Subtle signs of autism in girls

Pediatricians often provide parents with a list of signs to watch for that may indicate their child has a developmental delay. Does your baby make eye contact? Does your tot respond to his name? Are you sharing smiles and giggles?

According to the Centers for Disease Control and Prevention (CDC), autism spectrum disorder (ASD) is over three times more common among boys than girls. While missing those milestones could be a sign of ASD, girls often exhibit more subtle symptoms that may go undiagnosed.

“Many girls with autism present differently than the traditional stereotypes people associate with ASD,” explained Hannah Thompson, MS, CCC-SLP, Autism Program lead with Wolfson Children’s Rehabilitation. “Because girls are often socially motivated and may hide their struggles, they’re sometimes first identified as having anxiety, attention-deficit hyperactivity disorder (ADHD), or emotional regulation difficulties before autism is considered.”

Autism masking: Mirroring behavior and scripting conversations

Many signs of ASD in girls have to do with social skills and behavior, Thompson said. This may include difficulty with social communication, sensory sensitivities, anxiety, rigidity with routines and intense interests.

"Many girls are socially motivated and want friendships, which can make their challenges less obvious," said Thompson. "Some girls with autism may 'mask' their difficulties by imitating peers or copying social behaviors to fit in, though masking can occur in people with autism of any gender. Autism presents differently from child to child, and not all girls with autism will exhibit masking behaviors or subtle social differences."

Masking, also referred to as “camouflaging,” may present as:

• Memorizing scripts for conversations
• Forcing eye contact
• Imitating peers

“Girls may also internalize stress through anxiety, perfectionism, feeling emotionally overwhelmed or selective mutism rather than displaying more outward behaviors,” Thompson explained. “Their interests may appear age-appropriate but are often unusually intense.”

Spotting the signs and getting support

Thompson’s message to parents is to remember that ASD doesn’t look the same in every child.

“If a child seems socially exhausted, struggles to keep up with peers, has sensory sensitivities, experiences intense anxiety or feels emotionally overwhelmed, it’s worth exploring further,” she said. “Early support and understanding can make a significant difference in a child’s well-being and development.”

If you suspect your child has autism spectrum disorder or another developmental condition, speak with your pediatrician, who can make a referral for an evaluation if needed. Use the Find a Doctor tool to locate a provider near you or schedule an appointment online.

Reference: Centers for Disease Control and Prevention