Diagnosing autism is tricky. There’s no test or questionnaire people can take, autism looks different in everyone, and sometimes symptoms overlap with conditions like obsessive-compulsive disorder (OCD) or anxiety.
Diagnosing autism in girls is even trickier. Many experts don’t even consider an autism diagnosis when girls are brought in to a doctor or psychologist’s office, says Sara Webb, Ph.D., a psychologist and associate professor of psychiatry and behavioral sciences at the University of Washington.
“We’ve asked mothers of girls with autism what diagnosis was like, and many said it was a struggle,” Webb says. “Clinicians were pushing back on the autism label and saying things like, ‘Your daughter is too pretty to have autism.’”
The gender divide
Current diagnostic criteria for autism outline two primary areas of impairment: Difficulty communicating and interacting socially, and displaying repetitive, obsessive behaviors for certain objects or routines.
Boys are diagnosed with autism about four times as often as girls, but no one knows if this is because autism truly is more prevalent in boys or because girls are being underdiagnosed. Since diagnostic criteria for autism were developed primarily around boys, they may not apply as well to girls, leading to girls getting overlooked or misdiagnosed with something like obsessive-compulsive disorder (OCD) or anorexia, says Patricia Matestic, Ph.D., a licensed clinical psychologist and director of the UW Autism Center in Tacoma.
If a girl does get the right diagnosis, it isn’t uncommon for it to happen later in childhood, even into adulthood. Gary Stobbe, M.D., a neurologist who practices at the Adult Autism Clinic at UW Medical Center-Roosevelt, says he is surprised by how many new patients at the clinic come in seeking a diagnosis. Many of them are women.
The gender divide narrows among individuals who fall in the lower-functioning part of the autism spectrum, which includes individuals with significant intellectual disability. Boys and girls are more equally represented within this group, says Matestic.
“We don’t know if that’s because we’ve missed diagnosing women or if there are truly fewer higher-functioning women with autism,” she says.
How autism looks different in girls and women
Whether because of biology, socialization or, most likely, a combination of the two, many girls and women with autism simply don’t have the same symptoms as boys and men—at least, not in the way experts are used to seeing.
Girls with autism may be more skilled than boys at handling social situations and communicating with others, possibly because girls are taught and expected to be more sociable and emotionally intelligent from a young age. But even if a girl with autism can function better socially than a boy, that doesn’t mean it’s easy.