Autism Spectrum Disorder (ASD): Understanding The Signs & Impact Of Autism In Women
Autism spectrum disorder (ASD) is a neurodevelopmental condition that can affect communication, behavior, and social interaction. Traditionally, much of the research and diagnostic criteria have been based on how autistic traits present in those who identify as men, leading to a significant underdiagnosis in those of other genders—particularly women. Many Autistic women go undiagnosed well into adulthood, likely due to the gender bias in research and healthcare as well as to masking and societal expectations. Here, we’ll examine the nuances of autism in those who identify as women and how understanding key signs and challenges can help improve awareness, diagnosis, and support systems for those living with ASD.
What is autism spectrum disorder (ASD)?
Autism spectrum disorder, sometimes referred to simply as “autism,” is classified as one of the developmental disorders that affect an individual's neurological function, influencing how they perceive the world, communicate, and behave. Previously categorized into separate conditions, ASD is now recognized as a broad spectrum encompassing varying levels of symptoms and support needs.
Signs and symptoms of autism
The spectrum nature of ASD means that every individual experiences symptoms and traits differently, with some requiring minimal support while others need more comprehensive assistance in daily life. The presentation of ASD can vary widely among people of all genders, but core symptoms typically affect communication, social interaction, and behavior.
Social communication and interaction challenges can include things like:
- Difficulty understanding social cues, such as tone of voice or body language
- Trouble maintaining conversations or responding appropriately
- Limited or absent eye contact
- Preference for solitary activities over group interactions
- Difficulty recognizing or expressing emotions
- Challenges forming and maintaining friendships
- Literal interpretation of language; struggling with sarcasm or idioms
- Delayed or atypical speech patterns, often including echolalia (repeating words or phrases)
- Dislike of being hugged or touched
Restricted and repetitive behaviors can look like:
- Engaging in repetitive physical behaviors, such as rocking or hand-flapping
- Establishing strict routines and becoming distressed when they are disrupted
- Intense and specific interests (e.g., memorizing facts about a niche topic)
- Heightened or reduced sensitivity to sensory input, such as lights, sounds, or textures
- Strong aversion to certain food textures or extreme food preferences
- Difficulty with transitions or unexpected changes
- Fixation on certain patterns, numbers, or objects
While these symptoms can appear in Autistic adults of all genders, those socialized as girls or women often exhibit them in more subtle ways, leading to underdiagnosis.
Autism spectrum disorder (ASD) in adulthood
Autism spectrum disorder typically first appears in childhood. However, many people aren’t able to recognize or acknowledge their ASD symptoms or receive a diagnosis until adulthood—particularly women and others who do not identify as men.
For many years, autism was interpreted as a disorder that primarily affected boys and men. This misconception has led to what many experts believe to be a significant underdiagnosis in Autistic individuals of other genders—particularly girls and women. In fact, research suggests that ASD is equally common in girls as in boys, even though an estimated 80% of girls with autism remain undiagnosed as of age 18.
While Autistic girls may often go undiagnosed in childhood, the challenges of ASD tend to become more apparent in adulthood. Autistic adult women may struggle with workplace dynamics, maintaining relationships, or managing daily routines. The constant effort required to mask symptoms can lead to burnout, heightened mental health challenges, and an increased likelihood of co-occurring conditions such as anxiety and depression.
What causes autism spectrum disorder?
The exact cause of ASD remains unclear, but autism research suggests that it's likely due to a combination of genetic and environmental factors. There’s thought to be a genetic component, since genetic variations have been identified in some individuals with ASD. Examples of environmental factors that researchers are exploring as potential contributing factors to autism include certain elements of pregnancy, such as exposure to pollutants, obesity or diabetes in the birthing parent, and low birth weight.
How is autism different in women?
Many of those socialized as women or who identify as women exhibit distinct traits of Autism compared to those with ASD who were socialized as or identify as men. Non-men with autism tend to display more socially adaptive behaviors. Unlike Autistic men, who may be more likely to display externalized behaviors like meltdowns or hyperactivity, Autistic women and people of other genders tend to internalize their distress. These differences in presentation often contribute to signs of autism being overlooked in those who do not identify as men, potentially leading individuals to go years without proper support.
What is masking?
One of the most significant gender-based differences in those with ASD is the tendency for those socialized as women to mask their symptoms. Masking refers to the conscious or subconscious effort to hide autistic traits by mimicking socially acceptable behaviors.
While masking can sometimes help Autistic people “blend in” to social situations, it often comes at a significant emotional cost. Constantly suppressing one’s natural behaviors can lead to mental health challenges such as anxiety, depression, and burnout. Many Autistic adult women report feeling exhausted from years of trying to “fit in” before understanding why socializing often feels so overwhelming.
Signs of autism in women
Many Autistic women may feel pressured to mask or camouflage their natural traits or behaviors by:
- Forcing eye contact to appear engaged
- Rehearsing responses before conversations
- Imitating peers to fit in
- Suppressing repetitive behaviors in public
Women with autism may also be more likely to internalize feelings of distress. This may lead to:
- Social withdrawal
- Anxiety and obsessive thoughts
- Depression from isolation
- Self-harm (e.g., skin-picking, hair-pulling)
Another of the potential gender differences in autism lies in special interests. While boys and men with autism may be likelier to develop fact-driven interests (e.g., trains, technology), those with autism who are socialized as or identify as women or another gender may be likelier to fixate on:
- Fictional characters and fantasy worlds
- Psychology and human behavior
- Animals, such as horses or cats
Since these interests may be more aligned with neurotypical peers, they often go unnoticed as fixations. However, Autistic girls and women still tend to face challenges with friendships and exclusion, such as:
- One-sided friendships
- Short-lived social bonds due to misunderstandings
- Bullying or social exclusion even in adult settings such as in college or at work
Why are more men diagnosed with ASD?
The higher diagnosis rate in Autistic men is likely partially due to historical biases in diagnostic criteria, which were primarily developed based on presentations of ASD in boys and men. Additionally, societal norms encourage girls to develop social coping strategies from a young age, often further masking their autistic traits.
Autism spectrum disorder statistics
Some current autism spectrum disorder statistics include:
- ASD is diagnosed in approximately one in 36 children in the US, but the ratio of men to women diagnosed is about four to one.
- Studies indicate that for every Autistic man diagnosed, several Autistic women may go undiagnosed.
- Around 80% of Autistic adult women with an initial misdiagnosis of other mental disorders later receive an accurate autism diagnosis.
- The National Autistic Society estimates that a significant number of women with ASD remain undiagnosed due to traditional diagnostic biases.
Common challenges related to autism in women
Those with autism spectrum disorder who identify as women often face unique challenges that can significantly impact their daily lives. For one, it’s often part of the female autism phenotype to experience social exhaustion from excessive masking, as they may feel pressured to conform to certain expectations in social settings.
This constant effort to camouflage autistic traits can contribute to higher rates of mental health challenges, including anxiety, depression, and eating disorders. Research indicates that Autistic women may be more likely to develop psychiatric comorbidities in general, with studies suggesting that 20–30% of individuals with eating disorders exhibit autistic traits.
Additionally, the misdiagnosis of autism is common among women, with conditions like borderline personality disorder (BPD), obsessive-compulsive disorder (OCD), and bipolar disorder frequently mistaken for ASD. These diagnostic challenges leave many Autistic adult women without proper support for years. Also, in professio (Missing content)
Some women have been labeled as having “high-functioning autism” or may even self-identity as such. Still, executive function challenges, such as trouble with organization, planning, and time management, can make independent living more difficult for any individual living with ASD. Combined, these factors can contribute to many Autistic people who do not identify as men feeling consistently isolated and misunderstood.
The impact of ASD on mental health and daily functioning, particularly in women
The strain of navigating a world generally designed for neurotypical individuals often results in heightened mental health challenges for Autistic people of all genders—especially those who identify as women. The effort required to conform to social norms can also lead to chronic stress, anxiety, and depression. Additionally, the lack of proper support can contribute to a greater risk of burnout, identity confusion, and self-esteem issues.
How therapy can help
Therapy can often play a helpful role in guiding Autistic individuals through managing challenges and building self-acceptance. Research suggests that talk therapy approaches such as cognitive behavioral therapy (CBT) may support emotional regulation, social skills, and coping mechanisms.
The potential mental health benefits of online therapy
For some people with ASD who are prone to overstimulation or sensory issues in public places, receiving therapy virtually from the comfort of home might be a preferable alternative to in-person sessions. While more research on telehealth and autism treatment is required, studies suggest that online therapy can often be equally as effective as in-person therapy when it comes to treating general mental health challenges such as anxiety and depression. Online therapy is often also more affordable than traditional in-person therapy without insurance.
Takeaway
What does high-functioning autism in a woman look like?
Functioning labels in autism are often considered outdated and potentially harmful, as they don’t take into consideration the vast spectrum of Autistic characteristics and symptoms. Officially, Autistic children and adults are diagnosed with a level system, with level one requiring the least support and level three requiring the most support. However, these classifications are made for treatment purposes. Women with autism can have many different behaviors and symptoms. For example, some women have fewer social difficulties but more difficulty with sensory issues. Others may only use non-verbal communication and also experience an intellectual disability.
What some may see as high- functioning is often diagnosed as level one autism in female adults. They may be more socially motivated and high- masking, which can present differently from Autistic men, who may not mask as often. However, autism traits can vary significantly between two individuals. One person diagnosed with level one autism may have more frequent stimming behaviors than another, for example.
What is the female profile of autism?
Due to certain societal and environmental factors, women are often socialized differently than men, so they may experience different symptoms, such as a tendency to mask symptoms more frequently. Undiagnosed autism is also more common in women, as women may not be taken seriously as often and are not studied as frequently in autism research. Gender differences in autism symptoms have taken more of a lead role in research by companies like the Autism Research Institute in recent years. These efforts in the autism community look at better ways to diagnose autism and other developmental disabilities in women to reduce Autistic burnout and increase treatment opportunities for these individuals.
How can you spot a high-functioning Autistic woman?
Functioning labels are generally not helpful in understanding whether someone is Autistic, as all Autistic people are different. Instead, women with autism may have unique symptoms due to their experiences as women. For example, they may mask more often, and repetitive behaviors may be more focused on special interests that might not be “typically” associated with autism. For example, many women hyper fixate on topics like spirituality, animals, psychology, philosophy, and music.
What are the red flags for autism?
Signs a child might be Autistic can vary, but they often show in early childhood, as early as six months of age. Repetitive behaviors, a lack of eye contact, and sensory challenges are some of the most common first signs of autism. In girls, social behaviors may be more adapted, though they may struggle with understanding nuance, jokes, and metaphors. Some Autistic girls may have more socially “acceptable” interests, such as certain bands, horses, cats, or fantasy books. They may also be well-adapted in communication. However, some girls may be non-verbal and struggle with speech, so this stereotype doesn’t apply to all.
How do I know if I have autism as a female?
The only way to know if you are Autistic is to receive a diagnosis. However, diagnosis can be difficult for women to access in certain situations. If you’re an adult woman, look for a provider who has experience diagnosing and supporting adult women with autism. In addition, ask them how they evaluate for gender differences. You can also learn more by talking to a therapist who has experience in providing neurodiversity-informed cared.
What are the hand movements of autism?
Autistic people often “stim,” which stands for “self-stimulation.” Stimming behaviors reduce distress and often serve as emotional regulation. A common stim of Autistic people is hand movements, which can include flapping, shaking, or playing with their hands. Stimming is often harmless and may be helpful for Autistic people to regulate themselves during stressful situations. If a hand movement is harmful, such as hitting or scratching, working with a therapist may be helpful to redirect the movement or find accommodations.
What is the strongest predictor of autism?
The strongest risk factor for autism is a family history of autism. Around 80% of cases of autism are thought to be caused by genetics. Having an Autistic parent can increase a child’s chances of also being Autistic. Since diagnostic efforts of lower levels of autism are newer in the psychological world, many older people were not diagnosed as Autistic, even if they were. For this reason, more children may have Autistic parents than previously thought.
What are the strong senses of autism?
Autistic people are often highly sensitive to sensory input, such as sounds, smells, sensations, lights, colors, and tastes. Not all Autistic people have the same difficulties with senses. For example, one woman might struggle with loud noises, whereas another may become dysregulated with bad smells more frequently than noises.
What might be the noticeable physical characteristics of autism?
There are no physical characteristics in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Revised (DSM-5-TR) that must be present for a person to be diagnosed with autism spectrum disorder. However, some may say that autism can cause visible differences, such as difference in gait, posture, or facial expressions. These differences may be due to a lack of social awareness of expected body language. However, more research is needed to understand physical manifestations of autism.
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