For many years, autism was considered a condition that primarily affected males. This common misconception has had significant and lasting impacts on the timely identification and support of autistic females.
This article will discuss how autism can present differently in women, the challenges this can present in receiving a diagnosis, and what steps someone can take if they think they might be autistic. As a woman who was diagnosed as autistic well into adulthood, I will also be sharing some of my experiences throughout.
Autism is a neurodevelopmental disorder that affects how people communicate and interact with the world. It is a spectrum condition, meaning that it affects individuals in many different ways and to varying degrees.
There is no single ‘type’ of an autistic person, and the way autism presents can be influenced by a range of factors, including gender. It is likely that our understanding of what autism is is not necessarily representative of how it presents in girls, for instance.
For the purposes of this article, the terms female, girls, and women will refer to cis-gender individuals. More understanding of gender is needed overall for understanding autism as most research uses a binary approach to gender and often does not discuss autistic individuals who are gender non-conforming or transgender.
How can autism present in females?
Autism in females often presents differently compared to males despite meeting the same diagnostic criteria. This difference in presentation can make it more challenging to recognize autism in females, particularly those who have not received a diagnosis.
Here are some ways autism might present in females:
Difficulty with social communication and interaction
This can manifest as difficulty understanding social cues, engaging in reciprocal conversations, or navigating social situations.
However, some autistic females may develop sophisticated social strategies, such as mimicking peers or learning social scripts, to mask these difficulties. This ‘camouflaging’ can make autism less obvious to others but can be emotionally taxing for the individual.
When masking, I found that I often unintentionally mirror others’ personalities and mannerisms.
I have also found myself observing other people socializing and wishing that I could socialize as well as they do, thinking that others are just naturally ‘better’ at it than me.
Restricted interests
While autistic individuals are often characterized by strong interests in specific topics, autistic females may have interests that are less obvious or more aligned with typically developing females.
There is often a stereotype that autistic people are all mathematically minded and have an intense interest in transport and machinery.
When speaking to other autistic women and considering my own interests, they can be extremely vast and cover anything and everything.
For example, many autistic women report intense interests in social sciences and humanities, such as psychology, history, or literature; creative arts like music, writing, or drama; spirituality and religion; pop culture and media; and animals or nature.
Autistic men and boys can also have diverse interests that extend beyond the STEM fields or transportation.
While there may be a higher prevalence of certain types of interests among autistic males, such as those related to systems, it’s crucial not to make assumptions or overlook the potential for individuals to develop passions in any area.
Internalizing problems
Autistic females are more likely to experience mental health difficulties such as anxiety, depression, self-harm, and eating disorders.
These internalizing problems may overshadow the underlying autism, leading to misdiagnosis or delayed diagnosis.
I had always struggled with social anxiety since I was a child and believed that this accounted for all of my difficulties. However, even with medication and attending therapy multiple times, I was still finding social situations difficult, even if my overall anxiety levels had reduced.
It wasn’t until I started researching autism and how it impacts social interaction that I realized that I was probably socially anxious because I am autistic.
Sensory sensitivities
Autistic individuals often experience heightened or diminished sensitivity to sensory input, such as sounds, textures, or lights. This can lead to sensory overload, anxiety, and difficulty participating in certain activities.
While sensory sensitivities can affect any autistic person, the coping strategies employed may differ for females.
For example, I often find wearing certain fabrics uncomfortable and itchy but because a lot of women’s clothing can be uncomfortable, I often feel compelled to wear certain clothing to keep up with expectations of looking a certain way.
The Challenges of Late Diagnosis
The later a diagnosis is received, the more likely an individual is to have faced years of struggling to understand their differences.
Late-diagnosed women may have:
Spent years feeling misunderstood and invalidated: Many autistic women describe feeling like they don’t belong, often feeling pressure to conform to social expectations that don’t come naturally to them.
They may feel isolated and lonely because of this or struggle with romantic relationships and friendships.
In friendship groups at school, I often felt like I was on the sidelines and not fully involved in conversations because I was socially awkward. I would choose a group of people to hang around with, but I did not feel like I was really part of the group. I wanted to be included but did not feel skilled enough to socialize like everyone else.
Experienced misdiagnosis or dismissal of their difficulties: Some women may have been told their struggles are due to other conditions like anxiety, depression, or personality disorders. This can delay access to appropriate support and understanding.
‘‘When I mentioned the possibility (of being autistic) to my psychiatric nurse she actually laughed at me”
(Interview extract from Bargiela et al., 2016)
This dismissal may come from people you know, too. When I was awaiting my autism diagnosis, and I shared with some people that I thought I could be autistic and explained the reasons why, I would sometimes hear, ‘I don’t think you are,’ or ‘That doesn’t mean you’re autistic.’
Feeling like there is something inherently ‘wrong’ with you: Without considering that autism may be the reason for the differences in social communication and interaction, many autistic females may struggle with low self-esteem.
They may also have difficulties advocating for their own needs due to this lack of understanding of being autistic.
Before considering that I could be autistic, I would often set personal goals such as ‘I am going to try to be more social and outgoing’ or ‘I am going to overcome my shyness.’ Looking back, what I was really aiming for was to mask better (which is not helpful!).
Now that I have a better understanding, I can accept that being a very social person does not suit my needs and I can see value in being introverted.
Higher likelihood of mental health problems: Undiagnosed autistic women and girls may be more likely to experience anxiety and depression due to the effort required to mask autistic traits and meet social expectations.
I would often experience periods in my life when I felt ‘depressed’ but could not understand why. On reflection, I can see that I would often experience these ‘depressed’ periods at times when I was constantly masking or trying to balance too many responsibilities.
While it is possible that I could have been experiencing depression, it is also likely that I was experiencing what is known as autistic burnout.
Developed unhealthy coping mechanisms: Without an understanding of their autism, women may develop unhelpful coping strategies to navigate social situations, such as extreme people-pleasing or social withdrawal.
These coping mechanisms can take a toll on their mental well-being and prevent them from seeking help.
There have definitely been times when I have people-pleased so as to not disappoint others, such as staying in friendships where the other person did not align with my ideals and remaining in social situations that were too overstimulating because I wanted to be accepted and like everyone else.
Why does autism often go undiagnosed in females?
There are several interconnected reasons why autism often goes undiagnosed in females:
Symptoms may be more subtle in females
Autistic females may exhibit more subtle autistic traits than males. Their social difficulties might be mistaken for shyness or introversion, and their special interests may be less conspicuous. This can lead to parents and professionals overlooking the possibility of autism.
For example, an autistic woman who struggles with social communication but has learned to mask her difficulties through imitation and scripted responses may be perceived as simply being introverted or reserved rather than displaying signs of autism.
ASD symptoms may have similar symptoms to other conditions
Many autistic females experience co-occurring conditions like anxiety, depression, or ADHD, which can obscure the underlying autism. These overlapping symptoms make it difficult to disentangle autism from other conditions, resulting in misdiagnosis or delayed diagnosis.
For example, an autistic woman who experiences sensory overload in social situations may develop significant social anxiety.
When she seeks help, her anxiety symptoms may be more apparent and lead to a diagnosis of an anxiety disorder, while the underlying autism goes unrecognized.
Women are good at hiding their symptoms
While any autistic person can mask, autistic females often become adept at camouflaging their autistic traits to fit in and meet social expectations. They might observe and mimic others, learn social scripts, or suppress their natural responses.
While this camouflaging can help them navigate social situations, it can also mask their autism from others, including healthcare professionals.
For example, an autistic girl might study the social interactions of her classmates and learn to imitate their facial expressions, tone of voice, and conversational topics. She may develop a repertoire of socially acceptable responses and practice them in front of a mirror or with trusted family members.
Gender stereotypes and bias in diagnosis
Historically, autism has been viewed as a predominantly male condition. This has led to a bias in diagnostic criteria and assessment tools, which are often based on observations of males with autism.
Professionals may also be more likely to attribute certain behaviors to gender stereotypes, leading to misdiagnosis or underdiagnosis of autism in females.
For example, a girl who is quiet and withdrawn might be labeled as ‘shy,’ while a boy with the same traits might be referred for an autism assessment.
Lack of awareness and understanding of autism in females
Due to autism being viewed as a male condition and research predominantly male-dominated, many professionals may lack specific training on how autism presents itself in females. This lack of awareness can lead to misinterpretations of symptoms and missed diagnoses.
For example, a health professional who is not well-versed in the unique challenges faced by autistic girls may not recognize the signs of autism in a young girl who appears to be coping well socially but struggles with anxiety, sensory sensitivities, and executive functioning.
The health professional may attribute these challenges to other factors, such as shyness or a learning disability, and fail to refer the girl for an autism evaluation.
The Power of Diagnosis
While the journey to diagnosis can be long and challenging, receiving a diagnosis later in life can be incredibly validating and empowering for many women.
It can provide:
- Relief and self-acceptance: A diagnosis can bring a sense of relief, finally providing an explanation for lifelong feelings of difference. It can help women understand their strengths and challenges within the context of their neurodiversity.
- Access to support and community: A diagnosis can open doors to support groups, communities, and resources specifically designed for autistic adults. Connecting with others who understand their experiences can be incredibly beneficial for their well-being.
- A new sense of identity and authenticity: Armed with a new understanding of themselves, women can embrace their autistic identity and let go of the pressure to mask or camouflage. This can be a liberating experience, allowing them to live more authentically and connect with others who appreciate them for who they are.
What to Do if You Suspect You Might Be Autistic
If you resonate with the experiences described in this article and believe you might be autistic, here are some steps you can take:
Educate yourself about autism in women
Read books, articles, and personal accounts from autistic women. Understanding the female autism phenotype can help you better understand your own experiences.
Talk to a trusted healthcare professional
Reach out to a doctor, therapist, or psychiatrist who is knowledgeable about autism in adults, particularly in women. They can assess your situation, provide guidance, and potentially refer you for a diagnostic assessment.
Connect with the autistic community
Online forums and support groups can offer a sense of community and shared understanding. Engaging with other autistic people can be validating and empowering.
Write down your experiences
Something that helped me identify that I could be autistic was to write down specific experiences, behaviors, and feelings in a list that I felt may have a neurodivergent explanation.
You can do this in a journal or on your notes app on your phone so then you can easily add to it wherever you are.
Keeping this list can be helpful evidence if you choose to seek an official autism diagnosis, as well as helping you identify patterns and increase self-awareness.
Advocate for yourself
Even if you are not autistic, I think it is also valuable to advocate for your differences anyway.
For example, if you know that you are prone to people-pleasing and it is causing you to burnout, try to communicate boundaries with people and practice saying “no” before you get overwhelmed and prevent more burnouts.
Likewise, if you know that some social events are too overstimulating (e.g., too crowded or loud), you could:
- try to communicate to others that you would prefer to do a less stimulating activity
- explain that you will not be attending this event
- or make accommodations, such as taking earplugs and planning to leave by a certain time
Finally, remember that seeking a diagnosis is a personal decision, and there is no right or wrong answer. The most important thing is to prioritize your well-being, seek support when needed, and embrace your unique strengths and challenges.
References
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of autism and developmental disorders, 46, 3281-3294. https://doi.org/10.1007/s10803-016-2872-8
Cooper, K., Smith, L. G., & Russell, A. J. (2018). Gender identity in autism: Sex differences in social affiliation with gender groups. Journal of Autism and Developmental Disorders, 48(12), 3995-4006. https://doi.org/10.1007/s10803-018-3590-1
Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders, 7, 306-317. https://doi.org/10.1007/s40489-020-00197-9
Lai, M. C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11-24. https://doi.org/10.1016/j.jaac.2014.10.003
Leedham, A., Thompson, A. R., Smith, R., & Freeth, M. (2020). ‘I was exhausted trying to figure it out’: The experiences of females receiving an autism diagnosis in middle to late adulthood. Autism, 24(1), 135-146. https://doi.org/10.1177/136236131985344
