Women With Autism: How Autistic Traits May Differ

Autism spectrum disorder (ASD) is a developmental disorder typically diagnosed at or before age 3. Its symptoms can range from mild to severe and usually include social and communication delays, repetitive behaviors, restricted interests, and sensory challenges such as over-reactivity to light, sound, or touch.

The criteria for autism have changed over time. In 2013, several categories of autism, including Asperger syndrome and pervasive developmental disorder not otherwise specified, were removed from the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5), which is the diagnostic "Bible."

Today, everyone with autistic symptoms, whether mild or severe, receives an ASD diagnosis. This article will look at common symptoms of autism, autism in women, causes, diagnosis, support, and treatment.

According to the Centers for Disease Control and Prevention's (CDC) 2020 review of 2016 data (the most recent data available), about 1 in 54 American children are autistic—and only about 1 in 4 autistic children are female. While the 1-to-4 ratio is still considered accurate, other researchers have found that the ratio may actually be closer to 1-to-3.

The difference may result from using "gold standard" diagnostic tools that seem to be more appropriate for boys than for girls. It seems likely that many girls with autism do not receive accurate diagnoses until much later than boys. Some are not diagnosed until adulthood despite having had autism symptoms since early childhood.

Common Signs of Autism

Autism is a neurodevelopmental disorder that impacts people of all genders and races. Because autism is a spectrum disorder, people with the diagnosis are very diverse.

For example, some are highly intelligent, while others have severe cognitive challenges. Some are unable to use spoken language, while others are eloquent. Some prefer solitude, while others are relatively gregarious. Symptoms of autism must be present before age 3, even if the diagnosis itself isn't made until much later.

Communication Difficulties

Everyone who is accurately diagnosed with autism has some level of difficulty with communication. Some of the most common speech-related challenges include:

• Idiosyncratic use of language (repeating phrases from TV, using the same words in the same way over and over again, etc.)
• Flat prosody (robotic-sounding vocalization)
• Inability to recognize speech patterns and body language signifying humor, sarcasm, etc.
• Inability to use spoken language in a meaningful way

In addition to difficulties with speech and body language, people with autism have difficulty with social communication. These, like other symptoms, range from relatively mild to extreme and may include:

• Inability to distinguish between friendly and romantic conversation
• Difficulty discussing anything except a favored topic (e.g., will only talk about a favorite TV show)
• Inability to determine when it is or is not appropriate to speak, ask questions, or participate in a social group
  

Behavioral Differences

Autistic behavior can be easy or difficult to recognize depending on its frequency and severity. Typical autistic behavior may include:

• Stimming is a term describing apparently purposeless movements and sounds made to self-calm. Examples include rocking, humming, pacing, or repeating phrases.
• Meltdowns, or major temper tantrums, generally occur when the individual is overwhelmed and feeling panicky or stressed.
• Some (but by no means all) people with autism may behave aggressively, hitting or throwing objects or self-injuring.
• Preference for solitude or lack of interest in others' social overtures may be seen. Many people with autism are happiest on their own; in some cases, it can be hard to engage with a person on the spectrum because they are so involved with their own thoughts or activities.
• Most people with autism have difficulty forming and/or maintaining social relationships.

Sensory Differences

When the criteria for autism changed in 2013, the DSM-5 added a new set of symptoms to the list: "Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)."

Understanding Autism in Women

Autism is rarer in females than in males. In fact, one major researcher in the field, Simon Baron-Cohen, wrote that autism is a manifestation of the extreme male brain.

There does seem to be a real difference in the number of females who are actually diagnosed with autism versus the number of males. But this so-called "female protective effect" is still being explored.

In recent years, it has become clear that autism is underdiagnosed in females. There are a number of reasons for this:

• Girls are more likely to internalize anxiety related to autism; instead of behaving aggressively, they are more likely to become depressed or anti-social.
• Most cultures make it acceptable for girls to be "shy" whereas shyness is less acceptable in boys.
• When girls with autism focus exclusively on a particular interest, they are more likely than boys to choose a socially acceptable fascination such as unicorns or dolls.

Because fewer females have autism, fewer females with autism have been included in studies. More attention is now being paid to how autism manifests in females.

Camouflaging

Some research suggests that autistic girls may be more likely than boys to intentionally or unintentionally camouflage their symptoms. In other words, girls are more likely than boys to mimic their peers' facial expressions, vocal tone, and other behaviors, making it harder for diagnosticians to spot signs of autism.

It may also be the case that autistic girls are better than boys at using television and social observations to learn social rules. Finally, girls may be better than boys at forcing themselves to make eye contact and squelching behaviors such as hand-flapping.

While girls on the spectrum may be better than boys at imitation, their skills may be only skin deep. In general, autistic girls have difficulty establishing and maintaining peer relationships.

Comorbidities

Comorbidities are diagnoses that can be made in addition to a primary diagnosis of autism. According to recent studies, comorbidities are more common in autistic girls than boys. In addition, comorbidities are more likely when a child is diagnosed with autism at a later age.

Some common comorbidities among girls with autism include:

• Depression
• Attention deficit hyperactivity disorder (ADHD)
• Anxiety
• Anorexia nervosa
• Obsessive-compulsive disorder
• Tic disorders
• Sleep disorders

Causes and Diagnosis

In most cases, the cause of autism is unknown. Autism is, however, a highly heritable disorder; in other words, there is a genetic component to autism, and it runs in families. Many people with autism are also known to have unique genetic mutations which are not inherited. In addition, some known causes of autism include:

• Certain drugs taken by the birth parent during pregnancy
• Fragile X syndrome and other genetic disorders
• Being born to older parents (particularly when the father is older)
• Low birth weight (particularly when the baby is premature)

There is no medical test for autism, so diagnosis is based on observation and specific tests. Typically, autism is diagnosed in children as opposed to adults, and diagnosis is usually carried out by a developmental pediatrician, psychologist, or neurologist with the participation of experts in speech and physical development.

Parents fill out a variety of questionnaires about their child's infancy and toddlerhood and respond to questions about their child's development, behavior, and skills. In addition, clinicians may use various hands-on and observational tools to determine whether a child is autistic and which, if any, comorbidities exist.

Adults with autism are often diagnosed by psychologists and psychiatrists with strong expertise in autism.

Support and Treatment

There is no cure for autism. There are, however, a wide range of treatments available. While some treatments are medical and must be prescribed by a doctor, others are behavioral and/or developmental and may be provided by a therapist or even a parent.

Because there is no absolute "best" treatment for autism, parents often have the final word when choosing treatments for their children. Some of the most common treatments include:

• Applied Behavioral Analysis
• Speech therapy
• Play therapy
• Social skills therapy
• Occupational therapy
• Developmental therapies such as Floortime, SCERTS, and relationship development intervention (RDI)
• Medications such as Risperdal (risperidone) or selective serotonin receptor inhibitors (SSRIs) to help with specific symptoms
• Dietary interventions such as gluten- and/or casein-free diets

People diagnosed with autism as adults are typically quite high functioning; as a result, many are more likely to seek support through cognitive (talk) therapy. Some adults also seek out social skills coaching, sensory integration therapy, and support groups made up of autistic self-advocates.

Summary

Autism is more common among males than females, but females are also underdiagnosed and/or diagnosed at a later age. This occurs because females appear to be better at camouflaging their symptoms and imitating neurotypical behaviors.

It's also the case that girls' symptoms go unrecognized because of cultural norms and stereotypes. Girls with autism are more likely than boys to have comorbidities such as anxiety, anorexia, and obsessive-compulsive disorder.

A Word From Verywell

 If you or your daughter is experiencing one or more of the symptoms of autism, and you have concerns, it's always worthwhile to explore the possibility of an autism diagnosis.

Evaluation may result in an autism diagnosis, but it may also turn up other, related issues such as ADHD, anxiety, or obsessive-compulsive disorder which also require treatment.

While there is no "window of opportunity" for treating autism, and treatment can make a positive difference at any age, there is good evidence to show that early intervention is ideal.

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