Autism in girls: signs, symptoms, diagnosis and support

By Emily Cavanagh, Clinical Psychology Registrar

Autism in girls can look different to autism in boys. It’s often harder to pick up, because girls may mask their autism to appear neurotypical. This means many girls get a late diagnosis of autism and miss out on the early intervention that can them better navigate the world around them. Find out more about the signs and symptoms of autism in girls, how to get a diagnosis and where to find support. 

What is autism?

Autism, or Autism Spectrum Disorder (ASD),  is a neurological difference that impacts how people communicate and make sense of the world. Autism is life-long, meaning it begins when someone is born and stays with them for the duration of their life. 

There are two broad defining characteristics of autism: (A) challenges in social communication and interaction, and (B) restricted, repetitive patterns of behaviour, interests, or activities. Most people with an autism diagnosis meet both criteria; however, some people only meet one. 

When given a diagnosis of autism, a clinician will usually provide a level: – 1 (requiring support), 2 (requiring substantial support) or 3 (requiring very substantial support).The level may change over time. 

What are the signs of autism in girls?

The signs that a boy or girl might be autistic can be similar – however, more often than not, girls present very differently. Girls who are autistic may present with signs similar to those in boys, such as sensory sensitivities, social difficulties, an avoidance of eye contact, extreme reactions to change, or interpreting language literally. 

However, other signs that are more specific to autistic girls may include a tendency to be shy and quiet, intense focus, extreme attention to detail, overly dependent or reliant on one friend, and keeping emotions in check when at school, but having meltdowns at home. 

Additionally, girls with autism may have more friends who are boys, rather than girls. Typically, girls are more socially demanding, making it harder for someone with autism to meet their social needs, and thus gravitating towards boys. 

How are the symptoms different in girls and boys?

The core characteristics of autism are the same among girls and boys. This may include social and communication challenges,  and restricted or repetitive patterns of behaviour, interests or activities. However, the individual symptoms present differently. 

Girls with autism typically present with fewer and more subtle behaviours that are often misdiagnosed for other mental health problems, such as anxiety or depression. For example, some common repetitive behaviours in girls include twirling their hair or picking their nails. 

Boys often show clear challenges in social skills, girls may present as being shy and quiet. While boys with autism tend to have stereotypical restricted interests such as facts or numbers, girls usually have fewer and more ‘socially acceptable’ restricted interests that are specific to what they enjoy, such as ponies or princesses. 

Why does autism often get missed in girls?

Autism often gets missed in girls because they “mask” their symptoms. 

Masking often occurs is in friendships, where girls will typically follow social actions by imitating and copying their peers. Girls with autism often keep their emotions in check at school as part of their masking. They may then have meltdowns at home, which can often be misdiagnosed as another mental health problem or dismissed as ‘issues at home’. 

Autism in girls can sometimes be missed because their behaviour is seen as “socially acceptable”, such as a girl being shy and quiet or having extreme focus and attention to detail. Other times, restrictive and repetitive behaviours in girls can be misdiagnosed as Obsessive-Compulsive Disorder (OCD). 

Another common reason that girls get missed is due to the myth that speech is delayed in individuals with autism. In contrast, some girls may actually have highly developed speech and language skills.

What is the benefit of an early diagnosis?

An autism diagnosis often opens up access to funding and therapy services. Early intervention provides a child with the opportunity to develop lifelong skills, such as social skills, fine and gross motor skills, and language and communication skills. A child’s brain develops at a rapid pace, providing an ideal opportunity for early intervention. 

Autistic children, who do not receive a diagnosis and intervention,  can have social issues, including bullying, exclusion, relationship difficulties and an overall sense of “why am I different to other kids?”This can then lead to other mental health problems, such as depression, anxiety, and low self-esteem, where they are often left wondering “what is wrong with me?” 

A missed or late diagnosis can impair the individual’s academic functioning. They may have difficulty completing schoolwork, particularly activities that involve planning, organising, and prioritising. 

Lack of early intervention, friendship difficulties, self-esteem issues and academic functioning can all lead to school refusal. 

What causes autism in girls?

The cause of autism remains largely unknown. However, there are a variety of factors involved that are the same for boys and girls. One of the biggest and most well-researched factors is a possible genetic component, and often multiple people in the same family present with autism.

Early diagnosis and intervention is key to managing how well someone with autism will function in their life. Knowing the different signs of autism is vital for early diagnosis and intervention, particularly for girls where a diagnosis is often missed.

How is autism in girls treated? 

Autism is not ‘treated’ in the same way you might treat a medical issue. Autism is a disability that impacts the way an individual interprets and responds to the world around them. People with autism may benefit from interventions that help them navigate their lives.  

A disability support plan is unique and tailored to meet the needs of the individual. This means that the focus may vary to include support for mental health, emotions, skills, or social functioning,.. Often, multiple clinicians and therapists, such as psychologists, occupational therapists and speech pathologists work together with parents, families and schools as part of a collective team. 

The best practice is to adopt a neurodiversity-affirming approach. This means that the clinicians do not view autism as something to be fixed; rather, individual differences are celebrated, and strengths are drawn upon. 

Where can I find support? 

There are many different professionals who are usually involved in supporting someone with autism, and their family. These professionals all play a different role and may include psychologists, behavioural therapists, paediatricians, occupational therapists, speech pathologists or behaviour support practitioners. 

Psychologists can provide a formal assessment to diagnose autism and help determine a support plan. They may also complete individual or family sessions that include a focus on psychoeducation, mental health, or social skills. Usually, social skills training is best done in a group setting so that children have the opportunity to learn alongside their peers. We offer one at Spencer Health, called KidsLink.

If you’re unsure where to start, the best place is usually with your GP, who can then refer you to a psychologist or paediatrician who has a special interest in neurodevelopment. 

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