Autism is characterised by difficulties with how they respond to others, communicate, cope with change and experience the world. But autistic girls are more socially motivated than boys, so they may copy the behaviour of classmates to cope. In interviews they often appear to make better eye contact than autistic boys. At school they follow rules, get better grades, have a close friend, rehearse social responses and work hard at appearing socially adept, though they struggle and come home exhausted.

Clinical studies suggested that boys were diagnosed around three to four times more often than girls, though broader population studies showed the truer numbers were 3:1, indicating many girls missed or received expert attention late. Again studies revealed in fact they did, one to three years later, because of camouflaging their difficulties.

For decades girls were overlooked by science. For example, it was only in 2013 that atypical sensory differences became part of the formal diagnostic criteria revealing that many autistic people are unusually sensitive or under-sensitive to light, sound, smell, textures, pain or temperature. 

Girls are also more likely to internalise distress than boys. Instead of drawing attention to themselves through disruptive behaviour, many present with anxiety, perfectionism, depression or eating disorders making autism less obvious to families, teachers and clinicians.  

Autistic girls literally hide in plain sight

Manuals have remained overfocussed on social communication and repetitive behaviour. Autism was long seen as a ‘boy thing’, while girls were consistently underdiagnosed or misdiagnosed until much later, sometimes into their twenties, presenting instead with anxiety, depression, emotional difficulties and even suicidality.

A recent review of 56 studies done globally involving more than 13,000 autistic children and teens found girls experienced significantly higher anxiety symptoms than boys, with differences becoming more noticeable during adolescence and among those with higher IQ. 

On the other hand, eating disorders are also disproportionately common among autistic girls and women compared with autistic males, although the relationship is still being investigated.

The caveat is that many available studies are predominantly gender-biased and that there can be many differences between autistic individuals, making interpretations less obvious. 

For instance, girls may be fluent conversationalists but struggle academically. Others may experience periods of mutism under stress but show no obvious repetitive behaviours. The spectrum is broad, and relying on stereotypes inevitably leads to pitfalls.

British psychologist and autism researcher Wenn Lawson takes the view that monotropism, a tendency to focus deeply on one thing at a time, explains much of autism. He argues this is the common thread across boys and girls, although girls are often better at masking how it presents. Lawson believes monotropism is part of the underlying cognitive architecture of autism itself. 

Experts also talk about interoception, the ability (or failure) to notice internal body signals such as hunger, thirst or anxiety.

Lawson also discusses object permanence. This is maintaining a sense that people or things continue to exist when they are no longer present and extends the concept beyond infancy. An autistic child may know intellectually that someone still exists when they leave the room but find it difficult to hold on to the emotional sense of that relationship without routines or reminders, such as photographs. Lawson believes this influences friendships, transitions and responses to change far more than clinicians have traditionally recognised.

Modern psychiatry has also acknowledged that these experiences rarely appear on behavioural checklists, yet they profoundly shape everyday life.

Clinicians may simply have been asking the wrong question. Instead of asking, What autistic behaviours does this girl display? Lawson suggests asking, How does this child’s mind organise attention? His argument is that behaviours such as masking, sensory overload, repetitive routines or intense interests are not random symptoms. They arise from the way an autistic person – whether a girl or boy – directs and sustains attention. Understanding that process helps explain why two children may behave very differently yet still meet the same diagnostic criteria.

Think spotlight, not floodlight, moonlight, not sunlight. An autistic child may become so absorbed in a task or sensation that everything else fades into the background.