Autism in girls has been overlooked for decades. As is true in many areas of scientific research, historically, autism research has been disproportionately focused on males, leaving a critical gap in our understanding of autism spectrum disorder in females. Autism in girls and women has been underdiagnosed, misdiagnosed, and misunderstood.
Every person on the autism spectrum is unique, wonderful, and deserves to be seen. The goal of this article is to shed a much-needed light on autism in girls.
In this article, we will…
- Discuss the underdiagnosis of autism in girls and the implications
- Explore the ways that autism is different for girls (symptoms, behaviors, experiences, abilities, and treatment)
- Use key autism research to educate you on female autism
Autism Diagnosis Statistics
First, let’s look at the autism diagnosis statistics.
The following autism prevalence statistics are based on a survey of American 8-year-olds conducted by the CDC’s Autism and Developmental Disabilities Monitoring Network. It’s important that we emphasize that the statistics below are based on ASD diagnoses and ASD classification in special education, rather than the true number of autistic children.
- How many children have autism in the United States? 1 in 36 children have autism.
- What is the male to female autism ratio? 4 out of 100 boys have autism. 1 out of 100 girls have autism.
Additionally, girls receive autism diagnoses later than boys. According to the Organization for Autism Research:
- 8% of girls with autism receive a diagnosis before age 6 compared to 25% of autistic boys.
- By age 11, 50% of autistic boys are diagnosed, but only 20% of autistic females are.
National estimates of the adult autistic population in the US are as follows:
- As of 2017, an estimated 2.21% of US adults ages 18-84 were living with autism.
- The estimated ASD prevalence for American females was 0.86% and a significantly higher figure of 3.62% for adult males.
The Underdiagnosis of Autism in Females
The figures above might lead you to assume that boys are around 4x more likely to have autism than girls. While it is entirely possible that autism is more common in boys, these figures are based on diagnoses, so what they really reveal is that boys are 4x more likely to be diagnosed with Autism.
Recent research has shown that females with autism are underdiagnosed and frequently misdiagnosed significantly more than males. A 2022 clinical study estimated the biases in initial recognition and clinical diagnosis of autism by examining pediatric patients ages 1-18 and found that approximately 80% of autistic females remain undiagnosed at age 18. In addition to underdiagnosis, misdiagnosis of autism is a major issue for females.
The Misdiagnosis of Female Autism
Misdiagnosis is a rampant issue that a lot of women and girls with autism deal with. A study conducted by The National Autistic Society in the UK found that 42% of autistic women are diagnosed with a mental disorder other than autism when they are first assessed. According to another study, the most common misdiagnosis that autistic women receive is a personality disorder (36.4%). Misdiagnosis of autism has several potential consequences—the patient losing faith in the healthcare system, improper treatment, and a roadblock to finding the true diagnosis.
Why is Autism Underdiagnosed in Females?
Now that we know the severity of the issue, we need to examine the reasons why autism is underdiagnosed in females. In addition to misdiagnosis, here are the top reasons why so many women and girls with autism do not receive a diagnosis, or at least a timely autism diagnosis.
- Autism research, including diagnostic criteria, is predominately based on male subjects.
- Autistic females are more likely and better at camouflaging and masking autistic behaviors.
- Gender stereotypes cause autism symptoms in girls to fly under the radar.
In the following sections we will dive deeper into reasons 2 and 3 to provide you with insight as to how the symptoms, behaviors, and experiences of autistic females are different from males with autism.
Masking and Camouflaging Autistic Behaviors
Camouflaging refers to the strategies that autistic individuals use to blend in and appear neurotypical. The act of camouflaging autism involves hiding and downplaying ASD symptoms that may be considered socially unacceptable and replacing them with more socially acceptable behaviors.
Autism masking behaviors include:
- Forcing yourself to make eye contact
- Mimicking others’ social behaviors
- Imitating expressions
- Preparing phrases ahead of time to use in conversation
Camouflaging behaviors are more common amongst females with autism compared to males which contributes considerably to underdiagnosis.
The Consequences of Camouflaging
The ability to fit in socially might sound like a positive thing, but unfortunately there are consequences to camouflaging autism. Camouflaging is essentially putting on an act every day. Doesn’t that sound exhausting? A 2021 study of autistic adults that engage in camouflaging found that the “dangers of camouflaging” include “exhaustion, isolation, poor mental and physical health, loss of identity and acceptance of self, others’ unreal perceptions and expectations, and delayed diagnosis”.
Societal Pressure & Gender Stereotypes
Societal pressures and gender stereotypes contribute to the underdiagnosis of autism in females as well as the behaviors and experiences of girls and women with autism. Society encourages females, especially young girls, to blend in rather than stand out. This social pressure causes many autistic girls to prioritize assimilation over authenticity by engaging in camouflaging behaviors.
Symptoms of autism align better with girl stereotypes, so they are less likely to raise a red flag. Social awkwardness, sensory issues, and difficulty regulating emotions are all symptoms of autism. In young girls these symptoms are often overlooked and attributed to shyness, being sensitive, or dramatic—stereotypically feminine behaviors.
The Behavioral and Symptomatic Differences of Males and Females with Autism
Males and females with autism have similar symptoms—social and communication problems, restricted behaviors, repetitive behaviors, hyper fixation on specific interests, and learning differences. However, the ways that these symptoms manifest and the degree to which they present differ between the two genders. The following findings further explain how the behavioral and symptomatic differences in autistic females contribute to camouflaging and underdiagnosis.
- Girls display less repetitive and restricted behaviors compared to boys according to a study of 800 autistic children conducted by the Stanford University School of Medicine.
- Research shows that autistic girls display similar levels of social reciprocal behavior compared to neurotypical girls and significantly higher reciprocal social behavior compared to autistic boys. This is significant considering that deficits in social reciprocity are necessary to receive an autism diagnosis based on the DSM-5.
- Autistic girls are more likely to desire friendships. Adolescent girls with autism are more likely to engage in active social activities, like talking with friends, while autistic boys prefer passive activities like playing video games or watching TV according to a 2023 study.
- Intense, highly specific interests are a common symptom of autism shared by both genders. However, autistic girls are often highly focused on interests that are also popular with neurotypical girls, which allows them to fit in better, while the interests of autistic males tend to differ more from the interests of neurotypical males.
- In a clinical study of autistic youth, boys with ASD were more likely to display aggressive behaviors and recorded higher scores for aggression while girls with ASD displayed fewer aggressive behaviors.
The Implications Undiagnosed Autism & The Underdiagnosis of Female Autism
At this point, you’re probably frustrated about the fact that autistic females are underdiagnosed and overlooked. We know we are. So, what are the ramifications that women and girls with autism face when their disorder goes undiagnosed?
- Mental health struggles: Individuals with undiagnosed autism Without an autism diagnosis to help them understand and address their unique needs and behaviors, people with undiagnosed autism become discouraged, frustrated, and have a difficult time fitting in. This leads to higher rates of mental health issues such as depression, anxiety, and self-harm in the undiagnosed autistic population.
- Lack of early intervention: According to the National Institute of Child Health and Human Development (NICHD), “research shows that early diagnosis of and interventions for autism are more likely to have major long-term positive effects on symptoms and later skills.”. This is because young children’s minds are more plastic, or able to change, than older children and adults.
- Missing out on helpful treatments: Those with undiagnosed autism do not receive the support they need to thrive and reach their full potential. Underdiagnosed autistic individuals tend to underperform in the classroom, socially, and professionally compared to those who receive treatment. Without access to the right tools and professionals who understand and appreciate their unique traits and learning styles, their quality of life, independence, and capabilities are unfairly diminished.
Obviously, these unfortunate consequences can impact anyone with autism spectrum disorder regardless of gender, however autistic women and girls face these consequences at much higher rates due to higher underdiagnosis and misdiagnosis rates. It is important that researchers continue to study autism in girls and women and that we raise awareness for their struggles so that meaningful changes can be made until autistic girls and women no longer fall through the gender gap.
Life-Changing Treatment for Autistic Women and Girls
We are aware that girls and women with autism have been overlooked, underdiagnosed, and are often treated the same as autistic males when their needs are entirely different. At ABA LLC we are breaking down barriers that prevent females from receiving the level of treatment they deserve by truly treating each patient as an individual. With our fully personalized treatment style we step away from the damaging viewpoint of autism as a male disease and develop a plan from scratch based on the symptoms, struggles, problem behaviors, and goals of every person.
Visit our website to learn more about our areas of expertise, the wide range of services we offer, and more. Contact us today to start a life-changing journey with ABA.