Not everyone experiences autism in the same way. Some early signs may even be overlooked or misdiagnosed in females. So, do autistic girls behave differently?

Autism is a neurodevelopmental disorder that can result in differences in communication, social interaction, information processing, and behavior.

Typically, boys and men are more likely to receive the diagnosis. New research, however, suggests this may not be due to a lower prevalence among girls and women, but rather different behavioral patterns that often go unrecognized.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) doesn’t provide a separate list of signs of autism for males and females.

Instead, this list of criteria for diagnosis is used for everyone:

  • persistent challenges in social communication and interaction, including emotional reciprocity, nonverbal behaviors, and the ability to understand and maintain relationships
  • repetitive motor movements or sounds
  • difficulty adapting to change or preference for the same routines and rituals
  • narrow list of interests with intense curiosity or focus on them
  • low or high reactions to sensory stimuli or intense interest in sensory aspects of the surroundings
  • these differences lead to significant challenges in social, academic, or occupational areas of life
  • these differences are present from the early developmental stages
  • even if autism co-occurs with intellectual disability, these differences aren’t explained by it or by developmental delays

Autism is a spectrum disorder. This means that these differences may be more or less marked in some people. They may also vary according to the situation and change over time.

Autism may present differently in girls, women, and nonbinary people, says Sharon Kaye-O’Connor, a licensed clinical social worker in New York City.

“We know that girls and women are often skilled at masking or camouflaging their autistic traits, so they may not receive a diagnosis until much later,” she explains.

Other behaviors may also point to differences in autism in girls and women, especially for those who have average or above-average intelligence.

1. Mirroring

Autistic females may be more likely than males to copy other people’s mannerisms, speech patterns, or personas, says Kaye-O’Connor.

“Sometimes this form of masking is automatic and instinctual, and the autistic person may not even realize they are copying others.”

2. Social awareness

Autistic girls may be more socially aware, overall, than their male counterparts. They may have a higher ability to maintain relationships with other people and adjust their behavior according to what’s needed or expected of them in a given social context.

3. Hyper-empathy

Empathy is the ability to put yourself in someone else’s shoes and understand what they may be feeling or experiencing. Hyper-empathy is an elevated version of this.

“Outside of the traits formally listed in the DSM-5, we know that a trait like hyper-empathy can be a common experience among autistic folks,” says Kaye-O’Connor. “This trait often draws autistic folks, particularly autistic women, toward caring professions like social work, nursing, and psychotherapy.”

4. Social withdrawal

Autistic girls may tend to have a more direct communication style, which may come across as blunt, says Tasha Oswald, PhD, , a licensed psychologist in Palo Alto, California.

“They may share an observation that seems harmless to them, but the other person takes it as an insult. This feels very confusing for an autistic girl who has good intentions,” she explains. “She may learn to withdraw because it’s safer than the painful experience of sharing her thoughts and being misunderstood.”

5. People-pleasing behavior

When autistic girls and women express their feelings, they may be told a number of invalidating things, rather than receiving support, says Oswald.

For example:

  • “You’re too sensitive.”
  • “Stop overreacting.”
  • “Why can’t you be more like…”

“They may start to feel shame and believe there is something wrong with them. Rather than being accepted for who they are, they are told to act normal, be a good girl, or be socially appropriate,” says Oswald. “In order to feel accepted by others, autistic girls tend to become extreme people-pleasers and mask their true self.”

Autism may develop from a combination of contributing factors, including a genetic component, according to the Centers for Disease Control and Prevention (CDC). These factors may be different for each sex.

In a 2015 study exploring brain size among autistic folks, researchers found that autistic females tend to have smaller temporal lobes, compared to autistic males. The temporal lobe is involved in emotional regulation, language, and the processing of verbal information.

A 2021 study using MRI technology and genetic data also showed that autistic girls had a reduced brain response to human motion. This difference seemed to be explained by structural differences in the areas of the brain that coordinate the interaction between senses and movement. For example, how you move depending on your perceptions of the space around you.

Although the research doesn’t establish if these differences are causes or effects of autism in girls, the findings do suggest the need to work with female-predominant participants in order to study potential unique characteristics.

In another 2021 study, working with 54 autistic females and 55 autistic males ages 3 to18, researchers found differences in the clinical phenotypes between the two groups. Phenotype refers to someone’s observable features and characteristics that result from the interaction between your genes and the environment.

The study findings indicated that, compared to males, autistic females had a greater capacity to establish, maintain, and understand social interactions and relationships. They were also less likely to adopt and repeat the same routines or rituals compared to their male counterparts.

Finally, autistic females seemed to develop interests similar to nonautistic girls, like celebrities, makeup, and books. On the other hand, autistic males were more interested in trains, numbers, and video games.

Overall, more research is still needed in this area. It’s a newer topic of interest among experts, as most of the research has been done on autistic males.

Research shows that autistic females tend to be diagnosed at older ages than boys, due in part to the diagnostic criteria being modeled around male behavior. There’s still a stereotype about what autism “looks” like, which can make it harder to spot the signs in girls and women.

In addition, since females seem to be better at masking and camouflaging, and are less likely to adhere to the same routines as autistic males do, they may be more likely to receive different diagnoses or no diagnosis at all.

Autism spectrum disorder is thought to be more common among boys, but new research suggests this may be due to experts overlooking unique structural and behavioral characteristics in autistic females.

While more research is needed to determine the exact differences between the sexes, autistic girls seem to be more adept at internalizing or camouflaging their symptoms, establishing reciprocal relationships, and developing neurotypical (nonautistic) interests and routines.

These resources may help if you’re interested in learning more about autism and autism in girls.