- Male and female autism share some similarities, but overall, women with autism tend to present differently than men.
- Symptoms that may present differently in women include social difficulties, emotional regulation issues, and the nature of intense interests.
- Understanding that autism can manifest differently in women, and seeking an accurate diagnosis, may lead to better quality of life.
Women with autism tend to present differently than men, a fact which has often led to misdiagnosis and under-diagnosis. As a result, women who have autism and don’t receive a diagnosis tend to judge themselves harshly for finding life difficult; what's more, mental health issues are common in women with autism.
In contrast, women who do receive a diagnosis often find that it has a positive impact on their confidence and self-esteem1; they may even become advocates or mentors for other women with autism. Receiving a diagnosis can also help ensure that they receive the right kind of support and access any resources available.
Any woman who has reached the point of wondering whether or not she has autism may find it hard to find definitive information, given the fact that autism has predominantly been viewed as a male condition. If she's experiencing many of these symptoms, however, it might point towards a diagnosis of autism. In my book, I explore the difficulties in securing a diagnosis and coming to terms with having autism.
1. Social difficulties. One of the main reasons women begin to wonder whether they have autism is a lifetime of social difficulties. Autism spectrum disorder is a developmental disorder, which means that people are born with autism (although it may not be obvious until later in life).
Women with autism often find it difficult to read and respond to social cues. Many women navigate this difficulty by creating a social “checklist” and learning how to respond to people in socially appropriate ways. They often feel socially anxious, ruminate on their social interactions, and may end up feeling left out and lonely—despite their best efforts to be sociable. While autistic women may interact well in one-to-one situations, they often find it very hard to be in groups and may feel exhausted after too much social interaction.
2. Sensory sensitivity. People with autism experience the world in a different way than neurotypical people, and many women with autism experience intense sensory sensitivity. They may have a heightened sense of awareness when it comes to smells, light, sounds, and touch.
For someone with autism, it’s not just a matter of “not liking” certain things; it’s a sense of being unable to tolerate them. My clients have described being unable to sleep if people are breathing in the same room, having to leave a rail carriage because someone is eating, being unable to cross roads or drive due to sensory overload, and being unable to go to shopping malls because of the lights, sounds, and crowds.
3. Executive function. Many women with autism experience problems with executive function,2 a set of skills that involves working memory, flexible thinking, and self-control. People with executive function problems might find it hard to organise themselves, finish tasks, and maintain emotional control. Whether in the workplace or at home, it can be hard for women to complete tasks such as keeping a clean house, maintaining healthy habits, or carrying out daily tasks such as showering and eating breakfast.
4. Obsessive interests. Both men and women with autism tend to have specialised, intense interests. People with autism display “what if-then” thinking and often want to get to the bottom of how something works. They may want to know every single fact about their interest.
While boys’ and men’s interests often focus on specific objects or things, women often display an intense interest in a wider range of subjects—including how the mind works or people (particularly romantic partners, “crushes,” or celebrities). Many women with autism are skilled researchers, and may gravitate toward careers or hobbies which require a high level of intense focus.
5. Camouflaging. Autistic women tend to have a greater desire to be sociable than autistic men and spend a considerable amount of time and energy in masking, or camouflaging, their differences in order to pass as “normal.” Although neurotypicals of both genders and autistic men also camouflage, women with autism tend to do so to a far higher degree.3
6. Sleep issues. Many women with autism experience difficulty sleeping. Often, this is caused by sensory issues, including a high sensitivity to noise at night and problems feeling comfortable. The presence of another person can exacerbate sleep issues.
7. Difficulties with eye contact. Making eye contact can be extremely challenging for people with autism. Women, in particular, often become skilled at forcing themselves to make eye contact; if they do this enough, it may start to feel more natural to them. Thus, a woman with autism may be OK at making eye contact because she's learned to so—but if it feels unnatural or hard, it could potentially be a sign of autism.
8. Emotional regulation issues and meltdowns. Women with autism often have problems with emotional regulation. Research has shown that there is a poor connection between the frontal cortex and the amygdala in people with autism.4 Put simply, the amygdala can be thought of as an “emotion centre” in our brain, as it's part of our limbic system and our mammalian brain. The frontal cortex can be thought of as our “thinking brain,” the more rational part of our brain which makes judgments.
Because of the poor connection between the two areas, women with autism may find it hard to rationalise situations and stay in control. Many describe having meltdowns: extreme emotional reactions to situations that might result in losing their temper, crying, or going into shutdown mode.
9. Stimming. Stimming (short for self-stimulating behaviour) refers to repetitive behaviours. The most obvious behaviours we associate with autism are rocking, hand flapping, repetition of words or phrases, and rocking or spinning. However, women with autism may display other stimming behaviours such as skin picking, feet rubbing, pacing, or hair twirling. People with autism tend to stim more than other people and may not be aware of their behaviours. It is thought that stimming is a self-regulation tool.
10. Anxiety and depression. Anxiety and depression are not universal symptoms of autism. But because life is difficult for many women with autism, it is common for them to experience mental health issues like anxiety, depression, or problems with addiction. There is also a far higher than average rate of suicidality in women with autism, which appears to be related to the degree of camouflaging they engage in.5 Though their autism goes undiagnosed, it is more likely that they will receive a formal diagnosis for anxiety, depression or another mental health issue.
Anyone who identified with the above symptoms should seek out professional help. Autism displays similar symptoms to other conditions and a formal diagnosis can help establish whether or not autism may be at play.
To find a therapist near you, visit the Psychology Today Therapy Directory.
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1. Leedham, A, Thompson, A, Smith, R, Freeth, M (2020) ‘“I was exhausted trying to figure it out”: The experiences of females receiving an autism diagnosis in middle to late adulthood’, Autism, 24, p135-146
2. White, SW, Elias, R, Capriola-Hall, NN, Smith, IC, Conner, CM, Asselin, SB, Howling, P, Getzel, EE & Mazefsky, CA (2017) ‘Development of a college transition and support program for students with autism spectrum disorder’, Journal of Autism and Developmental Disorders, 47(10), p3072-3078
3. Hull, L, Lai, M-C, Baron-Cohen, S, Allison, C, Smith, P, Petrides, KV, Mandy, W (2020) ‘Gender differences in self-reported camouflaging in autistic and non-autistic adults’, Autism, 24, p352-363
4. Richney, JA, Damiano, CR, Sabatino, A, Rittenberg, A, Petty, C, Bizzell, J, Voyvodic, J, Heller, AS, Coffman, MC, Smoski, M, Davidson, RJ, Dichter, GS (2015) ‘Neural mechanisms of emotion regulation in Autism Spectrum Disorder’, Journal of Autism Developmental Disorder, 45(11), p3409-23
5. Cassidy, S, Bradley, L, Shaw, R, Baron-Cohen, S (2018) ‘Risk markers for suicidality in autistic adults’, Molecular Autism, 9(1), Article 42