Autism is significantly more common in boys than in girls. This skewed sex ratio has been recognised since the first cases of autism were described in the 1940s. But we’re not sure why autism appears in more males than females. It may be rooted in biological differences between the sexes. Or, some experts say, it may be an artifact of the way autism is defined and diagnosed.

But we also know that many autistic girls remain undiagnosed because many of the social signs of autism are less obvious in girls than they are in boys. One way that girls are “flying under the radar” of a diagnosis is the use of camouflaging as a coping mechanism.

Camouflaging means to pretend to know how to socialise by using observation, imitation, and adopting a persona or wearing a mask to meet social demands. An autistic girl – like an autistic boy – does not intuitively know what to do or say in a social situation. Social challenges are a hallmark of being on the autism spectrum. Compared with most boys, however, from a very young age an autistic girl will often closely observe and analyse her peers before making the first step. She will use imitation and acting to be able to conceal her confusion when socialising with peers.

What to Know about Autistic Girls

Unlike most autistic boys, girls are more likely to be able to accurately interpret and answer questions about social interactions, social situations, and friendship. However, they rely on intellect rather than intuition, so their responses will be slower, making it difficult for them to keep up in a group setting or with typically-developing and more socially skilled girls. Consequently, autistic girls tend to choose single close friendships rather than being part of a group. They often find males more appealing as friends because male friendship dynamics may be perceived as being easier to understand.

Autistic girls often show a willingness to follow the rules, a natural tendency to shyness, and social naivety. Such qualities can mean that they are easily missed in a classroom where louder children gain the teacher’s attention. Autistic girls are usually very hesitant to ask for help. They may fear drawing attention and are often self-directed and perfectionistic, so do not wish to be seen as stupid or making a mistake.

Autistic girls can focus much of their intellectual energy on learning about their social world, hence special interest topics may have more of a social focus, such as mental health, self, friendships, animals, celebrities, literature, and fantasy. Sometimes it is not the topic that differentiates them from their peers so much as the intensity of their hyper-focus on it.

Despite their frequently better coping mechanisms and ability to camouflage their social difficulties, their social difficulties are very real, on a par with those of autistic boys, and cause enormous stress, confusion, and exhaustion. In addition, autistic girls experience sensory processing challenges at the same level or more than autistic boys. These challenges generally lead to high levels of anxiety in the classroom and playground. When this occurs, you may observe an autistic girl:

• become overwhelmed in social situations
• be reluctant to participate in class activities
• be unable to communicate verbally (situational (selective) mutism)
• feel judged negatively by their peers
• withdraw from social interaction

During primary school autistic girls can appear to have no social difficulties, successfully ‘keeping it together’ at school. In fact, an autistic girl may be able to do such a great job at “wearing a mask” and fitting in that nobody would believe she has autism. However, the toll on their energy levels and emotions can be high. Girls will often come home feeling exhausted, irritable, and overly emotional, following a day processing both the academic and social curriculum. Over time secondary mental health concerns often develop including anxiety and depressive disorders, self-harm, eating disorders, and suicidality. The average age of diagnosis for autistic girls around the world is 12-13 years old, coinciding with the first year of high school, when the social world suddenly becomes far more complex, and hormonal changes that increase anxiety exacerbate autistic features.

What Next?

So now you know the signs, what do you do if you think you could have an autistic daughter? If you are a parent, approach your daughter’s teacher. Share this article and discuss what they have observed. If you are a teacher, you may approach the parents and ask them how their daughter is going at home. Mention the signs that concern you and share this article with them. Acknowledge that you are not a diagnostician, and you may be wrong, but that you are concerned and wish to do all that you can to assist their daughter.

To take the next step to obtain a formal diagnosis (or at least to investigate), carefully consider the level of experience of the Clinical Psychologist, Paediatrician or Psychiatrist you choose. The field of understanding the female presentation of autism is an emerging one and many health professionals did not receive training as part of their degree. Approach your local autism association for names of diagnosticians who are experienced in signs of autism in girls and women.