Autism in girls: why is it missed, why does it look so different, and what are the signs?

Autism was once thought to occur almost exclusively in boys, but we’re now beginning to understand that this is hugely inaccurate. Current research estimates that the male-to-female ratio for autism is nearer to 2:1, which is likely still an underestimate given how many females still go unidentified and undiagnosed until adolescence or adulthood, if they get diagnosed at all.

You’ve probably read alarmist headlines about surging autism referrals and an autism epidemic, but in reality, this isn’t the case. One of the main contributors to this rise is that our understanding of the diverse ways autism can present, including across genders, has significantly improved. This means that more people than ever before are being referred for assessment, lots of them girls, along with a lost generation of undiagnosed autistic adults (many of whom are women) who were never diagnosed as children. It’s not that there is more autism; we’re just better at identifying it now.

So why are so many autistic girls still missed or diagnosed late?

There are many reasons why girls and women are either diagnosed late, misdiagnosed, or not diagnosed at all. One of the biggest, though, is that traditional diagnostic criteria were largely developed based on how autism presents in males. And despite advances in our understanding, many professionals (and society at large) still haven’t caught up.

Many clinicians still hold outdated stereotypes about what autism “looks like,” dismissing girls who make fleeting eye contact or who have friends. School professionals often overlook the quiet, compliant autistic girl while readily referring “disruptive” boys for evaluation. Parents themselves might not recognize autism in their daughters when their reference points come from media portrayals centered on male presentations.

This invisibility extends into research as well, with fewer diagnosed girls included in autism studies, our scientific understanding remains skewed toward male presentations, perpetuating the cycle of missed diagnoses. This is improving, but not quickly enough.

For many autistic girls and women, this results in years of inappropriate treatments, misdiagnoses like borderline personality disorder and anxiety, mental health problems, abuse, and trauma. Not to mention the profound damage of believing there’s something fundamentally wrong with them rather than understanding their neurological differences. That’s why I’m so passionate about increasing awareness of how autism can present differently in girls and women.

But why do girls present so differently?

Well, although genetics may play a role, it’s largely down to socialization. From early childhood, girls face stronger social expectations to be cooperative, emotionally attuned, and socially engaged. To be “good girls.” These gendered expectations create powerful incentives for autistic girls to mask their natural behaviors and develop compensatory strategies that hide their challenges. But it comes at a huge cost to their mental, emotional, and physical well-being, which we’ll talk more about later.

Recognizing the unique patterns of autistic traits in girls isn’t just about getting a diagnosis or a “label” as some people like to put it—it’s about helping these young people understand themselves better, protecting their mental health, building appropriate support systems, and celebrating their strengths alongside addressing their challenges.

So, what are the signs of autism in girls?

Before we detail the common traits seen in autistic girls, keep in mind that just like no two people are the same, no two autistic girls will be the same. Each child will express their traits in their own unique way. What’s more, some autistic girls do present in a more stereotypical way, but those who do usually aren’t missed and receive an earlier diagnosis. Finally, although much less common, autistic boys can present with these more internalised traits that we’re about to discuss.

With that covered, here are 22 traits to look out for.

1. Social camouflaging or masking behaviors.

Because of the gender expectations placed upon them, many autistic girls become remarkably skilled social chameleons. They carefully observe and then mimic the behaviors of neurotypical peers around them and hold in their sensory distress. This “camouflaging” or masking isn’t manipulation—it’s an often unconscious survival strategy that helps them navigate complex social environments where they don’t feel safe to be themselves. And it begins from a startlingly young age.

As girls get older, they might rehearse conversations in their heads, practice facial expressions in the mirror, or develop scripts for different social situations. When they return home after a day of “performing,” they’re often emotionally exhausted from the constant vigilance required to maintain their social mask.

The effort involved in this camouflaging is substantial, and it has real harms. It causes anxiety, depression, a loss of identity, and even an increased risk of suicide. Autistic author and autism diagnostician, Sarah Hendrickx, highlights how masking is one of the primary reasons autism goes unrecognized in so many girls. It’s a sad fact that being able to make eye contact is still frequently used to refuse girls an autism referral, despite us knowing that many autistic girls learn to force uncomfortable, or even painful eye contact because of society’s obsession with it.

2. Emotional meltdowns that occur primarily at home after “holding it together” all day.

What is held in must eventually come out. Whilst autistic girls often demonstrate impressive, but unsustainable, emotional regulation in public settings, it’s usually followed by intense meltdowns at home. This pattern confuses many parents who hear “she’s fine at school” from teachers but witness emotional collapse at home. They question what they are doing wrong, when, in reality, it’s not home that’s the problem. It’s school. School requires suppressing sensory discomfort, social anxiety, and authentic responses while maintaining constant vigilance about social expectations.

This Jekyll-and-Hyde pattern reflects the immense effort these girls expend maintaining “socially acceptable” behavior in environments where they feel judged. By the time they reach home’s safety, their emotional regulation resources are depleted, making even minor frustrations overwhelming.

Autistic girls often need decompression space after school rather than immediately adding demands or social activities. Understanding that home meltdowns often reflect school stressors helps parents provide appropriate support rather than feeling that their parenting is at fault.

3. A vivid imagination and rich fantasy life.

Whilst the stereotypical (and inaccurate) view suggests that autistic people lack imagination, research now recognizes that autistic girls frequently demonstrate rich fantasy lives. Their imaginative play may differ from neurotypical patterns—being more scripted, detailed, or solitary—but is often remarkably creative and complex.

Many autistic girls create elaborate imaginary worlds where they can escape from overwhelming real-world demands. These fantasy realms often have complex rules, characters, and narratives that provide the predictability and control that social situations lack. What’s more, they become very distressed if others try to change the rules of play.

Many autistic girls engage in elaborate pretend play centered around animals, often identifying with and imitating animal behavior with remarkable dedication and detail. This play frequently persists longer than developmental norms would predict. Their animal play often differs from neurotypical children, focusing on accurate behavior, sounds, and movements. Some, but not all, autistic girls might research their chosen animals extensively, incorporating detailed knowledge into their play.

4. Perfectionism and high anxiety about performance.

Many autistic girls develop intense perfectionism that goes well beyond typical high standards. Their need for things to be “just right” can manifest as refusing to try activities they can’t immediately excel at or having meltdowns over minor mistakes. For example, they may tear up a beautiful piece of work because it doesn’t look exactly right (to them).

Their drive for perfection might stem from black-and-white thinking (something is either perfect or worthless) and difficulties with flexible problem-solving. It can also reflect genuine anxiety about making mistakes in a world that already feels unpredictable.

Some autistic girls develop selective mutism. It’s a severe anxiety condition where a child becomes unable to speak in certain social situations despite speaking comfortably in others. This condition is frequently connected to perfectionism and is linked to autism.

Their silence doesn’t reflect defiance or choice but genuine anxiety so overwhelming it renders speech physically impossible. An autistic girl might speak freely at home but be completely unable to speak at school, with relatives, or in public settings. It’s not a condition to be taken lightly or dismissed as mere “shyness,” and I speak from personal experience. If left untreated, it can persist into adulthood, and it has real and serious consequences for the safeguarding of autistic girls and women, who are already more vulnerable to bullying and abuse.

5. Difficulty maintaining friendships despite initial success.

Unlike the stereotype of the autistic boy uninterested in friendships (which is also not always true), most autistic girls genuinely want friendships—they just struggle in ways that differ from typical social development patterns. They might form intense “best friend” attachments that sometimes overwhelm the other child, or connect well initially but have trouble maintaining friendships over time.

On the flip side, they may not struggle with friendships much in their earlier years, but then things start to fall apart during the preteen and teen years, when friendship rules become increasingly complex and unspoken. An autistic girl might be bewildered when relationships suddenly end, having missed subtle social cues that the dynamic was changing.

In group settings, they might approach peers with genuine interest but use conversation strategies that feel awkward or intrusive to others. Their straightforward communication style—direct questions, honest observations—can clash with the indirect social norms of female peer groups.

What makes this particularly heartbreaking is that many autistic girls are deeply loyal, honest friends who don’t understand why their authentic approach to relationships keeps backfiring in a neurotypical social landscape that often values performance over authenticity.

6. A strong enjoyment in collecting or organizing objects.

Autistic boys are known for their love of lining up objects, and autistic girls often do this too, but it may look different. Many autistic girls develop elaborate collections that they enjoy organizing. Whether collecting books, soft toys, figurines, rocks, or any other toy or object, the act of gathering and systematizing provides both comfort and cognitive satisfaction.

Parents might notice these girls arranging and rearranging their collections, finding genuine joy and relaxation in the process. The collection itself becomes a controlled, predictable environment in contrast to the unpredictable social world.

What’s more, this organizing tendency extends beyond collections to stationery, digital files, or clothing, etc. The desire for order reflects both a cognitive preference for systemizing and a coping mechanism that creates predictability in an often chaotic sensory environment.

7. Sensory sensitivities that manifest as pickiness or preferences.

When a girl refuses certain foods or clothing, it’s usually seen as her being difficult. But this is rarely the case, and especially not for autistic girls. Autistic people’s brains process information differently than their neurotypical peers, making certain sensations genuinely uncomfortable or even painful.

The scratchy tag that others barely notice might feel like sandpaper against her skin. Background conversations in a restaurant could sound like twenty radio stations playing simultaneously. Food textures that seem normal to others might trigger genuine disgust responses, which we’ll discuss a bit more later on.

What’s particularly notable about sensory differences in autistic girls is how they often internalize these challenges rather than making them obvious. At school, they might tolerate them for appearance’s sake, but that takes up so much energy that they can’t focus on learning properly. Or in noisy environments, they might quietly withdraw or develop headaches, fatigue, and other physical complaints that are a manifestation of their nervous system’s overwhelm.

8. Intense special interests, but often socially acceptable ones.

In the realm of autism research, intense special interests are well-documented across genders, but research shows they manifest differently in girls. While boys might fixate on trains or memorize sports statistics, girls often develop passions that appear more socially acceptable.

A deep interest in animals, literature, favorite musicians, or certain TV shows might be dismissed as typical “girl behavior” rather than recognized as the deep focus and passion characteristic of autism. The distinction lies in the intensity and approach—the way information is collected and categorized, and the comfort these interests provide.

For autistic girls, these special interests aren’t just hobbies; they’re sanctuaries that provide predictability and joy in an otherwise overwhelming world. Professor Tony Attwood, a leading expert in autism, explains how these narrow but deep interests often function as both passion and emotional regulation.

9. Advanced vocabulary but difficulty with pragmatic language.

If a girl speaks with remarkable eloquence about her interests, using vocabulary that seems beyond her years, observers might dismiss autism as a possibility. This common misconception overlooks how language develops differently in many (but not all) autistic girls.

While they may excel at the mechanical aspects of language—vocabulary, grammar, pronunciation—they often struggle with pragmatic language skills such as understanding punch line type jokes or humour that plays on words, recognizing when someone is bored, or navigating the give-and-take of conversation.

A girl might deliver mini-lectures on topics she loves, missing social cues that her conversation partner wants to change the subject.

The linguistic profile of many autistic girls aligns with what researcher Uta Frith calls “hyperlexia“—advanced reading and vocabulary skills that develop earlier than social communication abilities.

10. A tendency to observe social interactions before participating, or needing explicit teaching.

The quiet girl reading alone during recess or hovering at the periphery of social groups might not be simply introverted—she could be an autistic girl who finds social interaction overwhelming but still craves connection.

Teachers might describe her as “in her own world” or “just a little shy” rather than recognizing signs of social difficulty.

When autistic girls do attempt to engage, they may observe social interactions extensively before participating, trying to decode the unwritten rules before risking involvement. This cautious approach can be misinterpreted as disinterest rather than recognized as careful social study.

11. Strong adherence to rules and social justice.

An autistic girl’s profound connection to rules and fairness extends beyond typical childhood concerns about what’s “not fair.”

In classroom settings, they might become distressed when rules are inconsistently applied, struggle with situations that seem arbitrary, or take on the role of reporting others’ infractions. This behavior stems from a genuine need for predictability and clarity in a social world that often feels chaotic.

While many children gradually develop flexibility around rules, understanding that context matters, autistic girls might maintain black-and-white thinking about right and wrong well into adolescence.

This rigid sense of justice can be both a strength and a challenge—it often leads these girls to stand up against bullying, discrimination, and fight for social causes (take Greta Thunberg, for example), but it can also create social friction when peers view them as inflexible or judgmental.

12. Exhaustion after social interactions (social hangover).

Many autistic girls experience profound fatigue after social interaction, sometimes called a “social hangover.” This exhaustion results from the cognitive demands of conscious social processing that neurotypical people perform automatically.

After school or social gatherings, these girls may appear irritable, withdrawn, or emotionally fragile. What looks like antisocial behavior is actually a necessary recovery period. The mental effort required to navigate social complexities all day depletes their resources in ways invisible to outside observers.

13. Intense emotional reactions to changes in routine.

In a world that often feels overwhelmingly unpredictable, routines become essential anchors for many autistic girls. But rather than having obviously rigid routines, they might internalize their distress when plans change or develop subtle rituals that aren’t immediately noticeable.

They might become quietly withdrawn when schedules shift unexpectedly, ask repetitive questions about upcoming events, or develop specific morning routines that help them feel grounded for the day ahead.

At school, substitute teachers or assembly days might trigger anxiety that manifests as stomachaches or irritability rather than obvious resistance. This need for predictability isn’t stubbornness—it’s how the autistic brain manages a world that often feels chaotic.

14. Strong attachment to comfort items.

Many autistic girls develop deep attachments to specific objects that provide comfort and security. These items might include stuffed animals, books, or seemingly random objects that hold special significance only they understand.

These attachments often persist longer than developmental norms would suggest, with teens (or even adults) still needing comfort items typically associated with younger children. The emotional regulation these objects provide is genuinely important, not something they can simply “outgrow” on a neurotypical timeline.

In stressful situations, access to these comfort objects can mean the difference between coping well and experiencing overwhelming distress. The objects often provide consistent, predictable sensory input that helps regulate an otherwise chaotic sensory experience.

Many autistic women report maintaining special comfort objects well into adulthood, though they often learn to use them privately in settings where judgment might occur.

15. Stimming behaviors that are less obvious.

While stereotypical autism portrayals often feature obvious stimming like hand-flapping or rocking, research shows that autistic girls frequently develop more socially camouflaged forms of self-regulation and repetitive behaviors. Their stimming might appear as seemingly typical behaviors—twirling hair, picking at skin, chewing on pencils, listening to the same song over and over, or tapping fingers in patterns that look like ordinary fidgeting.

These subtler stims serve the same essential neurological purpose—regulating sensory input, expressing emotion, or maintaining focus—but attract less attention or stigma. Many autistic girls unconsciously select stims that align with feminine behavioral expectations, like fiddling with jewelry or smoothing clothing repeatedly.

In classroom settings, a girl’s stimming might present as doodling elaborate patterns, bouncing a foot under the desk, or rubbing fabric between fingers. These behaviors are easily missed or misinterpreted as boredom or anxiety rather than recognized as important self-regulatory mechanisms.

16. Difficulty with transitions between activities.

Changes in routine, environment, or expectations can be genuinely disruptive for all autistic people. Their need for predictability isn’t stubbornness but reflects how their brains process and prepare for experiences.

Even seemingly minor transitions—switching between classroom activities, ending a favorite activity, or unexpected schedule changes—can trigger significant distress. This difficulty often appears as resistance, procrastination, or emotional outbursts that may seem disproportionate to the change involved.

Unlike more visibly rigid autistic boys, some girls might internalize their transition distress, becoming withdrawn, anxious, or physically ill rather than overtly “refusing” to transition. This internalization makes their struggle less obvious but no less real.

17. Hyper empathy (or emotional responses that neurotypical people see as a lack of empathy).

Contrary to outdated stereotypes, many autistic people experience emotions with extraordinary intensity—sometimes described as hyperempathy. This heightened emotional sensitivity means they might become overwhelmed by others’ distress or absorb the emotions of those around them like emotional sponges.

Autistic girls might become physically distressed when witnessing arguments between friends, avoid sad movies because they feel devastated for days afterward, feel distraught about the mistreatment of animals, or seem to “catch” the emotions of people around them without clear boundaries between their feelings and others’.

This emotional porousness often gets mislabeled as being “too sensitive” or “dramatic,” but it reflects a genuine difference in how autistic people process emotional information. The double empathy research by Damian Milton highlights how autism involves different, not absent, empathy patterns that neurotypical people often fail to recognize.

18. Gender non-conformity (but not always).

As autistic girls begin to state their own preferences, some display gender non-conformity, showing less concern about traditional gender expectations than their neurotypical peers.

These girls might prefer clothing based on sensory comfort rather than fashion, choose interests based on genuine passion rather than gender appropriateness, or feel less pressure to conform to feminine social norms. Their approach to gender often feels more practical and less performative.

In adolescence, gender non-conformity can become another point of social difference as neurotypical girls increasingly align with gender expectations. Autistic girls might feel bewildered by the sudden importance of makeup, fashion-conscious clothing, or stereotypically feminine interests. However, as we’ve mentioned, no two autistic girls are the same, and indeed, some autistic girls actually become hyper-focused on typically feminine pursuits, with things like makeup, fashion, or Taylor Swift being common special interests.

Many autistic women report significant gender exploration throughout their lives, with some identifying as non-binary, genderfluid, or transgender at higher rates than the general population.

19. Challenges with executive functioning masked by high academic achievement.

The disconnect can be puzzling—an autistic girl remembers obscure facts about her special interest but forgets to bring home her homework. She can focus intensely on projects she loves, but seems disorganized with daily tasks.

Many autistic people struggle with executive functioning—the mental skills that help organize, plan, remember instructions, and juggle multiple tasks. What’s fascinating is how creative girls and women often become at compensating for these challenges.

However, when these carefully constructed scaffolding systems break down during transitions, periods of increased demands, or when hormones begin to wreak havoc, parents might be confused by their “suddenly” disorganized daughter. The truth is that the challenges were always there—they were just temporarily managed through extensive compensation strategies.

20. An intense focus on details that others might miss.

Autistic girls often demonstrate remarkable memory for specific details while sometimes struggling with the big picture. They might recall precise wording from conversations years ago, remember exact layouts of places visited briefly, or notice minute details others overlook.

In contrast, they sometimes miss the overall gist or implied meaning that others extract from situations. For example, an autistic girl might remember every fact from a history lesson but struggle to summarize the main themes or significance.

21. Specific food preferences that may be misdiagnosed as an eating disorder (or that may become an eating disorder).

Autistic girls will often have very specific food preferences and may be labelled “picky eaters.” But this isn’t about being fussy; it stems from sensory sensitivities, a need for predictability, and genuine difficulties with certain textures, tastes, or smells.

They might eat only a small rotation of “safe” foods, refuse foods that touch each other on the plate, or which are “contaminated” with marks or perceived defects. Or they might show strong preferences for specific brands or preparations. Certain food textures might trigger strong disgust responses or even gag reflexes.

Some autistic girls develop Avoidant/Restrictive Food Intake Disorder (ARFID)—a serious condition involving severely limited food choices based on sensory sensitivities rather than body image concerns. Unlike other eating disorders, ARFID stems directly from sensory processing differences.

In adolescence, these restricted eating patterns can sometimes be mistaken for traditional eating disorders, leading to inappropriate interventions and trauma. While evidence shows a higher proportion of autistic girls compared to neurotypical girls do also develop traditional eating disorders, it’s often more to do with rigid thinking, perfectionism, and the need for control, rather than body image.

22. Intense feelings of being “different” without understanding why.

Many autistic girls experience a profound sense of being “different” from their peers long before receiving any diagnosis. This feeling typically emerges in elementary school as social differences become more apparent, but lacks a framework for understanding.

Without an explanation for their differences, these girls often internalize negative self-perceptions and the negative labels others give them, believing they’re simply “weird,” “awkward,” or somehow fundamentally flawed. This misattribution of their differences creates vulnerability to depression, anxiety, and low self-esteem. And what’s more, many of them are bullied because of their differences, which can result in post-traumatic stress disorder (PTSD) and complex PTSD (c-PTSD).

The experience of feeling different without understanding why creates particular psychological strain during adolescence, when fitting in becomes increasingly important socially. Many compensate by developing elaborate, but damaging, masking strategies to hide their perceived defects.

Diagnosis can bring tremendous relief by providing an explanation that reframes their differences as neurological variation rather than personal failing. But unfortunately for many autistic girls, diagnosis doesn’t happen until a mental health crisis forces professionals to finally pay attention. This can create a negative association with autism for the individual who is already struggling, which is why earlier identification is so crucial.

A final note: ADHD often complicates the picture.

Before 2013, ADHD and autism couldn’t even be diagnosed together, but we now know that 50-70% of individuals who have a diagnosis of autism will also present with ADHD. This AuDHD profile creates a complex picture that can further obscure diagnosis.

The combination of AuDHD presents uniquely. For example, girls’ special interests might shift more frequently than the stereotypical fixed autistic interests. They might crave novelty but find that deviating from routine leaves them feeling anxious and exhausted. Conversely, the autistic social caution might balance out ADHD impulsivity in certain contexts. And they may display chattiness that masks the social challenges associated with autism. This isn’t an exhaustive list. The result is seemingly inconsistent behaviors that confuse both the individual and outside observers.

Research increasingly shows that autism and ADHD share neurological overlaps. Understanding how these neurotypes interact and overlap is essential for identifying more accurate diagnostic criteria for the combined profile. If the signs on the list seem familiar, but not quite the whole picture, AuDHD is worth exploring.

Moving forward…

If the signs of autism or AuDHD seem familiar to you, your daughter, or loved one, I cannot emphasize enough the importance of early understanding and implementing neuro-affirming accommodations.

In my personal experience, and from speaking with many other families, when girls learn of their autistic identity from an early age, and when it’s framed as a difference rather than a deficit, it puts them in a much better position to understand and embrace it. As children grow older, they absorb the stigma about autism that society still perpetuates, and so, understanding their identity in a neuroaffirming way before this happens is crucial.

Yes, there will still be many (many) challenges, but early identification means those challenges can be accommodated appropriately and supportively, rather than being left struggling for years without understanding why. The longer it’s left unidentified, the more harm is done to mental health and self-identity.

Waiting lists are long and assessors aren’t always well-informed, but if you recognize these signs, there is nothing to stop you from accommodating and affirming your loved one’s needs now. Every child deserves to be supported in a way that honors who they are, not what neurotypical society wants them to be.

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