Why Autism in Girls Might Be Harder to Diagnose

blonde girl toddler playing with two wooden blocks

Statistics show autism in girls is far less common than in boys. In fact, the prevalence is said to be around four times higher in boys. But some experts have expressed doubts about the accuracy of these figures, instead proposing that autism might just be harder to diagnose or detect in females.

We wanted to take a closer look at some of the latest developments and theories around the way autism presents and is diagnosed in girls.

What the research says about autism in girls

Research has generally backed the hypothesis that autism is much more prevalent in males than females. As mentioned above, autism is diagnosed four times more often in boys than in girls – and this tends to be a worldwide trend. It was always thought females were much less predisposed to it.

Lately though, the methods used to diagnose autism have come under scrutiny. Many researchers are suggesting autism “looks different” in girls and the traditional methods of identifying and diagnosing autism might overlook many.

All this together means traction is being gained for the notion that autism in girls isn’t as uncommon as initially thought. Instead, it might be that girls with autism go undiagnosed until much later in life. Or are simply never diagnosed at all.

But why is this?

Why autism in girls might be harder to diagnose

Autism in girls, when diagnosed, is usually at a later age than autism in boys. There are several theories for why this might be. They include:

  1. Girls might “mask” better than boys (read more about masking here)
  2. Most of the research, data, and observations we have on autism have come from studying males, whereas girls might display different or more subtle symptoms
  3. Medical experts might be more reluctant to diagnose autism in girls given it’s been considered statistically less likely
  4. Girls with undiagnosed autism are often diagnosed with other conditions/co-morbidities like anorexia, depression, or ADHD. The overlap of symptoms can make diagnosis harder.

How autism in girls might present differently

If girls with autism are sometimes overlooked or misdiagnosed, what exactly is it about their signs which make it hard to diagnose? The hallmarks of autism (though these appear in some, not all, who live with it) are social communication deficits and repetitive or restrictive behavioural issues.

These can be very much present in girls, but interpreted or expressed differently. If this sounds a little like Asperger’s or “high functioning” autism to you, then you should know that nowadays there’s no distinction between Asperger’s and autism. Read more myths about Asperger’s Syndrome in our article.

Some research is even indicating that the brains of girls with autism don’t develop the same way as neurotypical females. However, they also don’t develop and respond the same way as the brains of boys with autism. Instead, their brains look very similar to neurotypical boys of the same age.

Also, remember that autism is very specific to the individual. So the way that one female’s autistic traits present themselves can be quite different to another’s.

Still, there are some common themes…

little girl in pink dress playing with plush dog. Girls with autism often have more socially acceptable interests so may be diagnosed late

The differences between girls with autism and boys with autism

Over the years, researchers have noticed the following trends with regards to autism in girls when compared to that in boys:

  • Boys tend to have very restricted and repetitive areas of interest. In girls, this is less obvious. For instance, while girls might fixate on princesses or horses, people often think this is “typicall” as their restricted behaviours or interests might be more socially appropriate than those of boys
  • Aggressive behaviour is less common in girls with autism than it is in boys with autism. Instead, girls tend to exhibit passive behaviour or withdrawal, which can be seen as meekness/shyness
  • While social communication issues in boys with autism become challenging and often obvious from very early on, girls are often able to mimic others in early childhood but struggle more as they reach the pre-teen and teenage years
  • Girls are often better at masking or hiding their symptoms to blend in with their peers and in public
  • Girls with autism are more likely to also live with anxiety and/or depression. These conditions can overshadow, pushing out the potential for a diagnosis of autism

It’s easy to see why girls are often overlooked and diagnosed later in life. Of course, that in itself comes with some issues.

The cost of being overlooked

Undetected autism in girls comes with significant risks. They’re often diagnosed with things like ADHD because their symptoms aren’t typical enough to be diagnosed with autism. Yet this doesn’t mean they aren’t struggling.

The misdiagnosis or lack of diagnosis can lead to other mental health issues such as depression, especially with navigating the intricacies of adolescence without the right support to guide them. The social challenges of this period of life can be tremendously confusing and difficult to traverse, which is why autism sometimes only “reaches its peak” in girls in high school or thereabouts. 

A female who lives with autism – of any age – often has difficulties building rapport and relationships with their peers. This can lead to withdrawal, social phobia, and problems with self-esteem.

Hence the very real concern that girls with autism who are diagnosed late miss the opportunity of early intervention. Proper support (such as through NDIS early childhood early intervention access, Autism Awareness Australia and local community support networks) can provide help in areas like education navigation, behaviour support and social interaction skills.

Supportive therapy is often more difficult to apply when autism has gone undiagnosed for a long period. Early diagnosis is an important factor in assisting girls with autism to realise their potential in life. Just as it is for boys.

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