By Claire Mitchelmore – Provisional Psychologist

Many women and girls continue to struggle to obtain a diagnosis, are misdiagnosed with mental health conditions or personality disorders,  and/or get diagnosed much later in life.  As a result, they are unable to gain a better understanding of themselves or access required support, with significant impacts on their socio-emotional wellbeing. It is therefore imperative to understand why autism presents differently in girls and ensure early diagnosis.

Why girls present differently : Masking and social camouflage

Girls are particularly adept at mimicking social behaviours, suppressing repetitive (stimming) behaviours and internalising their autistic traits to fit in and avoid standing out. Masking or social camouflaging can include conscious or unconscious strategies that can make it difficult to for parents and educators to identify social, sensory and emotional difficulties experienced by autistic girls. Autistic girls with good verbal skills and moderate levels of intelligence are particularly adept at masking.

Given the subtlety of these behaviours, what do parents and clinicians need to look for when assessing girls for autism?

Early Signs of autism in girls

Girls with autistic brain styles can present with autistic characteristics in the following ways:

Difficulties with social interactions

• Less interest in co-operative play or a preference to maintain control over any games by leading or dictating the rules of play makes initiating and maintaining friendships difficult.
• More likely to be the victim of bullying than neurotypical peers.
• Can handle a limited number of social interactions within a day
• Frequently chooses to play with much younger or older children.

Intense interests 

• Deep, consuming or disruptive interests that often appear “mainstream”, e.g. popular TV shows, books, movies, or musicals; animals; music; fashion or fandom.
• Deep interests can be accompanied by a strong imagination into elaborate and creative world of nature, fantasy or fiction.

Sensory sensitivities

• Become distressed by loud noises, bright lights, strong smells, or certain textures in busy environments like shopping centres, play centres or classrooms.
• May seek out sensory input such as spinning objects, making strange sounds or sing phrases repeatedly, seek out forms of deep pressure, or frequently touching objects
• Might engage in unsafe behaviours, such as touching hot objects or refusing to wear appropriate clothing in extreme temperatures.

Repetitive behaviours 

• Uses socially acceptable repetitive behaviours to soothe intense sensory experiences such as hair twirling, fidgeting with pens, or arranging objects.
• Reports ‘internal’ repetition such as repeating phrases, words or scenarios in their minds.
• Attempts to manage or control repetitive thoughts or behaviours lead to emotional distress.

Persistent need for sameness and routine

• Becomes distressed if daily rituals, personal belongings or household objects are disrupted or interfered with.
• Experiences significant and seemingly disproportional levels of distress in response to unexpected changes in daily routines, such as having a substitute teacher for the day

Frequent difficulties with emotion regulation

• Masking at school may result in seemingly disproportional levels of emotion, defiance or tiredness once in the safety of the home.
• Experiences difficulties in recognising and understanding their own internal emotional or physical cues.

Pathways to Diagnosis

A diagnosis and resulting therapeutic support can provide the autistic child and their family with a better understanding of their different brain style, including key strengths, and provide them with relevant coping skills.   If you suspect your child may have an autistic brain style, the following pathways can assist you in gaining a diagnosis:

1. Contact your child’s GP or health practitioner to discuss any concerns about your child’s development and obtain a referral for further assessment.
2. Engage with the referred paediatrician and/or psychologist who will work with you to assess the following:
   1. Functional assessments to gain an understanding of your child’s strengths and support needs, including cognitive abilities, speech and language function, friendships, and academic performance.
   2. Medical examinations to understand whether there could be any medical causes for behaviours or characteristics that prompted the referral.
   3. Diagnostic evaluation through parent/ teacher questionnaires, caregiver interviews and play-based observations to determine whether your child meets the diagnostic criteria for autism.
3. Your paediatrician or psychologist may refer you to other specialist (such as a speech therapist, OT or optician) to assist with further assessment and evaluation.
4. After the assessment, the practitioner should provide you with a report, summarising their findings and explaining any diagnosis that has been made (including any reasons should a diagnosis not be made), and recommendations for ongoing support and treatment.

Ready to Take the Next Step?

If you are ready to book in an assessment or therapeutic support for yourself or your child, or are interested in having an initial conversation with one of our trained psychologists to decide if it is worth pursuing an assessment or therapy, please get in touch. Spencer Health is a neuroaffirming organisation and we are lucky to count many neurodivergent psychologists as colleagues.

If you would like to meet more of our team, or learn more about our services you can do so here https://spencerhealth.com.au/spencer-health-team/ or if you are ready to book in, you can do so here https://spencerhealth.com.au/contact/