thereby masking their autistic traits. This ability to “mask” can make it more difficult for educators, parents, and even professionals to recognise the signs of autism. As a teen I would watch stand up comedy DVDs every night in bed and memorise the timing, wording, mannerisms, context and accents these jokes and stories were delivered in and would use these scripts in social contexts regularly to make me appear funny. I noticed early that people liked funny people, so that was my goal. Throughout my life people have considered me witty - I’m not. I am an encyclopaedia of other people's jokes and I am excellent at delivering them within the correct context and with a comedian's delivery. This is an exhausting process but I managed to blend in. 

Do we grow out of this? No. Throughout my adult life I have mimicked the social communication skills of those around me, both socially and professionally, who I assessed to be succeeding in this area. Notice the language I used there. I am assessing you, all the time, everything about you. Not because I’m judgemental or unkind, but because I am so desperately trying to understand you and to be understood. I know that you don’t put this effort into understanding me but I don’t take that personally because I am used to it, but I may need to rest after our time together as I have used more energy than you have to be a part of it.

Moreover, societal expectations of gender roles play a large part in this issue. Girls are often expected to be more socially adept and empathetic, which can make their difficulties in these areas seem less obvious. This leads to a common stereotype that autism is a predominantly male condition, with diagnostic criteria historically based on male presentations of autism. Girls are more likely to be diagnosed with conditions like anxiety, depression, or even attention-deficit disorders before anyone considers the possibility of autism. Due to my struggles I began to show signs of depression and was given 18 weeks of counselling and anti-depressants at the age of 21, and was then diagnosed with suicidal ideation and considered a risk to myself. I now understand that my depression was due to struggling to manage the difficulties I had associated with my autism and ADHD, and that the compulsive ‘intrusive thoughts’ I was plagued with are likely a part of my potential OCD, rather than any desire to end my life. 

The impact of late or missed diagnoses can be significant. The professionals involved in my care didn’t consider autism of any kind as I was verbal, I could make (painful) eye-contact, I had friends and could tolerate socialisation, wasn’t cognitively impaired, had ‘normal’ interests, and didn’t stim (as far as they knew). 

Well then, what are the symptoms in girls?

Key Characteristics of Autism in Girls

1. Social Difficulties and Masking: While autistic boys may be more visibly withdrawn or struggle with social cues, girls often work hard to fit in. They may develop coping mechanisms like imitating social behaviours or rehearsing conversations. However, this effort can be exhausting and lead to burnout, especially in social settings.

2. Intense Interests: Girls on the spectrum may have intense, specialised interests, much like their male counterparts. However, these interests may align more closely with socially acceptable or stereotypically “feminine” topics, such as animals, books, or art. This can make these passions less noticeable as a sign of autism.

3. Sensory Sensitivities: Sensory processing issues are common in autism and can present in various ways, such as heightened sensitivity to noise, light, textures, or even food. Girls might be particularly sensitive to clothing fabrics, environmental stimuli, or the chaos of crowded spaces, which can lead to anxiety and discomfort.

4. Anxiety and Perfectionism: Autistic girls often experience high levels of anxiety, especially in social situations. The pressure to meet social expectations and their tendency toward perfectionism can result in significant emotional distress. Many girls with autism are hyper-aware of their social struggles and may overcompensate by trying to appear perfect.

While these characteristics overlap with those found in autistic boys, the way they manifest can differ significantly. Girls are more likely to suppress their behaviours to avoid standing out, making it harder for even the most observant adults to recognise their struggles.

The Challenges Faced by Girls with Autism

Autistic girls face unique challenges that can affect their social lives, education, and mental health. One of the most significant challenges is navigating the complexities of social relationships. While many autistic boys may be more overt in their social difficulties, girls tend to hide their struggles, often feeling like outsiders who don’t quite fit in but can’t express why. Throughout my life I have had this deep narrative running on repeat that I am different - I am meant for something different. I had no idea where this message came from or what it meant by that… As a child my mother told me it was that I was so clever that I was going to change the world, I would be prime minister! So I told myself that she must be right because she normally is. It wasn’t that. I am not prime minister. 

Emotional health is another area of concern. Many autistic girls experience deep emotional sensitivity, leading to frequent emotional overwhelm. This is contrary to what many who recognise the more archaic definitions of autism would believe. Having autism doesn’t mean that we lack empathy. Sometimes we even experience ‘hyper-empathy’ which can be absolutely crippling. This is something I struggle with personally and oh my goodness would I trade it in for a lack of empathy now and again. It means that I don’t just hear what you’re saying about your tough day/family loss/financial situation/friendship issue, I am feeling it - hard. I cannot separate myself from it and it can consume me sometimes. I am now finding it difficult to watch/read the news as my hyper empathy makes it such a rollercoaster of emotion that I am up at night worrying about individuals and their situations that I cannot influence. Without an understanding of why they are struggling, girls can feel lost and misunderstood, further exacerbating their emotional challenges.

In educational settings, girls with autism may be seen as simply shy or quiet, and their learning difficulties might be dismissed. Without appropriate support, they may fall behind academically or struggle with the pressures of a structured environment. I could publish a thesis-length document containing only the school reports that stated that I wasn’t ‘reaching my potential’ and that ‘if Natalie could just concentrate she could achieve so much more.’ I worked to exhaustion as a child to blend in, do ‘my best’ and make my teachers happy. I developed perfectionistic tendencies and internalised all struggles so as not to stand out. 

As an adult, during a teacher training placement in my own primary school, I was gifted the chance to be partnered with my old Year 5 teacher who was the inspiration behind my decision to become a teacher when I was older. I asked her what I was like as a child, knowing how hard I had worked that year to please her and make her proud. She answered, ‘a bit nothingy, actually.’ Realising that others don’t see and therefore cannot appreciate your efforts, was a painful step on my journey. Educators need to be aware of the less obvious signs of autism in girls, especially since these girls often work hard to avoid drawing attention to themselves and achieve what they can.

Conclusion

Early recognition of autism in girls can be life-changing. A timely diagnosis allows for the implementation of appropriate interventions and accommodations, which can significantly improve a girl’s quality of life. Early support can help autistic girls develop healthy coping strategies and self-advocacy skills, reducing the likelihood of mental health issues down the line.

For parents and educators, recognising the subtle signs of autism in girls is crucial. If a girl shows signs of social withdrawal, intense interests (even if they are in very ‘normal’ things), or struggles with sensory sensitivities, it’s important to seek professional evaluation. Professionals play a vital role in ensuring that girls with autism receive the right support. This includes offering gender-sensitive assessments and acknowledging that the diagnostic criteria for autism need to evolve to capture the full range of how it presents.

SENDinMama is soon to be releasing a CPD accredited course in exactly this area for education professionals and service providers, as well as a course for Parents and Carers to deepen understanding and offer practical strategies for support for our girls with Autism. Please Subscribe now to be first to find out when that course drops!

Please feel free to like this blog! I would also love to hear from you if anything about my journey or this blog rings true for you.