Due to a variety of factors, doctors may overlook or misdiagnose autism in girls. Older girls with milder forms of autism may hide their symptoms or work harder to “fit in” with their peers. Early diagnosis can help autistic girls access support, so it is important to recognize the symptoms.

A girl with autism on a swing setShare on Pinterest
Take A Pix Media/Stocksy

Autism is a developmental condition that can affect a person’s ability to communicate and interact with others. However, symptoms can vary widely among individuals.

The Centers for Disease Control and Prevention (CDC) estimate that about 1 in 44 8-year-old children have been identified as being on the autism spectrum.

The CDC also estimates that boys are four times more likely to be identified as being on the autism spectrum than girls. Doctors may underdiagnose autism in girls because they may not exhibit the “common” behaviors associated with autism or are better at hiding their symptoms.

The symptoms of autism tend to be the same for boys and girls, but every person is different, and symptoms can vary.

Since autism involves such a wide range of symptoms, many people prefer the term autism spectrum disorder (ASD).

Many autistic children have difficulty with social interaction and communication. Some examples of common symptoms include:

  • not responding to their name by the time they are 12 months old
  • preferring not to be held or cuddled
  • having difficulty following instructions
  • not looking at something when another person points to it
  • losing certain skills, such as no longer saying a word they could use before
  • having difficulty explaining what they want or need
  • having difficulty understanding how other people are feeling
  • avoiding eye contact

Other key characteristics of autistic behavior are strict routines and repeated actions. Some common examples include:

  • having difficulty adapting to a change in routine
  • being unusually attached to objects or toys
  • rocking from side to side
  • spending lots of time organizing items
  • repeating certain words, phrases, or sounds
  • having an unusual response to certain smells, tastes, or sounds
  • having movement issues, including impairments in balance or fine and gross motor skills

Most of these symptoms tend to appear in infancy or early childhood, though people may not always recognize them at the time. Other symptoms may not become obvious until a child is older.

Doctors more commonly diagnose autism in boys than in girls. This can mean that parents, caregivers, and healthcare professionals may be less likely to look for symptoms of autism in girls.

Stereotypes about typical male and female behaviors may cause some people to miss symptoms. Many people think of girls as naturally quieter or more content to play alone than boys. However, speaking less and preferring to spend time alone can both be symptoms of autism.

There is some evidence to suggest that certain symptoms of autism are more common in boys than in girls. For example, repetitive behaviors and difficulty with impulse control may appear more often in autistic boys than autistic girls. These symptoms can be easier to spot than difficulties with communicating or socializing.

Girls and boys may deal with the symptoms of autism differently. Girls may hide their symptoms or put more time and energy into learning social norms. Autistic girls are also more likely to be able to form friendships than autistic boys. This can mask autism because many people see difficulty socializing as one of the key symptoms.

A common misdiagnosis of autism is a mental health issue. Mental health issues can also occur alongside autism. Anxiety, depression, and personality disorders can all share some symptoms with autism, which may cause a doctor to misdiagnose it.

Autism can cause stress for some people. This can lead to different behaviors in girls and boys. Girls are more likely to react to stress in ways that people may not notice immediately, such as self-harm. Boys may be more likely to react to stress outwardly — for example, by becoming angry or misbehaving. This behavior is more visible and may flag autism sooner.

Girls may have more self-awareness and be more conscious of “fitting in” socially. This can mean that they are able to hide the symptoms of autism in childhood.

However, as girls get older and social norms and friendships become more complex, they may find it harder to relate to others. This can mean they may not receive a diagnosis of autism until their teenage years.

A general lack of understanding about autism may lead healthcare professionals, teachers, parents, or caregivers to miss the symptoms in girls.

Research from 2016 suggests that stereotypes about autism can result in a later diagnosis for some autistic girls. Such stereotypes include assumptions that all autistic people have a keen interest in math and science, and that autistic people are unable to form friendships.

However, this research used a cohort containing only 14 women, so this experience may not be a common one.

It is also important to note that healthcare professionals developed screening tests for autism mostly using male case studies. This could mean that these tests miss the symptoms that are more common in girls.

More research into how the symptoms of autism can differ between the sexes could help improve diagnosis methods.

ASD covers a wide range of symptoms and behaviors. Some autistic people have learning difficulties and need additional care. However, many autistic people have low support needs, which means they can participate fully in everyday society.

An autistic child with low support needs has typical intelligence and social skills for their age. This type of autism is more difficult to diagnose, and some doctors may overlook it in girls.

There are links between certain health conditions and an increased risk of autism. These conditions include fragile X syndrome, tuberous sclerosis, and epilepsy.

At a routine healthcare visit, a doctor should be able to find early symptoms of autism before a child reaches the age of 2 years.

They will ask questions about certain milestones, such as smiling for the first time, crawling, and making sounds, to check the child’s development. The CDC has a list of key milestones for different ages.

Early diagnosis can help children and their families access support and better understand certain behaviors.

In some cases, symptoms may be less obvious, and a doctor may not be able to diagnose autism in a toddler.

Older children may have a referral for ASD screening. Screening usually involves a series of simple tests to check a child’s speech, learning, and behavior. An appointment with a professional who specializes in autism may follow.

A child may show one or more symptoms associated with autism but not be autistic. For example, avoiding eye contact and being attached to routines are common personality traits.

Autistic children may have multiple symptoms that impact their daily lives. They may be able to mask these symptoms, but this can cause stress. Autistic children can also be more vulnerable to bullying or abuse. Parents, caregivers, and teachers should be aware of this so they can be ready to educate other children on the condition and provide support to those who have it.

Although doctors diagnose autism less frequently in girls, the symptoms are usually similar, if not the same, for both sexes. Some symptoms may be less obvious or less likely to occur in girls.

Due to the way autism screenings have been developed, autistic girls may not fit the commonly accepted profile of an autistic person. This can mean that they receive a diagnosis later in life.

Understanding the symptoms and standard milestones for child development can help a person spot autism in girls.

People who believe their child may be showing signs of ASD should speak with a doctor.