Many females may not know they are autistic until they are adults. Females with high functioning autism may internalize and mask their symptoms, leaving them without the right support.

Colloquially known as autism, autism spectrum disorder (ASD) refers to a group of developmental disorders. These conditions can affect the way people behave, socialize, and communicate with others.

Previously, ASD was broken down into subtypes, such as Asperger’s syndrome, but it’s now treated as a spectrum of wide-ranging symptoms and severity levels.

ASD is about four times more common in boys than in girls, according to the Centers for Disease Control and Prevention (CDC).

However, many autistic females may not receive an ASD diagnosis until adulthood, if at all. This may result from the fact that females can present with different symptoms and may mask their ASD more than males.

Read on to learn more about ASD in females and how to recognize it.

Are sex and gender the same thing?

People often use the terms sex and gender interchangeably, but they have different meanings:

  • “Sex” refers to the physical characteristics that differentiate male, female, and intersex bodies.
  • “Gender” refers to a person’s identity and how they feel inside. Examples include man, woman, nonbinary, agender, bigender, genderfluid, pangender, and trans. A person’s gender identity may be different from the sex they were assigned at birth.

Children ages 3 to 7 years are most commonly diagnosed with ASD. However, parents or caregivers may have concerns about the child’s social development before they’re 18 months old.

For example, autistic infants may not make eye contact, and some might show indifference toward their parents. Toddlers with autism may fail to respond to their names or start taking steps backward in their language development.

Still, ASD is a spectrum of disorders, and not all autistic children display the same symptoms. But generally, the symptoms can involve problems with social interaction and behavior.

Social communication and interaction symptoms

Autistic children and adults often have difficulty connecting with others.

This can result in a range of symptoms, such as:

  • inability to look at or listen to people
  • no response to their name
  • resistance to touching
  • a preference for being alone
  • inappropriate or no facial gestures
  • inability to start a conversation or keep one going
  • excessive talk about a favorite subject without giving attention to the reactions of others
  • speech problems or unusual speech patterns
  • inability to express emotions or recognize them in others
  • trouble recognizing simple social cues
  • difficulty following simple directions
  • inability to predict someone’s response or reaction
  • inappropriate social interactions
  • inability to recognize nonverbal forms of communication

Behavioral pattern symptoms

Autistic people often have repetitive behavior patterns that are hard to break.

Some of these patterns can include:

  • performing repetitive movements, such as rocking back and forth
  • developing routines or rituals that can’t be disrupted
  • repeating words and phrases
  • becoming extremely fascinated with a particular subject matter, fact, or detail
  • experiencing sensations of light and sound more or less strongly than others
  • fixating on particular objects or activities
  • having particular food preferences or aversions to food textures
  • self-harming, including biting and head-banging

ASD symptoms in females may not be very different from those in males.

However, research has found that males may have more visible behavioral problems, whereas females can internalize more. This may result in autistic females experiencing more mood issues, such as anxiety and depression, than males in some cases.

One large 2020 research review comparing behaviors between autistic males and females notes that autistic females are reported to have more internalizing behaviors. A 2020 study also reports that autistic males have greater externalizing behaviors.

The same large review also reports that autistic females may present with lower cognitive ability and adaptive functions, but generally, levels appear to be similar to those of autistic males.

More longitudinal studies are needed to draw clear conclusions about the diagnoses and behaviors among and between autistic males and females.

Experts still do not have any definitive information about these differences, including whether these are real or just a result of masking.

Masking

Research suggests that adult females and girls are more likely to mask their symptoms. This is particularly common among females at the lower support need end of the ASD spectrum.

Common forms of masking include:

  • forcing yourself to make eye contact during conversations
  • preparing jokes or phrases ahead of time to use in conversation
  • mimicking the social behavior of others
  • imitating expressions and gestures

While both autistic males and autistic females can camouflage their symptoms, this appears to be more common in females. Along with the differences in presentation, this could also explain why they’re less likely to receive an ASD diagnosis.

Experts aren’t sure what causes ASD. Given the wide range of symptoms and severity, it’s likely caused by several factors, including genetics and environmental factors.

While there’s no evidence that the exact cause is different between the sexes, some experts suggest that males have a higher chance of developing ASD.

A 2020 review suggests that females may have protective genetic material and a higher threshold before symptoms are visible.

No medical tests, such as a urinalysis or blood test, can tell you if someone is autistic. ASD is typically identified by observation of potential indicators over time.

You might begin to notice that your child is not hitting certain developmental milestones, particularly in the social sphere, and take them to their pediatrician.

Sometimes you may not notice the signs, but your pediatrician can identify some symptoms during their routine wellness visit. They may refer your child for a formal evaluation with a child psychologist or pediatric neurologist, who may conduct screening assessments such as:

  • Autism Diagnostic Observation Schedule (ADOS)
  • Childhood Autism Rating Scale (CARS)
  • Gilliam Autism Rating Scale (GARS)
  • Autism Diagnostic Interview (ADI)

The pediatrician will likely complete these assessments after observing your child in depth to see how they play and interact with those around them. They may also rely on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) criteria to make the diagnosis.

If you believe your child could be autistic, make an appointment with their doctor.

Diagnosis in adulthood

Most clinicians consider a diagnosis by a qualified professional to be reliable starting from 2 years of age. However, diagnosing ASD can be difficult. There are many cases in which a person is not identified as autistic until adulthood.

There are similar diagnostic tests for autistic adults. However, diagnosing ASD in adulthood can be challenging, and not every clinician is experienced in identifying the indicators, especially in females.

If you suspect that you may be autistic, you can start by talking with a primary care doctor. A psychologist can also help you evaluate your symptoms and rule out other potential causes. You may need to visit a few doctors before you find one who understands your symptoms and concerns.

If possible, try to ask close family members about any potential indicators or symptoms you might have displayed as a child. This can help give your doctor a better idea of your childhood development.

Throughout the process, remember that you are your most important advocate. If you feel your doctor is not taking your concerns seriously, consider speaking up or getting a second opinion. Seeking a second opinion is common, and you should not feel uncomfortable doing so.

Not every autistic person necessarily views ASD as a condition that needs treatment. But there are resources available for those who feel they need support.

While there’s no cure for ASD, resources are available to help autistic people reduce behaviors that may negatively affect their quality of life.

In children, this support often begins through early intervention developmental therapies. It may progress to different styles of behavioral or educational therapies, which may continue in various ways through adulthood.

Those who receive a diagnosis in adulthood can also access different therapy modalities that can support them, such as cognitive behavioral therapy (CBT).

Medications may also help autistic people with mental health conditions like anxiety or depression and behaviors such as difficulties with focus, self-harming behavior, and more.

For females

Since females may be better at masking their symptoms, being an autistic female can feel particularly isolating. For many, it’s an emotional process that involves revisiting childhood behavior and social problems.

To help you feel less alone, try reaching out to others who may have a similar experience. For example, the Autistic Women and Nonbinary Network is a nonprofit organization that supports cisgender females and gender nonconforming autistic people.

Even if you’re not ready to interact with someone, you can find blog posts, first-person stories, and doctor recommendations online.

In addition, the following reading materials may help you better understand and be more accepting of yourself:

  • “Thinking in Pictures” by Temple Grandin, PhD: This book provides the firsthand account of Temple Grandin, PhD, one of the most well-known autistic females. She offers her perspective as both an accomplished scientist and autistic female.
  • “Women and Girls with Autism Spectrum Disorder” by Sarah Hendrickx: This collection of research articles and personal stories offers multiple perspectives on how autistic adult females and girls navigate the world around them.
  • “I Am Aspienwoman Spectrum: The Unique Characteristics, Traits, and Gifts of Adult Females on the Autism (AspienGirl)” by Tania Marshall: This award-winning book explores how females uniquely experience ASD across different ages. It also discusses how ASD may be more of a beneficial way of thinking than a condition that needs aggressive treatment.

ASD appears to be more common in boys than in girls, and researchers are starting to better understand the differences in how boys and girls experience it.

While this is promising for future generations, adult females who think they may be autistic still face challenges getting a diagnosis and finding support.

But as awareness about ASD and its many forms grows, so do the available resources.

The internet has also made it increasingly easier to connect with others, including those living with social anxiety, a common symptom of ASD.