How Does Autism Present Differently in Girls?

Girls with autism are prone to internalising problems and are significantly more likely than boys to develop co-occurring internalising disorders.

Autism is comparatively more frequently diagnosed in males than it is in females. A widely accepted explanation is the ‘female protective effect’ – that there is something inherent in being biologically female that reduces that probability of developing autism. However, present research suggests that autism could be underdiagnosed in females because the diagnostic criteria – restricted and repetitive interest, social and communication impairments and sensory issues – do not often fit squarely with how females typically express their autism. Other overlapping diagnoses such as depression, anxiety and anorexia further complicate the issue. This article discusses why diagnosing autism in girls can be a thorny process and some female-typical autism presentation.

Challenges in Diagnosing Autism in Girls

A study (Szalavitz, 2016) compared the incidences of (observable) autism traits and formal autism diagnoses in a sample of more than 15,000 twins – they found that if girls and boys had comparable autism traits, the girls needed to have either a significant intellectual disability or severe behavioural problems, or both, for them to be formally diagnosed. This finding suggests that clinicians are overlooking many girls w