Autism in females can be diagnosed and supported in young girls and teens. Girls with autism need to be highlighted and understood.
When I was growing up, I played with a neighbor girl. We colored pictures, drew hopscotch lines on the street, jumped from space to space, and had picnics on the lawn. She had a younger sister who talked to the garage door opener. Her younger sister carried the plastic beige rectangle with the round brown button in the middle of it. She would go into the garage and talk to the box. Her sister called it “opener” and she asked it questions and told it about her toys. I remember that she was not an unkind girl. She just played on her own with her friend, Opener. No one seemed to say that she had a diagnosis, let alone that she may be a girl with autism.
Learning More About Girls with Autism
Years later, as a Developmental-Behavioral pediatrician, I have met a number of girls who seem to float into the exam room. Each girl reminds me of my friend’s sister and her Opener friend. They look healthy. They might make brief eye contact with me. But they appear to float across the exam room, sometimes spinning slowly, arms stretched out, talking to themselves about princesses, horses, or dolls. They carry themselves like ballet dancers, moving lightly, and leaning in to study the texture on the wall or the smoothness of the furniture.
They float past me as I try to engage them in a book or toy. The girls will babble to themselves or use real words out of context. When I get down on the floor with them, I offer the baby doll and crib, trying to engage them in play. They may take the item, wordless, smiling, but without looking into my eyes.
Do these girls have autism?
In order to answer this question, we must take a deeper look at the difference between boys and girls with autism.
Girls and Boys on the Playground
Imagine a boy in the second grade who goes out for recess and walks around the edge of the playground looking for shiny rocks. He walks alone, looks out through the diamond shapes of the cyclone fencing, and bends down to pick up rocks or sticks. He turns the rocks over and around in his palm and studies their colors and edges. Some other boys run up to him, bump him on his shoulder and shout out to come play tag. He looks up at them, then he goes back to his new discovery. The boys wait a few seconds and run off to catch someone else.
After a few days, the teacher, who has been watching this boy after the playground aid told her about his lonely rock-collecting, sends an email to the boy’s parents. She asks them to come in for a parent-teacher conference. The parents listen to the teacher’s observations and suggestions that they have him evaluated for autism.
Within a few months, the school also completes an assessment with the special education resources staff. Soon, he is seen by a Developmental-Behavioral Pediatrician and receives an autism diagnosis. He spends time in a “social skills” group at school and has modifications in his daily class experience to allow for time-out sensory breaks. He makes progress over the following year. By the time he reaches middle school, he has friends in the Chess Club.
Autism in Girls
Now imagine a girl in the second grade who goes out for recess and walks around the edge of the playground looking for shiny rocks. Some girls run up to her, bump her on the shoulder and shout out to come play tag. She looks up at them, then she goes back to her new discovery. She slowly follows the girls and watches them as they run after each other. Her teachers are pleased with her quiet manner in the classroom.
Unrecognized Autism in Females
The two stories start the same, but in the second version the playground aide does not mention her observations to the teacher. The teacher does not send any emails of concern to the parents. Time goes by. Now this girl arrives at middle school wearing her favorite clothes – soft, comfortable leggings with a long-sleeve T-shirt. She doesn’t like to wear socks, but she wears fuzzy-lined boots.
The girl didn’t want to wash her hair last night, and barely allowed her mother to put it into a ponytail. She moves through her day, trying to make it down the hallway without being bumped by other students. The girl has trouble staying focused in class and tends to think about her latest video games. She has low grades except in math, and she likes that teacher the best.
Her parents meet with teachers and learn that she is not doing well but has remarkable ability and keen interest in geometry. The math teacher suggests that she apply for the Gifted and Talented Program. Confused, the parents describe the way their daughter struggles with other subjects. The staff suggest an ADHD evaluation. After a few months, the school principal calls for a meeting.
Noticing the Signs of Autism
The parents have not been able to get an appointment with a specialist. They say that their daughter has been making negative comments about “hating school” and “wanting to die”. Her parents seek out a counselor and medication to help their daughter with her depression. Over time, the parents hear the therapist suggest that their daughter has anxiety and depression. But she also meets the criteria for Autism Spectrum Disorder.
Recent articles refer to the delay in diagnosis of autism in girls compared to boys. Studies show that women who receive an autism diagnosis as adults can feel a sense of relief after years of trying to cope with the social communication difficulties of autism. Anxiety and depression occur more frequently in young and teen girls who have autism. Some researchers feel that is due to the extra energy spent each day by females with autism who try to adapt and fit into the expectations and behaviors of surrounding peers and others.
Girls with Autism
An important study recently suggested that girls and boys score differently on the diagnostic tests used to assess for autism. This is true especially if the girl has higher thinking skills. Girls appear to have more awareness of social behaviors and tend to copy what they see.
This behavior can be called “camouflage.” More specifically, camouflage refers to the ability to blend in by imitating the mannerisms and speech patterns of peers. Boys on the autism spectrum may be less aware of the subtle social cues of those around them. They are also more likely to show odd repetitive behaviors and intense interest in how things work. Girls with autism enjoy collecting, arranging dolls or figures; even if they do not actually play with them.
There are several new resources for girls and women who are on the Autism Spectrum. The websites for Autism Society of America and Autism Speaks provide excellent links to more resources. Aspergirls: Empowering Females with Asperger Syndrome by Rudy Simone and Pretending to be Normal: Living with Asperger’s Syndrome (Autism Spectrum Disorder) by Liane Willey Holliday were published before the 2013 DSM-V change from using the term Asperger to the overall Autism Spectrum Disorder phrase.
Keep Your Eyes Open When Seeking Support
Autism Spectrum Disorder in females can be diagnosed and supported in young girls and teens. However, there is a growing trend for websites for females with autism to combine the diagnosis with other popular trends in today’s culture. An example is the Autism Women’s Network (AWN) which was once an excellent place for sharing stories and information for females with autism.
The organization continues with the AWN initials but is now the Autism Women and Non-binary Network. It continues to support girls and women on the Autism Spectrum but has incorporated the concepts of gender-fluid, non-binary labels. School programs to support females with autism may recommend websites such as AWN. Parents are advised to review resources such as this in order to help guide their daughters to optimal mental health and daily life.
Help Your Daughter with Autism Know Her Identity
As a believer in Jesus Christ and the Bible as God’s loving message to us, I support the view that humans are male and female. We all have an amazing variety of gifts, talents, interests, and abilities. Some have significant disabilities affecting developmental skills throughout life. Others have unusual, bright minds despite social communication deficits.
Males and females differ in awareness of others’ thoughts and emotions. That is part of the complementary nature of how we are created. Autism Spectrum Disorder tends to be missed if it is mild in females, but it still exists. Our goal as parents, caregivers, and professionals is to seek better ways to understand growing girls with autism. We should support them as the unique individuals that they are.
Final Thoughts on Girls with Autism
Any discussion of girls with Autism Spectrum Disorder calls for comments about Dr. Temple Grandin. Dr. Grandin is a world expert in understanding animal behavior and a professor at Colorado State in Ft. Collins. She started life as a non-verbal, spinning girl with moderate autism and grew to be an accomplished scientist PhD. Grandin has written a number of books including The Way I See It. It helps the rest of the world to view social communication through her eyes. Dr. Grandin offers excellent advice to anyone who seeks to help girls with autism as they grow and become thriving individuals.
Remember, your daughter is made in the image of God. As you seek diagnosis or treatment for your daughter with autism, know the Lord is with you and He cares deeply for you and daughter.
© 2022 Annelise Spees M.D. Used by permission. All rights reserved.
Bargiela S, Steward R, Mandy W. The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders. 2016;46(10):3281–3294. doi: 10.1007/s10803-016-2872-8
Wood-Downie, H., Wong, B., Kovshoff, H. et al. Sex/Gender Differences in Camouflaging in Children and Adolescents with Autism. J Autism Dev Disord 51, 1353–1364 (2021). https://doi.org/10.1007/s10803-020-04615-z
ANNELISE SPEES, M.D.