Understanding autism in girls: recognising symptoms and challenges across age groups
Outlining symptoms of autism in girls, underdiagnoses, and where to find support.
Autism is often less recognised in girls, leading to a high risk of misdiagnosis or delayed support. While boys are diagnosed with autism much more frequently, girls can display subtler symptoms that differ as they grow. This disparity highlights the importance of understanding the unique signs at every developmental stage, ensuring girls receive the timely support they need to thrive.
This article will guide you through the symptoms of autism in girls, the reasons for underdiagnoses, and where you can find support and resources.
Recognising autism symptoms in girls
Here, we explore what autistic characteristics look like for girls at different ages, from young childhood through to adolescence.
- Reduced eye contact: they may make less eye contact than expected for their age
- Delayed speech development: there might be delays in speech milestones, or they may not use gestures like pointing or waving by the expected age
- Limited response to name: they may not respond consistently, or at all, when their name is called
- Unusual play patterns: they might focus intensely on specific parts of toys, like the wheels of a toy car, rather than playing with the toy as a whole
- Repetitive behaviours: the most commonly recognised repetitive behaviours include engaging in repetitive movements such as rocking, spinning or hand-flapping. In autistic girls, behaviours can also include hair twirling. This can be deemed as a ‘typical’ behaviour for girls, which means it can sometimes go unnoticed
- Lack of social reciprocity: they may not smile back when someone smiles at them, or might seem indifferent to attempts by others to engage them in social interaction
- Delayed motor development: they might reach physical milestones like crawling or walking later than typical timelines suggest
Boys may show significant delays in speech development, less eye contact, and limited interest in social interactions from a young age. They might also exhibit more obvious repetitive behaviours. These early indicators can be more intense and easier to recognise, often prompting earlier concerns and evaluations compared to their female counterparts.
- Difficulties with social interactions: they may appear passive or aloof in social settings. They might struggle with making friends and prefer to play alone
- Mimicking behaviours to fit in: they may observe and mimic other children’s social interactions without genuine engagement or understanding of the social cues involved
- Emotional sensitivity: heightened emotional responses to seemingly minor changes or criticism
- Literal understanding of language: difficulties in understanding sarcasm, jokes or phrases that are meant to be interpreted figuratively
- Discomfort with eye contact: while they may make eye contact, it could appear forced or fleeting, and they might prefer not to look directly at others during conversations
In school-age boys with autism, behaviours are typically more pronounced and observable compared to girls. Boys may show clear difficulties in social communication, and their repetitive behaviours, are often more evident and less likely to be masked. Boys might also display more disruptive responses to changes in routine or sensory stimuli. Girls may appear to have less social challenges than boys, as they are more likely to mask their traits. This means girls on the autism spectrum are more likely to engage with friendship groups, which can therefore can lead to these differences being missed.
- Increased anxiety and depression: they might experience heightened levels of anxiety or depression as the demands of social interaction and self-management increase
- Difficulty with social communication: challenges in understanding and using verbal and non-verbal cues appropriately may become more evident as social interactions become more sophisticated
- Literal thinking: they may continue to interpret language very literally, struggling with abstract concepts or figurative language, which becomes more common as children get older
- Subtle masking: although they may have developed coping strategies to mask their difficulties, the stress of maintaining these can be considerable and may lead to burnout
- Emotional regulation issues: teens might have trouble regulating their emotions, leading to sudden emotional responses that seem disproportionate to the situation
In teenage boys with autism, behaviours often manifest as more overt social communication issues. Boys may exhibit more visible repetitive behaviours and have more intense reactions to changes in routine or disruptions. They might also show less interest in masking their difficulties, making their challenges more apparent compared to girls.
Understanding misdiagnosis and underdiagnoses
Statistics on autism suggest that 4 in 100 boys have autism, compared to 1 in 100 girls. It was once thought that autism in boys was simply more common when compared to girls, but as our understanding of this condition improves, the gap in diagnosis is closing.
Here is an overview of the some of the challenges of diagnosing girls with autism.
Presentation differences
Girls are good at masking their difficulties, mimicking social interactions to blend in. This ability to 'mask' genuine struggles has led to the possibility of autism being overlooked in girls. Unlike boys, whose social difficulties might be more overt, girls may quietly struggle to interpret social cues and engage naturally in social contexts.
Late diagnosis
Diagnostic tools and criteria for autism have historically been developed based on observations of boys, which may not capture the distinct ways autism manifests in girls. This can lead to girls receiving a diagnosis much later than boys, if at all.
Misdiagnosis
Some signs of autism overlap with other conditions such as anxiety, depression, or attention deficit hyperactivity disorder (ADHD). Historically, this has led to traits being mistakenly attributed to other conditions, leading to strategies that don’t address the underlying issues.
Diagnosis, support and resources
With correct diagnosis and additional support for autism, girls can reap significant benefits to their education and social life.
Here are some steps to take if you think your daughter may have autism and needs support.
Initial observation and symptom checker
If you suspect that a girl may be displaying signs of autism, make a note of some of their behaviours and symptoms and check them against the characteristics discussed in this article. You could also go to your GP. They won’t diagnose autism themselves but can provide some initial guidance and support.
You could also take an online autism test with your daughter. While this tool doesn’t provide an official diagnosis, it can indicate whether a more formal evaluation might be necessary. There are different options depending on how old your daughter is.
Getting a professional evaluation
A private autism assessment can help bring clarity to your daughter’s traits and could be the first step to getting the tailored support she needs. Autism assessments involve professionals carrying out a detailed evaluation of your daughter’s behaviours and traits.
To asses for autism, specialists use a diagnostic tool like the Autism Diagnostic Observation Schedule (ADOS). Clinicians use these tools to observe and interact with your child in ways that bring out behaviours that are typical of autism. Behaviours could be specific ways of playing, interacting and communicating, and the ADOS helps to identify them clearly and objectively. Autism diagnostic tools are constantly being improved for accuracy, making them more effective at identifying autism in girls.
Priory is a leading provider of detailed and personalised private autism assessments for girls. Our experienced professionals are available across the UK to provide you with the support and clarity you need.