Why Autism in Girls Looks Different – And Why That Matters
When Sophie’s parents sought my clinical advice, they were puzzled. Their bright 10-year-old was struggling socially, but not in ways they associated with autism.
She had friends, but this was mainly one intense friendship at a time, and often ended in conflict and upset. She could “do” eye contact with no problems, and spoke passionately about her special interests in mythology and art.
Previous professionals had suggested anxiety, perfectionism, or simply being “quirky.”
Yet beneath the surface, Sophie was working extremely hard to appear “normal”. This is a common experience for many autistic girls.
Is Autism Less Common in Girls?
Current estimates suggest that while autism is diagnosed in around 3 or 4 males for every 1 female who gets the autism diagnosis. But increasingly professionals and researchers are catching up to the fact that autism often presents differently in girls. This difference has often led to significant delays in diagnosis, or misdiagnosis (just like in Sophie’s case).
Early research studies were mainly on males and this has meant that the diagnostic criteria are “male-centric”.
How Autism Looks Different in Girls
Autism affects the brain in the same basic way for everyone, but how it shows up in someone’s behavior can look different depending on whether they’re male or female. This happens because of how they’re raised, what society expects from them, and some biological differences between the sexes.
Social Camouflaging in Autistic Girls
Autistic boys often (but not always) stand out as being different when they’re around other people. Girls can commonly be more socially aware, and become skilled at hiding their autism to fit in.
This is known as social camouflaging or masking:
- Social scripting: Memorizing phrases, facial expressions, and responses for different situations
- Mirroring: Closely observing and copying peer behaviour and interests
- Social echolalia: Repeating socially appropriate phrases without fully understanding their context
- Masking social confusion: Hiding uncertainty through techniques like nodding, smiling, or changing the subject
Research from University College London shows this camouflaging comes at a high cost, contributing to anxiety, exhaustion, and loss of identity.
Different Special Interests in Autistic Girls
Special interests in autistic girls often look different from boys’ interests:
Autistic girls tend to have intense interests in things that seem more “normal” or socially acceptable – like books, animals, or celebrities – rather than the stereotypical autism interests like trains or computer systems that boys might have. Of course, this is a generalization, and there are many boys who have more “socially acceptable” interests too.
What makes autistic girls’ special interests “autistic” isn’t necessarily what they’re interested in, but it’s often how deeply they’re interested in it. A girl might know everything about horses or a particular book series to an unusual degree.
Girls’ special interests also tend to involve other people more. For example, they might be deeply into fan fiction communities, which gives their interest a social side.
Finally, girls often collect detailed information about people (like knowing everything about a celebrity’s life or memorizing facts about their classmates) rather than collecting information about objects or systems.
Imagination and Play
There’s an old myth that autistic children don’t have good imaginations, but many autistic girls actually have very rich fantasy lives:
They might create detailed and complex imaginary worlds with very specific rules that must be followed exactly. (Just like boys, their pretend play can be quite repetitive, playing the same scenarios over and over.)
Many girls use stories and fiction as a way to figure out how social situations work in real life. Many autistic girls who are avid readers are essentially studying characters to understand how people behave.
When it comes to friendships, autistic girls often prefer playing with kids who are older or younger than them, rather than children their own age. This might be because these friendships feel easier or more predictable.
Emotional Presentation of Autistic Girls Vs Boys
Autistic girls tend to show their emotions differently than boys:
Their sensory reactions get misunderstood: When they have strong reactions to things like scratchy clothes, loud noises, or bright lights, people might think they’re being “overdramatic” or “too sensitive” – when really they’re experiencing genuine physical discomfort.
They keep feelings inside: Instead of acting out or being aggressive like some autistic boys might, girls are more likely to appear anxious, worried, or withdrawn.
They “mask” at school, then melt down at home: Many girls manage to hold themselves together all day at school, but then have emotional breakdowns at home where they feel safe. Parents might see a very different child than teachers do.
They’re often perfectionists: Autistic girls frequently put enormous pressure on themselves and feel intense anxiety about making even small mistakes.
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Autism in Girls: The Consequences of Missed Diagnosis
The average age of autism diagnosis for girls is 2-3 years later than boys, with many not identified until adolescence or adulthood.
This delay has significant implications for autistic girls:
Mental Health Impact
Research shows that undiagnosed autistic girls experience:
- Higher rates of anxiety and depression
- Greater vulnerability to eating disorders
- Increased risk of suicidal thoughts and self-harm
- Are more prone to chronic identity confusion and low self-esteem
Many describe the relief of diagnosis as finally understanding why they’ve always felt “different.”
Unrecognized Autism in Girls: What This Means for School
When autism in girls goes unrecognized, several problems can happen:
- Their learning needs get missed: Teachers might not realize a child needs extra support or a different approach to learning to support the differences in the way their brain works.
- They might not reach their full potential: Without the right help, girls may struggle academically even though they’re capable of doing well.
- Daily challenges go unsupported: Things like sensitivity to classroom noise, difficulty organizing their work, or trouble with transitions don’t get the accommodations they need.
- Social struggles get misunderstood: Teachers and other adults might just think a child is “shy,” “quirky,” or “standoffish” rather than recognizing she’s finding social situations genuinely difficult and needs support.
The key point: Getting the right diagnosis means girls can get the understanding and support she needs to thrive.
Recognising the Signs: What to Look For
While every autistic girl is unique, certain patterns may suggest autism that’s been overlooked:
Social Indicators
- Intense relationships with one or two friends rather than broader peer groups
- Confusion about unwritten social rules despite apparent social skills
- Social exhaustion after school or socialising
- Preference for socialising with adults or much younger children
- Difficulties maintaining friendships despite initial connections
Communication Patterns
- Highly developed vocabulary but struggles with pragmatic language
- Taking things literally or missing implied meanings
- Difficulty with reciprocal conversation (may monologue about interests or be unusually quiet)
- Using “prepared scripts” for social interaction
- Subtle voice differences in pitch, volume, or intonation
Emotional and Sensory Experiences
- Intense emotional reactions that seem disproportionate
- Extreme sensitivity to sensory stimuli (lights, sounds, textures, tastes)
- Strong need for routine and predictability
- Shutdown or withdrawal when overwhelmed rather than obvious meltdowns
- Difficulties with transitions or unexpected changes
How to Support Autistic Girls
Whether a girl has received a diagnosis or her parents simply suspect she may be autistic, there are practical and effective ways to support her wellbeing.
For Parents
- Believe her: If she says something feels difficult or overwhelming, trust that this is her genuine experience – even if it doesn’t seem like a big deal from the outside.
- Prioritise predictability: Keep routines consistent where possible. When change is unavoidable, prepare her in advance (e.g. “Tomorrow we’ll be taking a different route to school”).
- Address sensory discomfort: Remove clothing labels, allow headphones in noisy environments, and reduce harsh lighting – anything that eases sensory overwhelm.
- Respect her social needs: Avoid pressuring her to be more social. Time alone can be essential for recharging. When it comes to friendships, quality is far more important than quantity.
- Be explicit: Social cues can be missed. It’s helpful to explain things directly, such as: “When someone asks how you are, they usually expect you to ask them too.”
- Embrace her passions: Intense interests are not something to grow out of. They help her unwind and understand the world.
- Let go of ‘normal’: Focus on whether she is healthy and content, rather than whether she fits in with expectations.
For Teachers
- Don’t be misled by good behaviour or high grades: A girl may appear to be coping well but still be struggling internally.
- Use direct language: Rather than saying “I hope everyone remembers what we’re doing today,” be clear: “Take out your maths books now.”
- Consider sensory factors in the classroom: Flickering lights, scraping chairs and strong smells can make concentration very difficult.
- Provide structure: Tools like checklists, visual timetables and written instructions can ease the pressure of processing verbal directions.
- Support her during unstructured times: Breaktimes and lunch can be especially challenging, even if she seems fine. Offer check-ins and gentle support.
- Recognise executive functioning differences: If she often forgets homework or loses things, she may need support with organisation and planning, not just reminders to “try harder.”
- Look beneath the surface: A quiet, compliant student may be masking anxiety or emotional exhaustion.
For Doctors and Therapists
- Stay updated: Much of the traditional understanding of autism is based on male presentations. Girls often show different patterns that can be missed.
- Listen to parents: If a parent is concerned, take it seriously, even if the child seems fine in a clinic setting.
- Recognise co-occurring challenges: Anxiety, low mood, disordered eating, and perfectionism can be signs of unrecognised autism in girls.
- Go beyond checklists: Diagnostic tools may not capture the full picture. Take time to understand the girl’s experiences from her and her family’s perspectives.
- Seek specialist training: Identifying and supporting autistic girls requires tailored knowledge and a nuanced approach.
What Autism Diagnosis Can Offer Girls
A diagnosis is not about labelling; it’s about understanding.
For many autistic girls, being identified appropriately can bring deep relief after years of feeling “wrong” or “different.”
It opens doors to support, helps explain sensory and social differences, and connects them with others who share similar experiences.
Most importantly, it empowers them to ask for what they need and to build a strong sense of identity and belonging.
Related Articles
The Power of Neurodiversity: Celebrating Autism Strengths
Sensory Processing in Autism: An Essential Parent Guide
Autism Courses for Parents in the UK
Dr Lucy Russell is a UK clinical psychologist who works with children and families. Her work involves both therapeutic support and autism assessments. She is the Clinical Director of Everlief Child Psychology, and also worked in the National Health Service for many years.
In 2019 Lucy launched They Are The Future, a support website for parents of school-aged children. Through TATF Lucy is passionate about giving practical, manageable strategies to parents and children who may otherwise struggle to find the support they need.
