Many women go their whole lives thinking they’re inherently different but not knowing why. It isn’t until they’re well into adulthood that they learn they’re actually autistic.
Autistic females can sometimes “hide” their autistic traits their whole lives to fit in with the people around them. Coupled with the fact that many autistic women experience differences in how their autism presents itself, these women may take years to be diagnosed, or never be diagnosed at all. Having research and resources available to understand what autism may look like in women and high-masking individuals is vital to help autistic women receive diagnosis and support.
Below, we’ll explore some of the specific ways women’s experiences with autism symptoms and diagnosis differ from the experiences of many males.
Does Autism Look Different in Women?
Yes, autism can often look different in women and girls than in men and boys. While the causes of different presentations of autism symptoms are not fully known, varying presentations can often be accounted for by social and biological factors.
Social Differences in Women
Several theories have been presented about why autism in women might present differently, one of the most common involving the differences in how girls are raised as compared to boys.
Girls are often brought up from a young age to be more social than boys, more encouraged to make friends, and more educated on how to behave in a variety of social contexts. Thus, girls on average will often have less obvious presentations of autism in social situations.
Girls and women are more likely to internalize their discomfort in social environments versus showing their discomfort outwardly. So while a girl may appear to be on the same social level as her peers, she may internally be experiencing more anxiety and confusion that doesn’t present itself to others.
Biological Differences in Women
Further, autism is believed to have genetic and biological components, some of which may differ based on sex.
For instance, autistic females were found to have smaller temporal lobes than autistic males on average, according to a 2015 study. Because the temporal lobe helps with emotional regulation, language, and verbal processing, changes in temporal lobe size could account for some of the presentation differences common among autistic women.
A 2021 study also found that autistic girls often have different brain structures in areas involving senses and movement. Girls had a reduced brain response to human motion as compared to autistic boys, meaning interoception challenges might be more common.
Gender Disparities in Autism Diagnoses
Because autism can and often does present differently in women, autistic females often experience additional challenges with receiving an autism diagnosis. Below are some of the known disparities between autistic males and females who seek out an autism diagnosis.
Women May Be More Likely to Mask and Camouflage Their Autism
Girls are often taught to be more social from an early age and are more likely to be reprimanded when they say or do something that parents or teachers deem socially unacceptable. Thus, autistic females may be more likely to hide their autistic traits either consciously or without even realizing they’re doing so. This compensation strategy is known as “masking,” as though someone is wearing a mask to fit in with the people around them.
A high-masking autistic person might mimic the behavior of the people around them, such as laughing when the people around them are laughing, or copying others’ body language and facial expressions. Or, they might stop themselves from saying something blunt that they have gotten in trouble for saying in the past. They might force themselves to make eye contact when it’s uncomfortable for them to do so, or they might dress like the people around them even if the style is uncomfortable for them.
Instead of making these social difficulties obvious, girls often internalize them. For example, instead of refusing to join a group discussion, an autistic girl might force herself to participate while internally experiencing extreme anxiety. Or, she might have a running dialogue in her mind when talking to others that reminds her to occasionally make eye contact or nod her head. These actions don’t necessarily come naturally to her or feel comfortable, but she pushes through to be seen as “normal” by others.
While masking is not exclusive to females, many autistic girls and women do mask their traits, making it hard for those traits to be recognized by diagnostic professionals. Fortunately, today several tests are available to help medical professionals identify masking in autistic individuals, such as the Camouflaging Autistic Traits Questionnaire (CAT-Q) and the Ritvo Autism Asperger Diagnostic Scale – Revised (RAADS-R).
Women Are More Likely to Be Overlooked by Clinicians
Autism was originally thought to be a “male” condition. Still today the ratio of autistic males to females is generally said to be 4:1, meaning that for every four autistic boys there is one autistic girl.
However, as more and more adult women are receiving autism diagnoses, this number could be much smaller than originally thought. While most autistic boys are diagnosed at a young age, as many as 80% of autistic females remain undiagnosed when they are 18. This finding implies that the real ratio of autistic males to females might look something more like 3:1 or even 2:1.
This discrepancy in diagnoses could have several causes. First, because medical professionals have thought of autism as a male condition for so long, diagnostic tools are often based on the more stereotypically male presentation of autism.
Further, because women are often better at masking and camouflaging their autistic traits, clinicians sometimes can have trouble identifying autism as an underlying cause of autism symptoms. Medical professionals have been shown to be less confident diagnosing autism in girls and women, leading to fewer diagnoses being identified.
Misdiagnoses in Women Are Common
As a result of masking and the general incorrect assumption that autism is a male-dominant condition, autistic women are more likely to be underdiagnosed (correctly diagnosed with additional conditions while autism is missed) or misdiagnosed (incorrectly diagnosed with the wrong condition instead of a correct autism diagnosis) when seeking support for their challenges.
Some of the common co-occurring conditions that affect many autistic people include generalized anxiety disorder (GAD), social anxiety, major depressive disorder (MDD), obsessive-compulsive disorder (OCD), gastrointestinal problems, and sleep disorders, among others. Sometimes physicians will diagnose autistic kids and teens with these conditions without recognizing autism as the underlying cause.
Other times, clinicians may miscategorize autism symptoms as symptoms of other conditions such as dissociative identity disorder (DID), borderline personality disorder (BPD), or bipolar disorder — particularly if a woman experiences symptoms like mood swings and relationship instability. It isn’t until the woman is much older and is often treated for these incorrect diagnoses before autism is identified as the reason for their symptoms.
Lesser-Known Autism Traits in Women and High-Masking Individuals
The DSM-5 criteria does not indicate any differences between “male” or “female” presentations of autism. All autistic people share the same base characteristics of persistent social challenges as well as additional behaviors like repetitive movements or sounds, intense interests, sensory challenges and/or a difficulty adapting to change.
However, women often present these symptoms in different ways for reasons such as the ones we discussed above. The following are some lesser-known presentations of autism that women or other high-masking autistic individuals may experience.
1. More Social Motivation but Heightened Anxiety
In general, autistic females tend to experience more of the sensory difficulties of autism as compared to males who typically experience more of the social difficulties. Autistic girls are typically more socially motivated and will try to make and maintain friendships as well as participate in conversations. They may appear shy, but since shyness is a socially acceptable characteristic in girls, this trait is often not considered untypical.
In contrast, autistic boys may be more likely to shy away from social situations altogether and appear uninterested in making friends. Some professionals even today base their judgments on whether someone is autistic by how motivated they are socially. Even common autism assessments such as the Autism Quotient (AQ) test base their scoring on things such as whether someone would rather go to a library or a party, presumably with the assumption that autistic people would inherently feel uncomfortable in all social settings such as parties.
While girls may be more likely to participate in social engagement, they may still internally feel incredibly anxious during many of those situations. Or, they may experience bouts of depression afterwards due to the stress of trying to imitate others throughout their conversations.
2. More Socially Acceptable Special Interests
Intense interests in particular subjects, known as “special interests,” are how many autistic people regulate themselves and find a sense of peace and routine.
Many people think of special interests through the lens of the stereotypical interests displayed by many young autistic boys, such as trains, guns, cars, and video games. However, autistic girls often have more socially acceptable special interests that might not be detected as higher in intensity than other girls their age.
Some common special interests for autistic girls and women includes things such as:
- Animals such as horses
- Fashion and makeup
- Psychology
- Dance and theater
- Stuffed animals
- Collectibles
- Social justice
- Celebrities and pop culture
3. Differences in Routines and Repetitive Behaviors
Another stereotypical sign of autism commonly found in young boys includes repetitive behaviors such as hand flapping. While girls can certainly also display these more stereotypical traits, girls often have fewer repetitive behaviors than boys. Or, they may have developed behaviors that are seen as more socially appropriate, again partly due to their increased social motivation as compared to boys.
While many young autistic boys might flap their hands and spin in circles, autistic girls might instead bite their nails and fingers, twirl their hair repeatedly, tap their feet or fingers, bite their lip or cheeks, or fidget with their clothes. Because these behaviors aren’t as obvious to others, they are more likely to be overlooked.
4. Higher Intensity of Sensory Sensitivities
Autistic women may potentially be more likely than men to experience issues filtering out sensory input. Many autistic women report being unable to wear clothing with tags or tight outfits such as jeans. Or, they might be unable to stand high-pitched noises, or certain smells feel too intense to be around.
Some signs of sensory sensitivities that many autistic girls and women experience include an intense dislike for things like:
- Tags on clothing
- Loud noises
- Certain textures such as denim or wool
- Scents such as intense-smelling foods, perfumes, detergents and lotions
- Bright or flashing lights
- Types of foods
- The feeling of certain things touching the skin, such as lipstick
- The feeling of substances on fingers, such as dirt or sticky fruits
- Being touched or held
5. Additional Traits Common Among Autistic Females
Autistic women experience a wide variety of traits and symptoms, as does every autistic person. For more examples of autism symptoms that are particularly prevalent in high-masking women, many autistic women recommend reading Samantha Craft’s “Females with Autism: An Unofficial List.”
Some of the traits mentioned on the list include being:
- A deep thinker who often gets lost in thought,
- An innocent, naive individual who experiences trouble with lying or knowing when she is being lied to
- Someone who often makes friends with older or younger females versus someone her own age
- Someone whose friendships have often ended suddenly due to things like a tendency to overshare and having a hard time figuring out when it’s her turn to talk
- A person who feels intense relief when alone and who feels “threatened” by things like visitors to the home or upcoming social events
- A sensitive, highly empathetic individual who adjusts environmental factors to look for comfort
- Someone who has little sense of self and imitates others while suppressing her true self, feeling significantly younger inside than she is outside
- A creative person who uses lyrics and writing to relieve anxiety
Autism Research in Women Is Improving, But Has a Long Way to Go
Today, many professionals are reevaluating their understanding of autism and how it presents differently based on biological factors such as sex. The fact that so many studies are being done recently about the true ratio of autistic men to women emphasizes that more is being done now than ever to recognize autistic women and provide them with the support they deserve.
However, research still has a long way to go to make up for the harmful stereotypes of the past. For example, some women in communities such as Reddit and TikTok have given firsthand accounts of diagnostic professionals basing their diagnoses off harmful stereotypes such as whether the person was able to make eye contact or whether they were able to appear social.
As research plus these firsthand accounts begin to educate more professionals and individuals on how boys and girls may experience autism differently, autistic women will hopefully find more and more resources available to educate themselves and find support and community.
The Everyday Autistic 