Autism in Women: Symptoms, Causes, Diagnosis, and Treatment

Autism in Women

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Published on December 20, 2024
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Autism spectrum disorder (ASD) is a neurodevelopmental condition typically diagnosed in childhood. In part because symptoms of autism in girls and women can seem more subtle compared with symptoms in men, females often go undiagnosed, are diagnosed later in life, or are misdiagnosed.

Learn more about autism in women, including why the percentage of women diagnosed with autism is rising, how autism in women manifests itself, and how a woman with autism can learn to manage symptoms.

Overview

Why Are More Women Being Diagnosed With Autism?

Historically, the ratio of boys diagnosed with autism compared with girls has been about 4 to 1.

 But recent research suggests that’s changing, with the ratio more like 3 to 1.

Increased awareness that autism exists in females is likely a factor in the increase, says Lawerence Fung, MD, PhD, an associate professor of psychiatry at Stanford Medicine in Palo Alto, California, and a psychiatrist who specializes in autism and neurodiversity at the Stanford Neurodiversity Clinic.

Still, males are more likely to be diagnosed with autism than females. Experts aren’t sure if this discrepancy in reported rates is due to a higher incidence of the condition in males or because of disparities in diagnosis.

How Is Autism Different in Women Compared With Men?

Both men and women with autism have difficulties with social interaction and communication, and may also engage in repetitive behaviors or have narrow interests.

However, there are differences between the genders. For instance, women with autism may show fewer so-called externalizing symptoms, such as aggression or hyperactivity, and may be more likely to camouflage other symptoms in social interactions.

Signs and Symptoms of Autism in Women

Common signs of autism in women include:

  • Social difficulties
  • Sensory sensitivities
  • Intense interests
  • Repetitive behaviors
  • Difficulty with self-regulation and executive function

Social Difficulties

People with autism have trouble interpreting and responding appropriately to social cues.

 Women may be more motivated to camouflage this compared with men because they often have a stronger desire to fit in socially.

“Autistic women tend to be better at masking some of their symptoms,” says Anila D’Mello, PhD, an assistant professor and the Jon Heighten Scholar in Autism Research at UT Southwestern Medical Center in Dallas.

“Autism masking” is when a person with autism suppresses or hides signature behaviors of the condition. This can be done by mirroring the behavior of neurotypical people, forcing eye contact, or developing scripts that they use in social situations.

Sensory Sensitivities

People with autism, including both men and women, may have heightened sensitivity to sensory inputs such as light, sound, touch, or smell. These sensitivities can be overwhelming and may lead them to withdraw from situations that trigger discomfort, such as loud environments, or react negatively to certain textures.

Intense Interests

Similar to men with autism, women often develop intense, focused interests in particular subjects; they need to know every fact and focus on every detail. However, women with autism may have a wider variety of interests compared with men, and interests may be more socially acceptable to people who are neurotypical.

Dr. D’Mello offers up “Swifties” as an example. “Being super interested in Taylor Swift and talking about her all the time is more socially acceptable than some other intense interests might be,” she says.

Repetitive Behaviors

People with autism, including women, may adopt certain repetitive behaviors to help them regulate their emotions and thoughts. Typical “stimming” or self-stimulating behaviors include rocking, repeating words or phrases, and hand flapping.

Repetitive behaviors may differ in some women with autism. Rather than hand flapping, females might pick at their skin, pace, or twirl their hair, says D’Mello.

Difficulty With Self-Regulation and Executive Function

Autism can make it hard to stay organized or finish tasks. Working memory, self-control, and the ability to adapt may present extra challenges, especially at work.

Adults (both men and women) with autism may also struggle to manage their emotions — meltdowns may include crying or displays of anger.

Causes and Risk Factors of Autism in Women

While the exact cause of autism is not fully understood, several factors are believed to contribute to the development of autism in both men and women. These include:

  • Genetics, including certain genetic conditions such as Down syndrome and fragile X syndrome
  • Having a sibling with autism
  • Having older parents
  • Having a very low birth weight

How Is Autism in Women Diagnosed?

People of any age can receive a new autism diagnosis, though autism is considered a “developmental disorder” because symptoms usually appear in the first two years of life.

Typically, a healthcare team makes a diagnosis through a comprehensive assessment that includes:

  • Developmental history, with information about early childhood development, including speech and language milestones, social behaviors, and repetitive behaviors
  • Behavioral observation, including clinical observation and structured interviews, to assess social communication patterns, repetitive behaviors, and other typical autism symptoms

  • Screening tools, such as the Autism Diagnostic Observation Schedule (ADOS) to evaluate autism traits. The ADOS is a series of structured and semi-structured tasks in which the examiner evaluates how the patient interacts socially. Current assessment tools are often based on research that predominantly involves male participants, which may make the tools less useful in recognizing autism in women, says D’Mello.
On average, girls also receive a diagnosis almost a year later, at age 5.6, versus 4.8 for boys.

In many cases, women may only receive a diagnosis after they reach adulthood, often after years of struggling with social, emotional, or mental health issues. They’re often misdiagnosed with conditions such as depression, bipolar disorder, and anxiety (though sometimes people have both autism and one of those conditions), says D’Mello.

Treatment and Medication Options for Autism in Women

Although there are treatments that may address some symptoms of autism, there are no approaches that treat the core symptoms of autism.

The guidelines for treatment for men and women are the same, says Dr. Fung. Some address symptoms that are common signs of autism, like repetitive behaviors, as well as conditions that often accompany autism, such as hyperactivity or anxiety.

Medication Options

Medications may address specific symptoms and are most effective when used along with behavioral therapies.

Examples of medications that may be prescribed include the following:

Inattention and Hyperactivity

Stimulants:

  • methylphenidate (Ritalin, Concerta)
  • dexmethylphenidate (Focalin)
  • dextroamphetamine (Adderall)

Anxiety and Mood Symptoms

Selective serotonin reuptake inhibitors (SSRIs):

  • fluoxetine (Prozac)
  • sertraline (Zoloft)

Repetitive Behaviors and Rigidity

Selective serotonin reuptake inhibitors (SSRIs):

  • fluoxetine (Prozac)
  • sertraline (Zoloft)

Anxiolytic:

  • buspirone (Buspar)

Atypical antipsychotics:

  • risperidone (Risperdal)
  • aripiprazole (Abilify, Aristada)

Disruptive or Aggressive Behavior

Atypical antipsychotics:

  • risperidone (Risperdal)
  • aripiprazole (Abilify, Aristada)

Complementary and Integrative Therapies

Some women with autism (as well as men) may benefit from therapies that promote social and emotional well-being, which may include the following:

  • Cognitive Behavioral Therapy (CBT) This type of therapy helps individuals understand the connections between their thoughts, feelings, and behaviors, and can help with anxiety, depression, or social challenges.

  • Mindfulness and Meditation These can be very helpful activities for many women with autism, says Fung.
  • Speech and Language Therapy This type of therapy can improve communication skills in both children and adults.


Prevention of Autism in Women

Currently, there is no known way to prevent autism, as its exact causes are still being researched. Early diagnosis and intervention ensures the best possible outcomes.

Lifestyle Changes for Women With Autism

Certain lifestyle adjustments can help manage symptoms and improve overall well-being.

Stress Management

Women with autism may experience higher levels of anxiety and stress due to the challenges of navigating social situations and masking their symptoms. Stress management techniques, such as mindfulness, yoga, or relaxation exercises, can be helpful.

‘Dropping the Mask’ in Safe Social Situations

“If a woman shares that she has been masking autism for years, I tell her about the association between depression, anxiety, and masking — it can have mental health consequences,” says Fung.

However, “unmasking” can have potential consequences at work or social situations, he acknowledges.

“But that doesn’t mean you can’t drop the mask with people close to you, such as your family or close friends. That’s a good start,” says Fung.

Good Sleep Habits

Because sensory sensitivities can disrupt sleep, establishing a consistent and calming bedtime routine may help improve sleep quality for women with autism. That includes all the basics of good sleep habits: follow regular sleep and wake times, limit electronics, keep out noise and light, avoid naps, and get regular exercise.

Prognosis for Women With Autism

In most cases, autism is a lifelong condition, and how it manifests may change over time.

Symptoms of autism may become less disruptive to daily life as children become adults and possibly learn better coping skills. However, physical health tends to worsen in adults with autism.

Research suggests that people with autism die earlier than people without the condition. Women with autism without intellectual disability may die about six years sooner compared with their peers without the condition, and women with autism and intellectual disability may have a reduction in life expectancy of nearly 15 years.

But with the right support, individuals with autism can lead fulfilling, independent lives, says Fung.

Disparities and Inequities in Autism in Women

As the overall prevalence of autism has been rising, it’s also going up in Hispanic and Black Americans. Before 2016, white children were more likely to be diagnosed, but the most recent data indicates that the percentage of Black and Hispanic 4-year-old and 8-year-old children diagnosed with autism is now higher than white children.

Although it’s not clear why, it may be because of greater awareness, identification, and access to services.

Experts still believe that disparities in diagnosis remain. Black individuals are likely to be diagnosed later, more likely to have an intellectual disability, and are excluded from research and services for autistic people. Black girls with autism are “effectively invisible” in current scientific literature, according to a recent review.

Related Conditions to Autism in Women

Autism increases the risk that a woman will experience one of the following conditions:

Anxiety Disorders Anxiety disorders involve persistent and excessive worry or fear that interferes with daily activities. Symptoms may include restlessness, rapid heart rate, difficulty concentrating, and physical symptoms like sweating or shaking.

Depression This mood disorder is characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. It can affect sleep, appetite, and concentration, and may lead to thoughts of death or suicide.

Attention Deficit Hyperactivity Disorder (ADHD) A neurodevelopmental disorder, ADHD can express itself as inattention, hyperactivity, and impulsivity that affect school, work, and social relationships.

Eating Disorders The most common types of eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. Research suggests that anorexia may be the most common eating disorder in people with autism.

Obsessive-Compulsive Disorder (OCD) People with OCD have persistent, unwanted thoughts (obsessions), repetitive behaviors or mental acts (compulsions), or both.

Sleep Disorders Sleep disorders, including insomnia, sleep apnea, and restless leg syndrome, affect the quality, timing, and duration of sleep, leading to daytime fatigue, irritability, and difficulty concentrating.

Support for Women With Autism

A supportive network, whether in person or online, can help women with autism manage the emotional challenges associated with the condition, says Fung.

Some online support groups include:

The Takeaway

  • Autism in women doesn’t always look the same as it does in men, leading to underdiagnosis or late diagnosis.
  • Women with autism are more likely to mask their symptoms, which can intensify certain mental health challenges.
  • Diagnosis and support for women with autism are essential for improving quality of life.

Common Questions & Answers

Why are women with autism diagnosed later than men?
Women may be diagnosed later because they may feel more social pressure to mask their symptoms. Women are also not regularly included in research on tools to diagnose autism.
Masking can include mimicking social behaviors, forcing eye contact, or following social scripts. This can be exhausting and lead to emotional burnout, but women may be better at “fitting in” socially compared with men.
Anxiety, depression, and ADHD are common conditions that may accompany autism in women.
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Angela D. Harper, MD

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Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.  

A distinguished fellow of the American Psychiatric Association, Dr. Harper has worked as a psychiatrist throughout her career, serving a large number of patients in various settings, including a psychiatric hospital on the inpatient psychiatric and addiction units, a community mental health center, and a 350-bed nursing home and rehab facility. She has provided legal case consultation for a number of attorneys.

Harper graduated magna cum laude from Furman University with a bachelor's degree and cum laude from the University of South Carolina School of Medicine, where she also completed her residency in adult psychiatry. During residency, she won numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists, the Ginsberg Fellowship from the American Association of Directors of Psychiatric Residency Training, and resident of the year and resident medical student teacher of the year. She was also the member-in-training trustee to the American Psychiatric Association board of trustees during her last two years of residency training.

Harper volunteered for a five-year term on her medical school's admission committee, has given numerous presentations, and has taught medical students and residents. She currently supervises a nurse practitioner. She is passionate about volunteering for the state medical board's medical disciplinary commission, on which she has served since 2015.

She and her husband are avid travelers and have been to over 55 countries and territories.

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