We used to think that a lot more boys had autism spectrum disorder (ASD) than girls. The numbers told the story: Four times as many boys get a diagnosis as girls.
As researchers have focused more on how ASD shows up in girls, they’ve realized that the rates may not be that different after all. Because their symptoms are different, many girls and women are going undiagnosed until later in life. About 80% of girls with ASD don’t receive a diagnosis before they turn 18. And because of that, they’re not getting the support and help they could benefit from.
UVA Health Children’s psychologist Evan J. Anderson, PhD, confirms, “It is easier to misdiagnose or undiagnose girls.”
One of the biggest reasons for this is masking.
What Is Masking?
Masking is a term that describes when someone hides autistic traits and behaviors, so they seem more neurotypical. This isn’t always a conscious decision.
Many girls — and some boys — start masking early in life and don’t even know they’re doing it. Masking helps neurodivergent kids fit in, which is a powerful motivator, especially among school-age kids.
Some examples of masking include:
- Mirroring facial expressions
- Forcing eye contact
- Relying on conversation scripts
- Hiding special interests
- Copying dress and appearance
Masking Behaviors In Girls
Girls are much better at masking. Sometimes this is because expected behaviors make it easy to hide a special interest. If your special interest is horses or makeup, it’s easy for adults to dismiss as an age-appropriate interest.
What they may miss is the extent of the interest. While neurotypical girls may be interested a standard amount, in autistic girls, it may be a continual thought-loop. But it's less likely to be their sole topic of conversation.
Girls are socialized from a young age to be more agreeable and “keep the peace.” Even when it comes with personal discomfort. This makes them more willing to endure conversational topics they’re uninterested in.
But Anderson says that there is some neuroscience to it as well. Girls tend to use more areas of the brain with mirror neurons. Mirror neurons allow us to mimic or copy other people’s behaviors — a key part of masking. But it also prevents girls from getting a diagnosis.
The Cost of Masking
To a certain degree, everyone masks a little. In a job interview, you might dress more nicely than usual. You might rehearse your answers to questions well in advance. You’d probably be more aware of your body and what messages it was sending.
But a job interview ends.
Imagine a job interview that starts when you’re a young child. How long could you keep it up? A week? A month? Years?
What we know is that typically, around adolescence, the energy for the act starts to wear out. This can cause autistic girls to start struggling emotionally in other ways. This includes:
- Burnout
- Depression
- Suicidal ideation
- Anxiety
How Do We Identify Girls Sooner?
Getting help for girls with autism means learning to recognize how varied autism presentations might be. Stereotypical autism behaviors, like hand flapping, rocking, toe-walking, or being less speech-oriented, often lead to early recognition and help. The quieter symptoms of autism, repeating a phrase, hair twirling, or daydreaming, are all harder to notice.
But a lot of the misses are also rooted in stereotypes. What in a boy might be easily recognized as avoidant restrictive food intake disorder may be dismissed as anorexia nervosa in a girl exhibiting the same behaviors.
As more women are diagnosed and share what their autism looked like when they were children, we’re starting to understand more of the varying presentations. And are incorporating that knowledge into screenings.
Getting a Diagnosis in Adolescence
Because girls tend to be better at masking, it’s not uncommon for them to not be diagnosed until adolescence. Many parents are worried about their kids finding out they have autism at such a late age, and often following a highly emotional period. But conversely, most of the time, these kids have suspected something was different for a while. And an accurate diagnosis can help them find the words they’ve spent years looking for.
It also means finding community, support, and strategies that can help them as they become adults. Often, a psychologist can become a helpful tool for your child as they explore what their diagnosis means, and doesn’t mean, for them.
A psychologist or other mental health professional can also help your child with any depression or anxiety they may be feeling.
Educate Yourself About Your Child's Autism
But for late-diagnosed teenagers, sometimes it’s the parents who need the most help understanding their child’s new diagnosis. And because your child is a teenager, you may already have tensions in your relationship.
Learning and educating yourself on autism may seem daunting. But you already have the best resource in the world in your own home. “If you know one person with autism, you know one person with autism,” Anderson says.
Questions or Concerns About Your Child's Autism Diagnosis?
UVA Health Children's specialists can help your child and family understand and manage their ASD.
Books, memoirs, and other first-hand accounts may be helpful. They also show that you're trying, which your child may appreciate. But ultimately, your child is the only one who can help you fully understand what they need and what they’re experiencing.
Consistent Support & Acceptance
You’re a parent. It’s understandable if you’re scared about how the outside world perceives your child and their diagnosis. But adding pressure to fit a standard may be harmful.
Instead, guiding them towards opportunities to express themselves while also encouraging them to try out new experiences can be helpful for long-term mental health. But as with all things, these moves are easier for children when they have a strong foundation of support.
Your child is who they are. With consistent love, support, and acceptance, you can help them thrive.
