Autism in girls
Studies of girls with autism spectrum disorder have shown that they have various clinical, cognitive and biological characteristics that are associated with underdiagnosis and delayed diagnosis (5). Forms of clinical expression vary considerably. Studies based on qualitative methods, information from interest groups and our own clinical experience have revealed that the symptoms of autistic girls with a full-scale IQ over 70 manifest themselves in distinctive ways when compared to autistic boys, even though there are clear similarities (6–8).
Autistic children and adults have difficulty adapting to social expectations. Many girls in this group have a strong desire to be social but can nevertheless feel alienated. Even with an advanced vocabulary they can strive to understand the nuances of language, which may lead to misunderstandings and poor self-confidence. They can be perfectionists and at the same time socially immature. Situations that they perceive as unfair can trigger strong reactions, and the girls have a tendency to fixate on negative thinking.
Special interests are part of the behavioural profile in people with autism spectrum disorder. Compared with autistic boys, these types of focused passions in autistic girls may be more socially focused. They may include interests such as language, animal welfare and politics. Many have artistic abilities, a vivid imagination, and express themselves better through art than through 'normal' social communication. Their interest goes much deeper than that of their peers.
Difficulties with organising and repetitive behaviour are common in people with autism spectrum disorder. They repeat the same activity several times to soothe themselves and relieve stress. For girls with autism spectrum disorder, this may mean watching a favourite film or listening to the same audiobook repeatedly. They often need time to process information and move from one thing to another. Many autistic girls find the completion of tasks especially stressful, which can make them appear unreasonable and rigid.
People with autism spectrum disorder are generally sensitive to sound, light, taste and smell, and many are bullied when they struggle to cope with everyday life because of this.
Teenage girls are often interested in fashion, but autistic girls may have challenges in wearing trendy clothes due to their sensitivity to textiles. They can feel different and less accepted by their peers as a result.
Identifying emotions and body language is also difficult. This can affect mood, pain threshold, stress tolerance and hygiene. Many describe great frustration with simple tasks such as showering and haircare, and some also struggle with enuresis and (more rarely) encopresis. When stressed, many turn to self-stimulating techniques, such as using fidget toys.
Especially typical for girls with autism spectrum disorder is the development of compensatory skills and sophisticated methods to mask their autism and conceal their differentness. Masking usually occurs outside the home, for example at school, where they control their vulnerabilities only to 'explode' at home. They may have outbreaks of anger or a need for social withdrawal when overstressed. These stress reactions can lead to rejection and prejudice by those who do not know the background for their difficulties.
Especially typical for girls with autism spectrum disorder is the development of compensatory skills and sophisticated methods to mask their autism and conceal their differentness
Women with autism also have a greater diversity in terms of sexual identity, and those who have a homosexual orientation are more exposed to adverse sexual experiences (9).
People with autism have a considerable degree of comorbidity, and those with autism spectrum disorder have an increased risk of concomitant disorders such as anxiety, ADHD, depression, sleep disorders, suicidal behaviour, irritable bowel syndrome and eating disorders. Problems with motor coordination and sensory hypersensitivity can also affect daily life (10–13).