Understanding Autism in Women

Colloquially known as autism, autism spectrum disorder (ASD) refers to a group of developmental disorders. These conditions can affect the way people behave, socialize, and communicate with others.

Previously ASD was broken down into subtypes, such as Asperger’s syndrome, but it’s now treated as a spectrum of wide-ranging symptoms and severity levels.

ASD is about four times more common in boys than in girls, according to the Centers for Disease Control and Prevention (CDC).

However, many autistic females may not be diagnosed or receive a diagnosis until adulthood. This may result from the fact that females can present with different symptoms and may mask their ASD more than males.

Read on to learn more about ASD in females and how to recognize it.

Children ages 3–7 are most commonly diagnosed with ASD. But in many cases, parents or caregivers may have concerns about the child’s social development before they’re 18 months old.

For example, infants may not make eye contact. In some cases, they might show indifference toward their parents. Toddlers may fail to respond to their names or start taking steps backward in their language development.

Still, ASD is a spectrum of disorders, and not all autistic children display the same symptoms. But generally, the symptoms can involve problems with social interaction and behavior.

Social communication and interaction symptoms

Autistic children and adults often have difficulty connecting with others.

This can result in a range of symptoms, such as:

• inability to look at or listen to people
• no response to their name
• resistance to touching
• a preference for being alone
• inappropriate or no facial gestures
• inability to start a conversation or keep one going
• excessive talk about a favorite subject without giving attention to the reactions of others
• speech problems or unusual speech patterns
• inability to express emotions or recognize them in others
• trouble recognizing simple social cues
• difficulty following simple directions
• inability to predict someone’s response or reaction
• inappropriate social interactions
• inability to recognize nonverbal forms of communication

Behavioral pattern symptoms

Autistic people often have repetitive behavior patterns that are hard to break.

Some of these patterns include:

• performing repetitive movements, such as rocking back and forth
• developing routines or rituals that can’t be disrupted
• self-harming, including biting and head-banging
• repeating words and phrases
• becoming extremely fascinated with a particular subject matter, fact, or detail
• experiencing sensations of light and sound more or less strongly than others
• fixating on particular objects or activities
• having particular food preferences or aversions to food textures

ASD symptoms in females may not be very different from those in males.

However, research has found that males may have more visible behavioral problems, whereas females can internalize their symptoms more. This may result in autistic females experiencing more mood issues, such as anxiety and depression, than males in some cases.

Not all studies fully support this conclusion.

One large 2020 research review comparing behaviors between autistic males and females reported that autistic females were reported to have more externalizing behaviors. On the other hand, another study also reported that autistic males have greater externalizing behaviors.

The same large review also reported that autistic females may present lower cognitive ability and adaptive functions, but generally, levels appear to be similar to autistic males.

More longitudinal studies are needed to draw clear conclusions about the diagnoses and behaviors among and between autistic males and females.

Experts still do not have any definitive information about these differences, including if these are real or just a result of masking.

Masking

Researchers believe that adult females and girls are more likely to mask their symptoms. This is particularly common among females at the lower support need end of the ASD spectrum.

Common forms of masking include:

• forcing yourself to make eye contact during conversations
• preparing jokes or phrases ahead of time to use in conversation
• mimicking the social behavior of others
• imitating expressions and gestures

While both autistic males and autistic females can camouflage their symptoms, this appears more common in females. Along with the differences in presentation, this could also explain why they’re less likely to be diagnosed as autistic.

Experts aren’t sure what causes ASD. Given the wide range of symptoms and severity, it’s likely caused by several factors, including genetics and environmental factors.

While there’s no evidence that the exact cause is different between the sexes, some experts suggest that males have a higher chance of developing ASD.

For example, investigators believe that girls might be born with genetic protective factors that reduce their risk of ASD.

Male brains are exposed to higher levels of male hormones in the uterus, which can affect brain development and may be a factor in ASD development. This is called the “extreme male brain” theory.

As a result, a child’s mind might focus more on understanding and categorizing objects, traits that are generally associated with the male brain. This is in contrast to empathizing and socializing, which are more often associated with the female brain.

While this is still only a theory, research seems to support this hypothesis, though not conclusively. The effect of hormones on brain development isn’t well known yet, giving this theory some limitations.

No medical tests, such as a urinalysis or blood test, can tell you if someone is autistic. ASD is typically identified by observation of potential signs over time.

You might begin to notice that your child is not hitting certain developmental milestones, particularly in the social sphere, and take them to their pediatrician.

Sometimes you may not notice the signs, but your pediatrician will identify some symptoms during their routine well-child visit. They may refer your child for a formal evaluation with a child psychologist or pediatric neurologist, who may conduct screening assessments such as:

• Autism Diagnostic Observation Schedule (ADOS)
• Childhood Autism Rating Scale (CARS)
• Gilliam Autism Rating Scale (GARS)
• Autism Diagnostic Interview (ADI)

They will likely complete these assessments after observing your child in depth to see how they play and interact with those around them. They may also rely on the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition, text revision (DSM-5-TR) criteria to make the diagnosis.

If you believe your child could be autistic, make an appointment with their doctor.

Learn more here about the process of working with a doctor to get an autism diagnosis.

Diagnosis in adulthood

Most clinicians consider a diagnosis by a qualified professional to be reliable starting from age 2 years. But diagnosing ASD can be difficult. There are many cases in which a person is not identified as autistic until adulthood.

There are similar diagnostic tests for autistic adults. But diagnosing ASD in adulthood can be challenging, and not every clinician is experienced in identifying the signs, especially in females.

If you suspect that you may be autistic, start by talking with a primary care doctor. A psychologist can also help you evaluate your symptoms and rule out other potential causes. You may need to visit a few doctors before you find one who understands your symptoms and concerns.

If possible, try to ask close family members about any potential signs or symptoms you might have displayed as a child. This can help to give your doctor a better idea of your childhood development.

Throughout the process, remember that you are your most important advocate. If you feel your doctor is not taking your concerns seriously, consider speaking up or getting a second opinion. Seeking a second opinion is common, and you should not feel uncomfortable doing so.

Learn more about ASD in adults.

Not every autistic person necessarily views ASD as a condition that needs treatment. But there are resources available for those who feel they need support.

While there’s no cure for ASD, resources are available to help autistic people reduce behaviors that may negatively affect their quality of life.

In children, this support often begins through early Intervention developmental therapies and may progress to different styles of behavioral or educational therapies that may continue in various ways through adulthood.

Those diagnosed in adulthood can also access different therapy modalities that can help them, such as cognitive behavioral therapy (CBT), for example.

Medications may also help autistic people with mental health conditions like anxiety or depression and behaviors such as difficulties with focus, self-harming behavior, and more.

Learn more about the different treatments for ASD.

For females

Since females may be better at masking their symptoms, being an autistic female can feel particularly isolating. For many, it’s an emotional process that involves revisiting childhood behavior and social problems.

To help you feel less alone, try reaching out to others who may have a similar experience. For example, the Autistic Women and Nonbinary Network is a nonprofit organization that supports cisgender females and gender nonconforming autistic people.

Even if you’re not ready to interact with someone, you can find blog posts, first-person stories, and doctor recommendations online.

In addition, the following reading materials may help you better understand and be more accepting of yourself.

• Thinking in Pictures. This is the firsthand account of Temple Grandin, PhD, one of the most well-known autistic females. She offers her perspective as both an accomplished scientist and an autistic female.
• Women and Girls with Autism Spectrum Disorder. This collection of research articles and personal stories offers multiple perspectives on how autistic adult females and girls navigate the world around them.
• I Am AspienWoman. This award-winning book explores how females uniquely experience ASD across different ages. It also discusses how ASD may be more of a beneficial way of thinking than a condition that needs aggressive treatment.

Looking for more book recommendations? See our list of other essential books for autistic adults or parents of autistic children.

ASD appears to be more common in boys than girls, and researchers are starting to better understand the differences in how boys and girls experience it.

While this is promising for future generations, adult females who think they may be autistic still face challenges getting a diagnosis and finding support.

But as awareness about ASD and its many forms grows, so do the available resources.

The internet has also made it increasingly easier to connect with others, including those living with social anxiety, a common symptom of ASD.

Read this article in Spanish.