Autism – women and girls

Historically, autism has been more associated with males – it is estimated to be 3 times more prevalent in males than in females[1] although until recently this figure was much higher. Due to this, research has largely focused on autism expression mainly in men and boys. Diagnostic tools are skewed towards male based stereotypes of autistic traits[2], meaning that autistic females are often overlooked or underdiagnosed.

Research is now moving towards better understanding of autism expression in women and girls. There is a difference in characteristics presented in autistic boys and men[3], with the female expression of autism being one that does not meet the current diagnostic criteria. We’ll be taking a look at some of the key differences as well as looking at the lived experiences of autistic women at school.

Social relationships

Diagnostic criteria;

• ‘failure to initiate or respond to social interactions’

Autistic males can be less motivated to form social relationships whereas autistic females show similar motivations to form social relationships as non-autistic females[4].

Camouflaging and masking

Diagnostic criteria;

• ‘difficulties adjusting behaviour to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers’

Masking is a process where individuals imitate others, and hide or stop behaviours to ‘fit in’ with society. This can lead to difficulties such as mental health issues. While being more likely in females, it can occur with males and those who are gender fluid or non-binary. Camouflaging can involve copying others, preparing and rehearsing a script for social interactions, or being highly observant of others e.g., laughing along with a joke even if they have not understood the context or the joke. Masking and camouflaging makes identifying autistic girls and women difficult as they don’t appear to have the traditional autistic traits.

Interests

Diagnostic criteria;

• ‘stereotyped or repetitive motor movements, use of objects, or speech’
• ‘highly restricted, fixated interests that are abnormal in intensity or focus’

Autistic males are often more interested in ‘objects’ whereas autistic females may be more interested in topics with ‘relational’ purposes, showing more motivation to form relationships with people or pets as opposed to ‘objects’.  Self-stimulatory behaviour often seen in autistic females is perceived as more socially appropriate, such as twirling their hair, humming or fiddling with a pen.

Internalising

Diagnostic criteria;

• Over or under activity ‘to sensory input or unusual interest in sensory aspects of the environment’

It is understood that there are further differences between autistic males and females in the ways in which they express distress:

• Autistic males are more likely to experience externalising distress.
• Autistic females are significantly more likely to have co-occurring internalising conditions than males.[5]

School experiences

Due to not receiving appropriate diagnoses in a timely manner, autistic girls might not get the support they need at school. If the right support isn’t in place, this can lead to mental distress and emotionally based school avoidance (EBSA).

Below we explore the unique experiences of autistic females and the challenges they faced in education and school*. We focused on 5 key areas; friendships, relationships with teachers, teaching approaches, school environment (sensory aspects), and overall wellbeing along with their advice for educational professionals working with autistic female pupils.

*The views shared here may not represent all autistic females.

Friendships

Making friends during school was a challenge. They wanted to make friends but didn’t know how to and so felt alienated from other girls. They found it harder to relate to the same gender because of ‘social rules’ for example, they either didn’t display popular characteristics or didn’t have shared interests[6].

Advice:

• Support pupils in creating and maintaining friendships in school. This should be provided at a young age, so young autistic women can use such skills throughout their school experience.

Relationships with teachers

Relationships with teachers were friendship based. They bonded more with a teacher who shared the same interests and they felt supported them.

Advice:

• Actively build a relationship with your students through shared or common interests. This will allow them to feel more understood and supported.

Teaching approaches

Teaching felt like it was not individualised. Some felt they were given less support because they were more able than their peers or because they had good grades. They wanted their specific strengths to be recognised and enhanced.

Advice:

• Don’t set the bar too low because of a diagnosis. However, recognise when students need support, not only academic support but also wellbeing.
• Nurture the talent of autistic females, if there is a particular subject or topic they excel at, encourage them to purse it.
• Every autistic person learns in a different way, take the time to learn and take a teaching approach that is suited for the individual.

School environment (sensory aspects)

A small school helped to reduce the impact of sensory overload. For others who attended larger schools, these were found to be very noisy, and impacted on concentration. When non-school uniform was offered at secondary school, this reduced anxiety as school uniform at primary school had been very uncomfortable.

Advice:

• Provide quiet routes for transitions.
• Allow movement breaks and regulation breaks.
• Be aware of the school environment and how this may impact on an individual. What affects one person may not affect another, so it’s important to understand each individual person’s needs.

Overall wellbeing

Being told they were different and being treated differently led to low self-esteem, internalised ableism and self-hate. People tended to associate their shyness to autism and failed to explore other co-occurring conditions such as social anxiety.

Advice:

• Offer direct support when diagnosed to support understanding of diagnosis.
• Acknowledge the strengths of the students to build self-esteem.
• Teachers should have training to notice subtle mental health signs and autism signs in girls.

What signs are there that may indicate autistic characteristics in females?

Please note that if someone is displaying some of the behaviours listed below, it doesn’t necessarily mean that they are autistic but they can be signifiers. If you have any concerns about a child or young person, it’s important to speak to a medical professional.

• Masking: You may hear from the child or young adult’s family that their behaviour at home differs from their behaviour at school where they appear to be ‘fine’.  Families may report they are avoiding going to school in the morning, and may express exhaustion at the end of the school day, which may present in behaviours that challenge.
• Camouflaging: copying others, preparing a script for social interactions and rehearsing these prior to the social interaction, being highly observant of others e.g., if others laugh, laughing too, even if they have not understood the context or the joke.
• Having passionate but limited interests, such as only watching one film, and watching this repeatedly.
• Difficulties in maintaining friendships, which can include overthinking every interaction, and/or having regular disputes with friends.
• Appearing to be ‘passive’, often saying ‘yes’ to everything, and/or appearing to be shy.
• Difficulties in understanding emotions and seeing things from other people’s points of view. Can also be overly empathetic and be very good in recognising emotions in other people, whilst experiencing difficulties in understanding and managing their own emotions.
• Highly sensitive to sensory experiences e.g., sound and smell. Although, this is just as common in autistic men, and not necessarily more common in females.

It is important for educators and society to recognise and understand the experiences of autistic females and to provide them with the support and resources they need to thrive. With increased awareness, we advocate for a shift in the diagnostic criteria to be more inclusive for autistic females.

For more detail on the subject, watch our Lunch and Learn below.

[1] The NHS, Mental Health of Children and Young People in England, (2017)

[2] Navarro-Pardo, E., López-Ramón, M.F., Alonso-Esteban, Y. and Alcantud-Marín, F., 2021. Diagnostic tools for autism spectrum disorders by gender: Analysis of current status and future lines. Children, 8(4), p.262.

[3] Hull et al, 2020, The Female Autism Phenotype and Camouflaging: a Narrative Review, https://link.springer.com/article/10.1007/s40489-020-00197-9

[4] Sedgewick et al., 2015 Gender Differences in the Social Motivation and Friendship Experiences of Autistic and Non-autistic Adolescents – PubMed (nih.gov)

[5] Solomon et al., 2012 Autism Symptoms and Internalizing Psychopathology in Girls and Boys with Autism Spectrum Disorders – PMC (nih.gov)

[6] Dark, J., 2022. The Lost Generation of Autistic Women’s Experiences of Secondary School: An Interpretative Phenomenological Analysis Approach. Educational Psychology Research and Practice, 8(1), pp.1-11.