Introduction
For decades, autism was widely considered to be a predominantly male condition. As a result, much of the early research focused on boys, and many of the diagnostic criteria and assessment tools were developed using predominantly male samples. We now know that autism occurs in girls and women too, but it often presents differently and can be much harder to recognise.
Many autistic girls and women spend years feeling different without understanding why. Some receive diagnoses of anxiety, depression, eating disorders, obsessive-compulsive disorder (OCD) or personality disorders before autism is considered.
Others become experts at hiding their difficulties, meaning they appear to cope well despite significant internal struggles. This guide explores the signs of autism in girls and women, why autism is frequently missed, the impact of masking, mental health considerations and when to seek an assessment.
What is Autism?
Autism is a lifelong neurodevelopmental difference that affects how a person:
- Communicates
- Interacts socially
- Processes information
- Experiences sensory input
- Manages change and uncertainty
Autism is not a mental illness, behavioural problem or parenting issue. It is a natural variation in human neurodevelopment.
Every autistic person is different. Some require significant support, while others live independently, pursue successful careers and maintain relationships. The diversity within the autistic community means there is no such thing as a “typical” autistic girl or woman.
Why Is Autism Often Missed in Girls and Women?
One of the most important discoveries in autism research has been the recognition that many autistic females present differently from the traditional stereotypes associated with autism.
Historically, autism was often characterised by:
- Obvious social difficulties
- Limited friendships
- Highly visible repetitive behaviours
- Restricted interests that stood out from peers
Many autistic girls do not fit this stereotypical presentation.
Instead, they may:
- Appear socially interested
- Have friendships, although maintaining them may be difficult
- Develop age-appropriate interests that become unusually intense
- Observe and copy peers
- Hide their difficulties from others
As a result, many girls pass under the radar despite experiencing significant challenges.
Understanding Masking and Camouflaging
Perhaps the most important concept when understanding autism in girls and women is masking, sometimes called social camouflaging.
Masking refers to conscious or unconscious strategies used to hide autistic characteristics and appear socially typical.
Examples include:
- Copying other people’s behaviour
- Rehearsing conversations
- Forcing eye contact
- Memorising social rules
- Suppressing stimming
- Hiding sensory difficulties
- Watching and imitating peers
- Carefully monitoring facial expressions
Many autistic girls learn these strategies from a surprisingly young age. Some become so skilled that parents, teachers and professionals overlook the underlying autism entirely
Find out more:
Signs of Autism in Preschool Girls
The signs of autism can often be observed during the preschool years, although they may be subtle.
Possible signs include:
Social Differences:
- Preferring interactions with adults rather than peers
- Watching children rather than joining play
- Finding group activities overwhelming
- Seeming shy or socially anxious
Play Differences:
- Repetitive play themes
- Controlling how games are played
- Re-enacting scenes repeatedly
- Strong attachment to particular toys or interests
Communication Differences:
- Difficulty maintaining reciprocal conversations
- Repeating phrases from books, television or favourite programmes
- Using learned scripts during interactions
Sensory Differences:
- Strong reactions to noise, clothing textures or food textures
- Seeking particular sensory experiences
- Becoming overwhelmed in busy environments
Research suggests that girls may be more likely than boys to observe peers closely and copy behaviour, making difficulties less obvious to adults.g to understand social expectations and fit in with peers. This can become exhausting over time.
Signs of Autism in Primary School-Aged Girls
As school becomes increasingly social, difficulties often become more noticeable.
Common signs include:
- Having one close friend rather than wider friendship groups
- Following others socially rather than initiating interactions
- Becoming exhausted after school
- Difficulty navigating playground politics
- Increased anxiety
- Strong perfectionism
- Reliance on routines
- Distress when plans change unexpectedly
Some girls become highly skilled at copying other children’s behaviour. Teachers may describe them as quiet, shy, sensitive or anxious without recognising the underlying autism.
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Signs of Autism in Teenage Girls
For many autistic girls, adolescence represents a significant turning point.
Teenage friendships become increasingly complex and rely heavily on subtle social skills, emotional insight and unwritten social rules.
Common signs include:
- Feeling different from peers
- Difficulties maintaining friendships
- Social exhaustion
- Increased anxiety
- Sensory overwhelm
- Intense interests
- Perfectionism
- Emotional burnout
- Low self-esteem
Many autistic teenagers describe feeling as though everyone else has been given a rulebook for social interaction that they never received.
Signs of Autism in Adult Women
Many women are first diagnosed in adulthood.
Some have spent years wondering why life feels harder than it appears for other people.
Common experiences reported by autistic women include:
- Feeling different throughout life
- Social exhaustion
- Difficulty understanding social expectations
- Strong need for routine
- Sensory sensitivities
- Anxiety
- Perfectionism
- Chronic feelings of overwhelm
- Difficulties balancing work, parenting and relationships
Others describe feeling as though they have spent their lives performing a role rather than being their authentic selves.
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What Does High-Masking Autism Look Like?
Many autistic women are exceptionally skilled at appearing socially competent.
From the outside they may seem:
- Successful
- Friendly
- Sociable
- Independent
- High-achieving
Internally, however, they may experience:
- Constant anxiety
- Overthinking conversations
- Exhaustion after social situations
- Feelings of isolation
- Fear of “getting it wrong”
Many women describe spending hours preparing for social interactions and then replaying conversations afterwards to analyse whether they behaved appropriately.
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Mental Health and Autism in Women
Research consistently demonstrates higher rates of mental health difficulties in autistic women compared with the general population.
Common difficulties include:
- Anxiety disorders
- Depression
- Panic attacks
- Obsessive-compulsive disorder
- Emotional dysregulation
- Burnout
These difficulties may be linked to years of masking, social exclusion, sensory overload and unmet support needs.
Importantly, mental health difficulties do not cause autism. However, living for years without understanding one’s neurodivergence can have a significant impact on psychological wellbeing.
Autism and Eating Disorders
EOne area receiving increasing attention within autism research is the relationship between autism and eating disorders.
Autistic girls and women are overrepresented within eating disorder services, particularly amongst those with anorexia nervosa.
Several factors may contribute to this overlap, including:
- Sensory sensitivities around food
- Rigid thinking styles
- Anxiety
- Difficulties identifying emotions
- Need for predictability
Some females initially present to eating disorder services long before autism is considered as a possible explanation for their underlying experiences.
Understanding autism can be crucial to providing effective eating disorder treatment. Research increasingly suggests that treatment outcomes improve when autism is recognised and accommodated appropriately.s
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Autism, Perimenopause and Menopause
For many women, perimenopause and menopause can be a turning point in recognising previously unidentified autism.
Perimenopause typically begins during a woman’s 40s, although it can start earlier, and is characterised by fluctuating levels of oestrogen and progesterone. During these hormonal transitions, many women report significant changes in mood, cognition, sensory experiences and emotional regulation.
Increasingly, autism clinicians are observing that women who have successfully masked autistic characteristics throughout childhood and adulthood may find those coping strategies become much more difficult to maintain during this stage of life.
Many women describe feeling as though their lifelong coping mechanisms suddenly stop working. Many women begin exploring autism because they feel that menopause has changed something fundamental about how they cope with daily life.
Find out more:
Why Late Diagnosis Can Be Life-Changing
Although a diagnosis cannot change the past, many women describe receiving an autism diagnosis as a moment of enormous relief.
Common reactions include:
- Relief
- Validation
- Increased self-understanding
- Improved self-acceptance
- Reduced self-blame
A diagnosis can help explain experiences that may previously have been attributed solely to anxiety, depression, being “too sensitive” or simply feeling different from everyone else.
For many women, diagnosis marks the beginning of a more compassionate understanding of themselves.
When Should You Consider an Autism Assessment?
You may wish to explore autism further if you recognise a lifelong pattern of:
- Social communication differences
- Sensory sensitivities
- Difficulty with change
- Intense interests
- Social exhaustion
- Chronic masking
- Anxiety linked to social situations
- Feelings of being different despite appearing to cope
A comprehensive autism assessment should explore both current experiences and developmental history while considering how masking might affect presentation.
Final Thoughts
Autism in girls and women has historically been misunderstood and under-recognised. Many females spend years adapting to a world that was not designed with their needs in mind, often becoming experts at hiding their differences.
The growing awareness of masking, camouflaging and female autistic presentations is helping more girls and women access understanding and support than ever before. While autism may present differently in females, the impact can be just as significant.
Recognising autism is not about placing limitations on a person. It is about understanding how they experience the world, celebrating their strengths and ensuring they receive the support they need to thrive.
References
Cook, J., Hull, L., Crane, L. and Mandy, W. (2021) ‘Camouflaging in autism: A systematic review’, Clinical Psychology Review, 89, 102080.
Hull, L. et al. (2017) ‘Putting on My Best Normal: Social Camouflaging in Adults with Autism Spectrum Conditions’, Journal of Autism and Developmental Disorders, 47(8), pp. 2519-2534.
Lockwood Estrin, G., Milner, V., Spain, D., Happé, F. and Colvert, E. (2021) ‘Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls’, Clinical Psychology Review, 89, 102066.
Mandy, W. and Lai, M.C. (2017) ‘Towards sex- and gender-informed autism research’, Autism, 21(6), pp. 643-645.
Westwood, H. and Tchanturia, K. (2017) ‘Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review’, Current Psychiatry Reports, 19(7), 41.
American Psychiatric Association (2022) Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR. Washington, DC: American Psychiatric Publishing.
