By Natasha Binns, Clinical Psychology Registrar

Autism is a neurodevelopmental condition that affects how a person’s brain develops and is often associated with challenges in social interactions, communication, and repetitive behaviours. Until recently, autism was thought to be more prevalent amongst boys more than girls, with boys 3 to 4 times more likely to receive a diagnosis, however it is becoming increasingly clear that girls with autism can present differently, with this often leading to missed diagnoses or significant delays in receiving diagnosis.

How Autism Presents Differently in Girls

While each person’s experience on the spectrum is unique, there are characteristic of autism that are more commonly observed in girls and women which can often be missed by healthcare professionals. Some common traits include:

• Masking: Autistic girls often develop strategies to mask their differences, making their symptoms less apparent to others. They may learn to mimic social behaviours, such as making eye contact, non-verbal communication, speech, and actions of others, even though they may not fully understand the underlying social cues.
• Avoidance: Autistic girls may avoid or not seek social interactions with others and may seem shy and reserved unless engaged in their interests or hobbies.
• Intense Friendships: Autistic girls may have a very limited number of friendships, preferring close friendships, and may have a tendency to become possessive within these friendships which can lead to these friendships ending suddenly.
• Emotional Regulation: Due to their abilities to mask their differences, autistic girls can often control their emotions when in social situations, but can become distressed and upset once home as a means of releasing these emotions.

• Strong Imaginative Play: Autistic girls often have a highly developed imagination, enjoying fiction, pretend, and fantasy play, however this play can tend to be one-sided and overly controlled, with difficulty playing cooperatively with others.
• Intense Interests and Repetitive Behaviours: Autistic girls can often have intense interests which may be more advanced for their age, and considered more “mainstream” literature, art, people, or animals. They can appear extroverted when talking regarding these interests and introverted at other times. Their repetitive behaviours are often more movement based and can take the form of actions such as hair twirling or nail picking.
• Sensitivity to Sensory Stimuli: Autistic girls are often sensitive to sounds, textures, light, food, or touch which can impact their daily lives.
• Anxiety: Autistic girls are more likely to internalise their negative emotions which can lead to higher levels of anxiety, perfectionism, and a desire to control their environment to allow them to feel safe.

Common Signs Mistaken for Other Conditions

Due to the complexities of autism in girls and the differences of how these traits present to autistic boys, these traits can often be misattributed to other disorders below that may share similar traits to Autism.

• Anxiety: As many autistic girls experience anxiety and tension, especially in social situations due to difficulties understanding social cues, these signs can often be mistaken for Generalised Anxiety Disorder or Social Anxiety Disorder.
• Obsessive Compulsive Disorder (OCD): As one characteristic of Autism is repetitive behaviours or seemingly ritualistic behaviours, these traits can often be misattributed to OCD rather than Autism and can frequently co-occur.
• Attention Deficit Hyperactivity Disorder (ADHD): ADHD commonly co-occurs with AUTISM and as such, autistic girls may be diagnosed with only ADHD with their autism traits being lumped in with this diagnosis and discounted.
• Eating Disorders: Autistic girls can often have sensory sensitivities to touch which can cause avoidance of certain foods and textures, preferring “safe foods” which may be misconstrued as an eating disorder.
• Mood Disorders: Feelings of anger and sadness and difficulties with emotional regulation may lead to diagnoses of a mood disorder.
• Personality Disorders: While some traits within personality disorders, such as Borderline Personality Disorder, can appear similar to autistic traits (e.g. difficulty regulating emotions, unstable or intense interpersonal relationships, impulsive behaviour, dissociation in times of stress, intense anger disproportionate to the situation), these traits are driven by different underlying factors to autistic traits and thus, autistic girls will have different needs which will be missed by an incorrect diagnosis.

Due to this, it is important to consider autism as a possible diagnosis if a girl exhibits any of the above traits.

Why Early Diagnosis and Support Matters for Autistic Girls

Early diagnosis and intervention are crucial for autistic girls and boys to receive the support and interventions that can aid in the development of essential skills. The early children are able to access these supports, the more malleable their brain is, meaning these skills can be learnt and adapted more readily at an earlier age.

Without these supports, undiagnosed autistic girls can end up developing depression, anxiety, low self-esteem, and fatigue due to the difficulties they are experiencing attempting to fit in and mimic social interactions. They may not understand nuances in social communication which can lead to difficulties in friendships and relationships and can make them more at risk for traumatic experiences as they may have difficulty identifying warning signs of danger.

When autistic girls receive incorrect diagnoses, they will often be receive the wrong treatment and wrong support for their needs which can compound their difficulties, lead to admittance into hospitals, and lead to disillusionment and disheartenment in the mental health care system. This can lead to disengagement with mental health services, and can lead autistic girls to turn toward unhelpful coping strategies to aid them instead.

Seeking Support

If you suspect your daughter may be autistic or has been misdiagnosed, it is important to advocate for your child and that this be discussed with your doctor, your child’s paediatrician, or a mental health professional, and to seek a comprehensive evaluation by a qualified professional. Ongoing support will often involve a multidisciplinary team, and can include:

• Paediatrician: Who can assess physical health and prescribe medication if appropriate to reduce anxiety or emotional difficulties.
• Psychologist: Can provide a safe space to explore emotions, develop coping strategies, and build self-esteem, as well as develop strategies to increase emotional regulation and increase awareness of social cues and social skills.
• Speech Therapist: Can provide an assessment of communication abilities and develop strategies for verbal and non-verbal communication skills.
• Occupational Therapist: Can assess sensory processing and fine motor skills and provide strategies to minimise the impact of sensory difficulties and development of coping skills.

It is important to remember that early intervention is key to improving the quality of life for autistic girls. By recognizing the signs, seeking support, and advocating for their needs, we can empower autistic girls to have access to the supports they need or want to receive.

At Spencer Health, we offer compassionate and evidence-based support for neurodivergent individuals. To learn more, or to book an appointment, please reach out to our team: enquiries@spencerhealth.com.au