Autism in Girls: Search and Find!

Autism in girls: How many females with autism have you seen so far in your career?

^{updated 2024} Evaluation of autism in girls. Are their gender differences? We know that autism affects both males and females. Men and boys are more frequently diagnosed with autism than women and girls. It is debated whether this is due to a sex difference in rates of autism spectrum disorder or whether females are underdiagnosed. The prevalence ratio is often cited as about 4 males for every 1 female diagnosed. There is some evidence that females may also receive diagnoses somewhat later than males. Hans Aspberger originally thought that females were not even affected by the syndrome he described. (He later retracted this statement). Some autism experts believe the numbers of males and females on the autism spectrum is far more equal but females are undiagnosed or misdiagnosed.
Wikipedia: sex and gender differences in autism

Autism in Girls-personal experiences

I remember being on an evaluation team some years back for a female first grader. The mother of the student (who had an older daughter with autism) strongly believed her younger daughter had autism. I recognized that the girl had differences in her social communication. She also had a few select friends but the team could not identify any high interest areas that were out of the norm for a girl her age. Her high-average intelligence and average academic performance in the first grade curriculum did not reinforce an autism diagnosis, according to the school psychologist.

Looking back, I see that we made mistakes. We didn’t know what we were looking for at the time. Here are some things SLPs and evaluating professionals should search for or consider when they are performing assessments on females with autism.

Autism in Girls-Evaluation Considerations

Autism research has focused on males. Therefore, the diagnostic criteria for autism reflects characteristics of males with autism not necessarily females with autism.

Females excel at masking their autism and at mimicing good social skills. This can be exhausting for them and they may not keep up this facade away from school. Be sure to observe female students in their home environment and pay close attention if the parent is describing home social behavior that is very different from school social behavior. If she is not self regulating at home but is at school, this isn’t necessarily poor parenting at home! This child might be keeping it together all day and then losing it at home
Girls with autism may have interests that are similar to their neurotypical female peers. Their high interest areas may be age-appropriate but far more intense. Dig deep and find out the specifics of their interest and you may discover that their high interest areas may not be “typical.” For example, a parent may tell you their daughter likes art. On the surface, that seems typical, right? However, as you explore further, you may find she only draws one type of image or she loves “collecting” markers and colored pencils but not necessarily using them. Simon Baron-Cohen and his colleagues found that autistic women camouflage to a greater extent than autistic males.
Autism in Girls: rigid play behaviors. They may set up a beautiful pretend meal in their pretend kitchen. Great pretend play skills? Maybe not. Ask questions and look further. Does she just set up the meal and do nothing further? Does she also allow others to interact with it? Does she get upset if the meal set up is disturbed?
Restricted play behaviors. Girls can easily engage in pretend or fantasy play, but play is prone to being one-sided, scripted and overly controlled. My former student appeared to have good dramatic play skills as she played “dog and owner” with her friend. However, she always wanted to be the dog. She would never agree to be the “owner.” She became angry and hurt when the other girl wanted to revise the play scheme or play something different. I have found working in dramatic play centers to be a great way to help kids improve their play repetoire. This prior post on holding your social language sessions in a dramatic play center might be helpful!
Stimming behaviors. Girls may find more neurotypical ways to stim than their male counterparts. They may consciously make their stimming less visible to others.
Girls are naturally more social than boys. Girls with autism might seek out social interactions more than boys with autism. However, stick around and observe their conversational skills and you might find difficulties with reciprocity and making relevant contributions to the conversation. Observe your student talking with her peers and if there are differences, they should stand out to you.
Self-assessment with older students. Make sure you include some type of interview or self-assessment with girls as part of you evaluation protocol for autism. They may be able to describe how they feel different than their peers. (This prior blog post might be helpful). I have a set of self-rating scales that are editable and designed for older students here!

No intellectual impairment? Do your due diagnostic diligence during evaluation of girls who have IQs over 70. Historically, girls with lower IQs are more likely to be diagnosed with autism and provided with necessary services.

Autism in Girls-Helpful links:

1. The Chameleons: Women with Autism by the Australian public broadcast service.

Learn more about how females with autism often go undiagnosed or misdiagnosed.

2. Autistic Women and Girls: What’s that? by Agony Autie.

This engaging young woman with autism gives you the lowdown about how girls mask their symptoms of autism.

3. I Am Aspiengirl: The Unique Characteristics, Traits and Gifts of Females on the Autism Spectrum by Tania A. Marshall.

Tania Marshall’s award-winning book also has a sequel “I am an aspien woman,” also available on Amazon.

4. Invisible Girls: ASHA Wire, by Nancy Volkers.

Girls with ASD are more likely to internalize their behaviors which can lead to mental health issues, self-harm and eating disorders.

The bottom line? Performing an assessment on females with potential autism, especially those that do not have intellectual impairments, requires a thorough assessment and observation in multiple settings.