Today I want to talk a little about autism in girls. Historically more men/ boys have been diagnosed as autistic than women or girls. However we now recognise this is largely due to diagnostic criteria favouring traits more typical in boys. In the past it was even believed by many professionals that autism was only seen in boys – we now know this is rubbish.
All autistic people will present differently however there are some typical traits. Some of those traits are more typically seen in boys and others in girls. Whilst remembering everyone presents differently and no trait is only seen in a specific gender. I do want to focus in on some of those traits more typically seen in girls.
An autism diagnosis for young children is still usually based on the ‘triad of impairments’ identified by Lorna Wing:
- Social interaction
- social communication
- Rigidity of thinking.
They will often use ADOS assessments looking at this triad to support a diagnosis.
Professionals understanding of autism is improving and it is recognised that sensory processing will often sit alongside the trio. However whilst understanding of autism in girls is also improving there are still many challenges around providing a diagnosis within the existing guidelines.
Some typical traits in autistic girls
Unexpected change is very hard for most autistic people. Girls can often become extremely anxious just thinking about unexpected change. This can result in refusal to leave the house. This video from the National Autistic Society looks at this issue.
Autistic girls can sometimes be described as socially immature. Whilst they will often be very intelligent and have interests beyond their years, socially they can be lacking and may well be vulnerable because of this.
Emotions will often be heightened and some will feel emotion from others deeply and can struggle to be around someone with a strong emotion. Some will struggle enormously with injustice and fail to understand how it can happen.
Often autistic girls will be trying hard to please and will sometimes answer a question in the way they think the person asking wants them to answer. Their energy goes into how am I supposed to answer and may not have even considered what they want to answer.
Abstract concepts will also be difficult for many.
Masking is the art of hiding or almost acting a part. Whilst it isn’t unique to women and girls it is very common in autistic females. Girls are more likely to have a desire to ‘fit in’ and to do so they will often watch closely how people interact and then imitate that behaviour.
Social interaction can be particularly challenging for some autistic people and often doesn’t come naturally. Girls will often learn to teach themselves by observing behaviours. They may mimic others, use pre-prepared phrases or stories in conversations. Copying body language like eye contact is a typical when masking. If masking is done well it is impossible for others to see that the person is masking.
This post on the art of masking and women with autism from Tiimo is very helpful. Another great post on masking from Tourette Tales.
The Coke Bottle Effect
You may have heard of the ‘Coke bottle effect’ this is the idea that the child is a coke bottle and all day it is being shaken so when the lid comes off at home you get an explosion. Most parents will recognise this as many young children will be difficult when they get home from school.
However you may find this on a much more extreme level for some autistic children. Social interaction takes a lot out of many autistic children and having to behave in what may be an unnatural way all day certainly takes its toll. Add to this sensory sensitivities and masking and you will find many will explode the second they enter the house. And this can be full scale exploding which to others in the house can feel like it has come out of nowhere. This is because it has been held in all day so the moment the child gets to their safe place it all comes out.
Whilst for some this may come out loudly others will be tearful and go inside themselves wanting to hide. Many girls will internalise struggles which can be very hard to spot.
Many girls are naturally more sociable
Young girls often hang around in groups and will all be vying for attention. This makes it very easy for young autistic girls to stick with a group and almost hide within it. Younger girls are usually quite inclusive and it is not until puberty that the social dynamic for girls changes (often dramatically).
Autistic girls will often start to stand out from their peers when they go through puberty and move to secondary school. The move to secondary school has a significant impact on children who struggle with change. They have to move from class to class, teacher to teacher all day and for some that find security in familiarity this is too much. In addition social groups become more competitive and girls particularly have more interest in boys and going out which can leave a socially immature child behind. Bullying is also common when a girl is seen as different at this age. This can all lead to internalised anxiety and depression.
Young autistic girls will often have special interests but they can often fit with interests typical for their peers such as princesses or horses, as such they are not seen as repetitive even when they may be. There are so many stereotypical associations with interests in trains and puzzles with autistic boys that professionals look out for them, but this isn’t the case for typically female interests.
Covered up by Coexisting conditions
There are many related conditions we often see diagnosed alongside autism. Examples include dyslexia, ADHD, epilepsy and dyspraxia. Mental health disorders such as anxiety, eating, depression and obsessive compulsive conduct are other conditions we often see coexisting with autism.
It is often the case that these other conditions overshadow autism in girls. They may get a diagnosis for one of the related conditions but not autism itself.
The National Association for Special Educational Needs – NASEN produced this helpful guide: Girls and Autism – flying under the radar.
Women and girls on the National Autistic Society website.
I can recommend the book How to be autistic by Charlotte Amelia Poe. It is a wonderfully honest account of growing up on the spectrum. Undiagnosed until she was an adult Charlotte provides great insights into being autistic.
Limpsfield Grange School specialise in girls with autism.
Swedish Climate activist Greta Thunberg credits her autism as her superpower check out some other famous autistic females.