Understanding Autism in Women: Everything You Need to Know

Autism is a neurodevelopmental condition that affects how people behave, socialise, and communicate. It is more commonly diagnosed in men than in women. This may be because symptoms of autism in girls can appear differently than in boys, and girls are often better at masking their symptoms by mimicking others to blend in. However, this masking presents its own set of challenges, which we will explore later.

In many cases, women do not receive an autism diagnosis until adulthood. At Autism Detect, we recognise that this late recognition is linked to various mental health struggles, as undiagnosed autism can lead to persistent anxiety and depression.

Female Autism Traits: Signs and Symptoms in Women

Autism is most commonly diagnosed in early childhood, but many women are not identified until much later. In fact, it’s increasingly common for autistic women to be diagnosed in their teens or adulthood, especially as their traits can be more subtle or easily masked. Signs may include social anxiety, difficulties with change, or intense focus on specific interests.

Understanding autism in the early years can offer further insight into these early signs.

The most common symptoms of autism include:

• Delayed or impaired communication skills
• Difficulty in social interactions
• Repetitive behaviours with highly specific interests
• Sensitivity to light, sound, touch, or other stimuli

In women, these symptoms can present differently, contributing to the delay in diagnosis.

Social Communication and Interaction Symptoms

Autistic girls and women often struggle with social connections, which can manifest in various ways:

• Difficulty making eye contact or listening during conversations
• Not responding when their name is called
• Discomfort with physical touch or avoiding it altogether
• A strong preference for solitude over social interaction
• Limited or absent facial expressions in social settings
• Struggling to start or maintain conversations
• Talking extensively about a specific interest without noticing others’ reactions
• Unusual speech patterns or difficulties with verbal communication
• Finding it hard to express emotions or understand others’ feelings
• Difficulty picking up on social cues like tone of voice or body language
• Struggling to follow simple instructions
• Difficulty predicting how others will react in a conversation or situation
• Social interactions that may seem awkward or out of place
• Trouble interpreting gestures, facial expressions, or other nonverbal communication

Behavioural Symptoms

Repetitive behaviours are common among autistic individuals, but some women may consciously suppress or modify these behaviours in social settings to avoid standing out.

This masking can make their autism less noticeable to others, even though these behaviours may still emerge in private or under stress as:

• Engaging in repetitive movements like rocking back and forth
• Relying on strict routines or rituals and becoming distressed if they are disrupted
• Self-stimulatory or self-harming behaviours, such as biting or head-banging
• Repeating words or phrases, sometimes without clear context
• Developing deep, intense interests in specific topics, facts, or details
• Experiencing heightened or reduced sensitivity to sound, light, or other sensory inputs
• Fixating on certain objects or activities for extended periods
• Having strong food preferences or avoiding specific textures

Why Autism in Women Often Goes Undiagnosed or Misdiagnosed?

Men and women share the same autism symptoms, but the intensity and visibility of these symptoms may vary. Some studies suggest that women internalise their autism traits, while men tend to display their differences outwardly. However, not all research agrees. A large 2020 study found that autistic women sometimes exhibit their behaviours more prominently than men.

More research is needed to determine whether these differences are real or a result of masking.

Masking in Autistic Females

Masking, or camouflaging, occurs when an autistic person consciously or unconsciously hides their traits to blend in. Research suggests this is more common in autistic women, particularly those with lower support needs (also known as high-functioning autistic individuals).

Some common masking behaviours include:

•  Forced eye contact in conversations
• Rehearsing jokes or phrases before socialising
• Copying what others do in social situations
• Imitating facial expressions and body language

While both men and women mask their symptoms, women tend to do it more frequently. This is thought to be one of the reasons they are less likely to receive an early diagnosis.

The Risks of Constant Masking

Masking may help autistic individuals blend in, but it takes a toll on their mental and physical well-being. Over time, masking can lead to autistic burnout – a state of physical, mental, and emotional exhaustion. Autistic burnout can also result in the loss of skills, greater difficulty managing daily activities, and intensified sensory sensitivities.

Women are particularly at risk of autistic burnout due to societal pressure or internal struggles to conform. Beyond burnout, autistic women are also more likely to experience co-occurring conditions such as depression, anxiety, and even suicidal thoughts.

Co-Morbid Conditions

Comorbidity refers to the presence of additional medical or mental health conditions alongside a primary condition. In autism, comorbidities are particularly common due to overlapping genetic, neurological, and environmental factors.

Autistic women are often diagnosed later in life or misdiagnosed entirely, which can lead to prolonged struggles without the right support. This delay increases the likelihood of developing comorbid conditions, making them more common in autistic women than in autistic men.

Common co-morbid conditions in autistic women include:

• Depression
• Attention Deficit Hyperactivity Disorder (ADHD)
• Anxiety
• Anorexia Nervosa or other eating disorders
• Obsessive-Compulsive Disorder (OCD)
• Tic Disorders

What Causes Autism in Women?

While experts do not agree on the exact cause of autism, it is likely influenced by both genetic and environmental factors.

There is no definitive reason why autism is more commonly diagnosed in men, but some theories suggest:

Diagnosis in Adulthood

Many women do not receive a formal autism diagnosis until adulthood, particularly if they mask their symptoms or their differences are not prominent.

While the diagnostic process for adults is similar to that of children, identifying autism in adults can still be challenging. If you recognise autism traits in yourself, seeking a proper diagnosis from experienced clinicians, such as those at Autism Detect, is a valuable step forward.

In Conclusion

Autism in women is often underdiagnosed or identified later in life, primarily due to diagnostic criteria that have historically been based on traits more commonly seen in boys.

Many autistic women and girls excel at masking, adjusting their behaviours to fit social expectations, or having special interests that align with socially accepted hobbies. As a result, their traits may go unnoticed, leading to a delayed diagnosis. Additionally, autistic women are more likely to experience co-occurring conditions like anxiety, eating disorders, and obsessive-compulsive disorder.

While early diagnosis and support can make a significant difference, seeking help at any stage is beneficial. Support options like cognitive behavioural therapy (CBT) can improve emotional well-being, while medication may help manage anxiety, depression, or focus-related difficulties. Finding a supportive community is also essential for personal growth and self-acceptance.

With the right understanding and support, autistic women can embrace their identity and thrive.

We offer Initial Screenings specifically for women who suspect they may be autistic. This helpful first step helps you understand yourself and decide whether to pursue a formal assessment.