When we think of autism symptoms, what we are really thinking of is male autism symptoms. Most autism research and diagnostic criteria are based on studies on males. However, girls and women with autism spectrum disorders (ASD) often present with very different symptoms than males. As a result, many girls and women go undiagnosed and unsupported, living with confusion, frustration, and low self-esteem over their inability to be more like their neurotypical peers. In fact, people who were diagnosed with autism in their 50s grew up thinking they were bad people according to a recent study.

While ASD affects primarily males, it may affect more girls than we realize due to insufficient knowledge. Girls with autism often behave more like neurotypical boys than boys with autism or neurotypical girls.

Instead, female ASD is typically misdiagnosed as depression, anxiety, borderline personality disorder, bipolar disorder, or ADHD. It’s also more common to see obsessive-compulsive disorder (OCD) and eating disorders in girls with autism. The extreme focus required for anorexia and body obsession is believed to derive from autism in many girls —autism shows up in about 20 percent of girls with anorexia.

Why girls with autism go undiagnosed

One of the more common reasons girls with ASD go undiagnosed is because they are more adept than boys at “masking.” Masking means hiding their normal behaviors and studying and mimicking neurotypical behavior.

Scientists believe girls excel at these traits because they are more wired for connection and social behavior. Masking may seem like an acceptable workaround, but the truth is it creates an enormous amount of stress and exhaustion, and can lead to depression, anxiety, sensory overloads, and the “meltdowns” that mark the disorder.

Diagnostic criteria for autism come from studies based on male neurology and behavior. Male bias in science in general is a very well-studied phenomenon and has female-based medicine lagging far behind medicine for males.

Boys with ASD tend to exhibit difficulties socializing and communicating. They also are known for repetitive, inflexible behavior patterns. While girls with ASD may exhibit these behaviors, they also may not to the same degree.

As a result, the pattern has been that only girls with more extreme or male-like manifestations of ASD have been diagnosed, leaving many girls with milder ASD spectrum going undiagnosed but still suffering unsupported and misunderstood.

Girls with autism behave more like neurotypical boys

This confusion in diagnosis could stem from the fact that girls with ASD act more like neurotypical boys. Brain scans show girls with ASD process social information more like neurotypical boys and much differently than neurotypical girls. They also score closer to boys than girls in tests assessing friendship quality and empathy.

This is further illustrated in the book Aspergirls, in which the author gives examples of many girls with ASD who feel they are half boy or more male than female.

Being labeled as “too intense” is a common female ASD symptom

A common reaction people have to girls and women with ASD is that they are too intense, too emotional, too sensitive, or too something else. This contributes to many girls with ASD growing up feeling ashamed and isolated.

This “too intense” behavior stems in part from the hypersensitivity and sensory overload associated with ASD.

ASD girls are more vulnerable to bullies, depression, and isolation

Female ASD symptoms can make for social misfits who end up being more vulnerable to bullies and predators, more prone to isolation, and more likely to suffer from anxiety, low self-esteem, social isolation, and depression.

In fact, two-thirds of women with milder forms of ASD report suicidal thoughts.

This is why increased awareness, diagnoses, and support are so important.

The role of brain inflammation in autism

Diagnosis is extremely important in girls and women with ASD. This is because it can relieve years or decades of shame and anxiety around feeling like such an outsider to the rest of the world. Knowing why they feel and act the way they do can bring enormous relief from feeling like they are constantly failing.

Autism in both males and females is increasingly linked with brain inflammation and autoimmunity that can begin in utero. Maternal autoimmunity (such as Hashimoto’s low thyroid), high blood sugar, or infections increase the risk of giving birth to a child who will develop ASD.

In addition to proper diagnosis and support, strategies to dampen brain inflammation and autoimmunity can help mitigate symptoms of autism that cause suffering. Ask my office for ways to support girls with ASD.