Symptoms of autism in girls may include having strong attachments to objects and avoiding eye contact. Doctors may underdiagnose autism in females due to masking, stereotypes, and other factors.

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

Doctors may underdiagnose autism in females because females may not display the “common” behaviors or may be better at hiding their symptoms.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Since autism spectrum disorder (ASD) involves such a wide range of symptomsTrusted Source, people may not have every symptom.

Autistic children may have difficulty with social interaction and communication. Examples of significantTrusted Source symptoms in children include:

  • not responding to their name by the time they are 12 months old
  • having difficulty following instructions
  • not pointing out interesting objects by the time they are 14 months old
  • losing certain skills, such as the ability to say words they could say before
  • having difficulty explaining what they want or need
  • not returning smiles or imitating silly faces
  • preferring to play alone
  • avoiding eye contact

Other key characteristics of autistic behavior may include strict routines and repeated actions, such as:

  • 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
  • experiencing difficulties with movement, such as impairments in balance or fine and gross motor skills

These symptoms may appear in infancy or early childhood, though people may not always recognize them at the time. Other symptoms may only become obvious when a child is older.

People without ASD may alsoTrusted Source show some of these symptoms.

Do girls have different symptoms?

A small 2019 study of 17 males and 11 females with ASD suggests that females are more likely to display camouflaging or masking, which involves disguising symptoms in social settings to better fit in with social norms.

The study’s authors suggest that this means ASD symptoms may be harder to detect among females.

The authors of a 2022 review suggest that clinical presentations of ASD symptoms differ in males and females, but they highlight that recent research offers conflicting results on sex differences and that results may vary across ages and symptom types.

The review’s authors suggest that females may be more likely to have an increased or reduced response to sensory stimuli and may be less likely to show patterns of restricted or limited interests.

They also suggest that females may be more likely to show fascination with random objects, such as stickers or pens, and play obsessive, repetitive games with toys.

Age and cultural factors may cause symptom differences to become more pronounced over time.

More research is necessary to understand symptom differences between males and females.

The Centers for Disease Control and Prevention (CDC) estimates that boys are four times more likelyTrusted Source to have ASD than girls.

Below are some potential causes for the different ASD diagnosis rates among males and females.

Research centering males

Since doctors more commonlyTrusted Source diagnose ASD in boys than in girls, parents, caregivers, and healthcare professionals may be less likely to look for symptoms of autism in girls. This may lead to a cyclical pattern of underdiagnosis.

A general lack of understandingTrusted Source or knowledge about autism may also cause healthcare professionals, teachers, parents, or caregivers to miss the symptoms in girls.

Additionally, because healthcare professionals developed diagnostic tools for autism using mostly male case studies, those tools miss the symptoms that are more common in girls.

More research into the differences in autism symptoms between the sexes may help improve diagnosis methods for females.

Masking

Males and females may manage autism symptoms differently. A 2020 study suggests that females may be more likely to mask symptoms in social situations.

Some research cited in a 2022 review also suggests that autistic females have a greater capacity for forming friendships and greater social motivation than autistic males.

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

Stereotypes

Stereotypes about typical male and female behaviors may cause some people to miss symptoms.

People may 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.

The United Kingdom’s National Autistic Society suggests that outdated stereotypes about autism can result in a later diagnosis for some autistic girls. These stereotypes include assumptions that all autistic people have a keen interest in math or science and that autistic people cannot form friendships.

Misdiagnosis

Healthcare professionals commonly misdiagnose autism as a mental health condition. Mental health conditions can also occur alongside autism.

Mental health conditions that may share symptoms with ASD, leading to a misdiagnosis, include:

Additionally, autism may cause stress for some people, which can lead to different behaviors in girls and boys. Girls may be more likelyTrusted Source 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 can be more visible and may cause people to notice autism sooner.

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

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) divides ASD into three severity levels based on the amount of support someone may need:

  • Level 1: A person may need support to help them manage social challenges, such as making and maintaining friendships.
  • Level 2: Someone may need substantial support to overcome social challenges but may still find it difficult to communicate and meet social norms.
  • Level 3: People may need very substantial support and typically find it very difficult to communicate and conform to social norms.

Learn more about levels of autism.

There is no medical testTrusted Source to diagnose autism. However, at routine healthcare visits, a doctor can monitor children for early symptoms of autism before they reach the age of 2 years.

A doctor may ask questions about whether a child has reached certain milestones, such as smiling for the first time, crawling, and making sounds, to check their development.

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 receive a referral for ASD screening, which may involve tests to check their speech, learning, and behavior. An appointment with a professional who specializes in autism may follow.

Even if a child shows one or more symptoms that are often associated with autism, they may not be autistic. For example, avoiding eye contact and being attached to routines are common personality traits.

Autistic children may have multiple symptoms that affect their daily lives. They may be able to mask these symptoms, but doing so can cause stress.

Autistic children may alsoTrusted Source be more vulnerable to bullying or abuse. Parents, caregivers, and teachers should be aware of this so they can be ready to educate non-autistic children about the condition and provide support to autistic children if needed.

Although doctors diagnose autism less frequently in girls, it can occur. Some symptoms are the same for both sexes, while others may be less obvious or less likely to occur in girls.

Because of the way healthcare professionals developed autism screenings, autistic females may not fit the commonly accepted profile of an autistic person. This can contribute to later diagnoses.

Understanding the symptoms and the standard milestones for child development can help a person spot autism in girls. People who believe their child may be showing signs of ASD can speak with a doctor.