Under the Radar: Autism in Girls
- Caitlin Burke
- Jul 4
- 3 min read
Receiving my autism diagnosis (albeit later in life) made a profoundly positive impact on the way I view myself. Before I knew I was autistic, I held a lot of shame around my difficulties with social interactions and relationships. I viewed myself through a negative lens – I was shy, bossy, selfish – the list goes on.
Home videos from my childhood showed an awkward girl who didn’t always answer questions, spoke in different voices, and had sensory aversions. Growing up, I remember feeling intense social anxiety as I often didn’t know where I stood in relationships and constantly worried about how others viewed me. Was I saying the right thing? Did I just offend them? What are they thinking right now?
It wasn’t until I was in graduate school that I was diagnosed with anxiety and given medication. While the medication definitely helped, I still had difficulty navigating and maintaining relationships and attributed this to what could only be my shortcomings. This went on for 15 years.
After having my son, I had a difficult postpartum period. I was given the additional diagnosis of obsessive compulsive disorder (OCD), but this didn’t feel right to me. Yes, I had a strong desire to control my world, but I wasn’t having intrusive thoughts. I reached out to my friend Lucas, who is also autistic, and he helped me understand how the female presentation of autism perfectly described my lived experience.
After receiving my autism diagnosis, I felt an immense sense of relief and was able to give myself grace. So what exactly is the female presentation of autism? And why are girls misdiagnosed or not diagnosed at all? Let’s dive into this.
Female Presentation of Autism
Masking (or Social Camouflaging): Autistic girls learn to mimic the social behavior of others and hide autistic traits. They tend to do this outside of the home (which is usually their safe place) in order to fit in. Masking is exhausting and often leads to burnout or meltdowns. For example, an autistic girl may mask all day at school only to come home and “let it all out.”
“Typical” Special Interests: Like many autistic boys, autistic girls have special interests (which are more intense and focused than hobbies). However, autistic girls’ special interests usually appear more socially appropriate, such as animals, fashion, or art. What is atypical is the intensity of the special interest as it will consume a significant amount of time and energy.
Subtle Social Differences: Autistic girls are often highly verbal and appear socially adept. However, they struggle with more nuanced language and may take things literally and struggle with small talk and group conversations. Additionally, maintaining long-term friendships can be challenging.
Internalized (or Hidden) Emotional Distress: As a result of masking, autistic girls tend to hold their emotions inside until they reach a breaking point. Contrary to stereotypes, autistic girls may be highly empathetic, but overwhelmed by emotions, often having difficulty processing and regulating emotions, especially in social situations. Anxiety, depression, eating disorders, and self-harm are more common and misdiagnoses, such as anxiety disorder, ADHD, bipolar disorder, and OCD, are common.
Sensory Differences: Like autistic boys, girls have sensory processing differences, but these may be masked or attributed to “quirkiness.”
Need for Routine & Predictability: Autistic girls strive for predictability by controlling their environment, but this may be more subtle in settings where masking is occurring. Routines are important, but may be expressed more subtly, such as rigid food preferences, clothing, and order of task within routines.
Getting the Right Diagnosis
If you believe your daughter is autistic, but is high masking, it will be important to find a psychologist who is not only neuro-affirming, but also knowledgeable about the female presentation of autism. Currently, diagnostic criteria favors the “traditional” autistic male profile. You will need to ask psychologists how they diagnose autism in high-masking females using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
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For autistic women and late-diagnosed adults, the CAT-Q can be especially validating, as they often engage in high levels of camouflaging.
A good autistic quiz can help you identify specific traits you may not have realized were related to autism, like sensory sensitivities or special interests.