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Autism, also known as Autism Spectrum Disorder (ASD), is a neurodevelopmental condition characterised by challenges in social communication and interaction, as well as restricted and repetitive behaviours and interests. Autism is a spectrum disorder, meaning it affects individuals differently and to varying degrees. Symptoms can range from mild to severe, and each person with autism has a unique set of strengths and challenges.

Importance of Recognising Autism in Females

Historically, autism has been more commonly diagnosed in males, leading to a perception that it is less prevalent in females. However, growing evidence suggests that autism is underdiagnosed in females, who may present symptoms differently than their male counterparts. Recognising autism in females is crucial for several reasons. 

Early identification and diagnosis can provide access to tailored support and interventions, improving quality of life and overall wellbeing. If you are looking for an autism assessment in Oxford, contact us at Oxford CBT. 

Additionally, understanding how autism manifests in females can help reduce stigma and promote a more inclusive society. If you are interested in finding out more about autism friendly social activities, take a look at our article about Autism Social Groups in Oxford

This article aims to shed light on the unique characteristics of autism in females and provide a helpful checklist for recognising potential signs and symptoms.

Female Autism Checklist

Autism can present differently in females compared to males. Here is a detailed checklist of signs and symptoms to help identify potential indicators of autism in females:

1. Social Interaction:

  • Difficulty in making and maintaining friendships
  • Prefers solitary activities or playing alone
  • Struggles with understanding social norms and cues
  • Appears shy, withdrawn, or overly anxious in social settings
  • May seem to have superficial friendships without deep connections

2. Communication:

  • Delayed speech development or unusual use of language
  • Uses learned phrases or scripts in conversations
  • Difficulty with back-and-forth conversations
  • Literal interpretation of language, difficulty understanding jokes or sarcasm
  • Monotone or unusually formal speech patterns

3. Interests and Behaviours:

  • Intense interests that may appear typical (e.g., animals, books, celebrities) but are pursued with unusual intensity
  • Repetitive behaviours or rituals (e.g., lining up toys, following strict routines)
  • Resistance to changes in routine or environment
  • Engages in stimming behaviours (e.g., hand-flapping, rocking) for self-soothing

4. Emotional and Sensory Sensitivities:

  • Highly sensitive to sensory input (e.g., textures, sounds, lights)
  • Overreacts to minor changes or unexpected events
  • Experiences frequent meltdowns or shutdowns in response to overstimulation
  • Displays heightened empathy but struggles with expressing or managing emotions

5. Coping Mechanisms:

  • Masks or camouflages symptoms to fit in with peers
  • Practices conversations or social interactions in advance
  • Mimics the behaviours and speech patterns of others
  • Feels exhausted or overwhelmed after social interactions

Understanding Autism in Females

How Autism Manifests Differently in Females

Autism can manifest differently in females compared to males, which can lead to underdiagnosis or misdiagnosis. Research has shown that females with autism often exhibit less obvious symptoms and may be more adept at masking their difficulties, particularly in social situations. For instance, females are more likely to mimic social behaviours and use learned scripts in conversations to blend in with their peers (1).

Females with autism may also have different interests than their male counterparts. While males with autism often have intense interests in specific topics like trains or technology, females might have intense interests that are more socially acceptable, such as animals, books, or celebrities, which can further obscure the diagnosis (2).

Another key difference is that females with autism are more likely to internalise their struggles, leading to higher rates of anxiety, depression, and other mental health issues (3). This internalisation can make the core symptoms of autism less visible to observers, complicating the diagnostic process.

Common Misconceptions About Autism in Females

There are several misconceptions about autism in females that contribute to underdiagnosis and misunderstanding:

1. Autism is more common in males: While it is true that autism is diagnosed more frequently in males, this does not mean it is less common in females. The differences in how symptoms manifest can lead to fewer diagnoses in females, but the prevalence may be closer than previously thought (4).

2. Females with autism are not as affected as males: This misconception arises from the subtler presentation of symptoms in females. However, females can be just as affected by autism, but their struggles may be less visible. They often experience significant internal distress and may have comorbid conditions like anxiety and depression (5).

3. Females with autism lack empathy: This is a common stereotype about autism in general, but it is particularly untrue for females, who often demonstrate strong empathy and concern for others. Their social challenges are more related to understanding and navigating social norms rather than a lack of empathy (6).

Signs and Symptoms of Autism in Females

Autism can present differently in girls compared to boys, and understanding these indicators can help in early identification and intervention:

1. Social Challenges: Girls with autism may struggle to understand social norms and cues, leading to difficulties in making and maintaining friendships. They might prefer solitary activities or play alongside peers rather than interact directly. For instance, a girl might play with dolls in a repetitive manner, focusing on lining them up rather than engaging in imaginative play with others.

2. Communication Differences: Girls with autism might have delayed speech development or use language in unusual ways. They may echo phrases (echolalia), speak in a monotone voice, or have an advanced vocabulary but struggle with back-and-forth conversations. A girl might be able to recite facts about her favourite animal but find it hard to engage in small talk.

3. Intense Interests: While boys with autism often have focused interests in niche topics, girls might have intense but more socially acceptable interests. These can include a deep fascination with animals, books, or celebrities, often collecting extensive information or memorabilia about their interests.

4. Emotional Sensitivity: Girls with autism might be highly sensitive to emotional and sensory stimuli. They may overreact to changes in routine or be very sensitive to textures, sounds, or lights. For example, a girl might refuse to wear certain fabrics or become overwhelmed in noisy environments.

5. Masking and Camouflaging: Girls with autism are often better at mimicking social behaviours and masking their difficulties to fit in with peers. This can make their symptoms less noticeable to teachers, parents, and even healthcare professionals. A girl might use learned social scripts or imitate her peers’ behaviour to navigate social situations.

Differences in Social Interactions and Communication

Social Interactions

Superficial Friendships: Girls with autism may form superficial friendships where they appear to have friends but lack deep, meaningful connections. They might be on the periphery of social groups, involved but not fully integrated.

Playing Pretend: While girls might engage in pretend play, it may be more rigid and less interactive. They might insist on playing the same scenario repeatedly or struggle to adapt their role within the play.

Reading Social Cues: Girls often have difficulty reading social cues such as body language, facial expressions, and tone of voice. This can lead to misunderstandings or inappropriate responses in social settings.


Language Use: Girls might have advanced vocabulary and be highly articulate, which can mask their difficulties in understanding the pragmatic aspects of language, such as taking turns in conversation or staying on topic.

Nonverbal Communication: They may have atypical nonverbal communication, such as limited use of gestures, difficulty making eye contact, or using exaggerated facial expressions that do not match the context.

Literal Interpretation: Girls with autism may interpret language very literally, struggling with idioms, jokes, and sarcasm. For example, if someone says, “It’s raining cats and dogs,” a girl with autism might look confused or even look outside to check.

Behavioural and Sensory Issues

Behavioural Issues

Repetitive Behaviours: Girls with autism might engage in repetitive behaviours or rituals, such as rocking, hand-flapping, or repeating certain actions. These behaviours can serve as a coping mechanism for anxiety or sensory overload.

Routine and Predictability: They often prefer strict routines and may become distressed with any changes. For instance, a girl might insist on following the same route to school every day and become very upset if a detour is taken.

Meltdowns and Shutdowns: In response to overwhelming situations, girls might experience meltdowns, where they express distress through crying, yelling, or aggressive behaviour. Alternatively, they might have shutdowns, becoming non-responsive or withdrawn.

Sensory Issues

Sensory Sensitivities: Girls with autism often have heightened or diminished responses to sensory input. They may be particularly sensitive to sounds, lights, textures, or smells. A girl might cover her ears in loud environments or refuse to eat foods with certain textures.

Sensory-Seeking Behaviours: Conversely, some girls might seek out sensory input, such as spinning, jumping, or touching objects repeatedly. These behaviours can help them regulate their sensory experiences.

Overstimulation: Environments with a lot of sensory input can be overwhelming, leading to anxiety, discomfort, or behavioural outbursts. For example, a girl might struggle in a crowded, noisy classroom and need a quiet space to retreat.

Recognising these signs and symptoms is crucial for understanding and supporting girls with autism. Early identification and tailored interventions can significantly improve their quality of life and help them navigate the complexities of social and academic environments.

The Concept of Masking in Females

What is Masking?

Masking, also known as camouflaging, refers to the behaviours individuals with autism use to hide their autistic traits and blend in with neurotypical peers. This phenomenon is particularly prevalent among females with autism, who may consciously or unconsciously adopt strategies to cope with social situations. Masking can include mimicking social behaviours, using rehearsed scripts in conversations, suppressing stimming behaviours (repetitive movements or sounds), and forcing eye contact. These efforts are often driven by a desire to fit in and avoid negative social repercussions.

How to Know if You’re Masking Autism

Recognising whether you are masking autism can be challenging, as the behaviours become deeply ingrained over time. Here are some signs that you might be masking:

1. Exhaustion After Social Interactions: Feeling extremely tired or drained after socialising can indicate that you are expending significant energy to maintain a facade.

2. Rehearsing Conversations: If you find yourself practising what to say in advance or mentally reviewing past conversations to analyse your performance, you might be masking.

3. Imitating Others: Frequently copying the behaviours, speech patterns, or expressions of those around you to fit in could be a sign of masking.

4. Suppression of Natural Behaviours: Deliberately stopping yourself from engaging in stimming behaviours or other actions that feel natural to you in public settings is a common form of masking.

5. Discomfort with Authenticity: Feeling like you cannot be your true self around others and constantly adjusting your behaviour to match social expectations are strong indicators of masking.

The Impact of Masking on Mental Health

While masking can help individuals navigate social environments more smoothly, it often comes at a significant cost to mental health. The constant effort to suppress one’s true self and conform to societal norms can lead to several negative outcomes:

1. Increased Anxiety and Stress: The ongoing effort to monitor and adjust behaviours can lead to heightened anxiety and chronic stress.

2. Depression: Feeling unable to be authentic and the ongoing strain of maintaining a facade can contribute to feelings of depression and low self-esteem.

3. Identity Confusion: Consistently pretending to be someone else can lead to confusion about one’s true identity and a diminished sense of self.

4. Burnout: The relentless effort required to mask autistic traits can result in autistic burnout, characterised by extreme exhaustion, reduced functioning, and a significant decline in mental and physical health.

Recognising and addressing the practice of masking is crucial for the mental wellbeing of individuals with autism. It is important to create supportive environments where autistic individuals feel safe to express their true selves without fear of judgment or ostracism. At Oxford CBT, we are dedicated to providing compassionate care and tailored support to help individuals with autism navigate these challenges and improve their overall quality of life.

Mild Autism and Late Diagnosis

Can You Be Mildly Autistic and Not Know It?

Yes, it is possible to be mildly autistic and not know it, particularly if the symptoms are subtle or have been masked effectively. Individuals with mild autism, often referred to as having “high-functioning autism” or being “on the milder end of the spectrum,” may possess good language skills and average or above-average intelligence, which can help them adapt and cope in social situations. However, they may still face significant challenges in understanding social cues, managing sensory sensitivities, and maintaining relationships. These difficulties can be misattributed to personality quirks, shyness, or other factors, delaying recognition and diagnosis.

Why Autism Might Be Overlooked in Females

Autism is often overlooked in females for several reasons:

1. Different Symptom Presentation

Females with autism frequently exhibit symptoms that are less overt than those in males. They might be more socially aware and better at imitating social behaviours, which can mask their autism.

2. Coping Mechanisms

Many females develop sophisticated coping strategies, such as mimicking peers or rehearsing social interactions, which can hide their difficulties from parents, teachers, and healthcare providers.

3. Social Expectations

Societal expectations often place higher demands on females to be socially adept, leading them to work harder at fitting in. This effort to conform can further obscure their autistic traits.

Diagnostic Criteria

Historically, diagnostic criteria have been based on male presentations of autism, leading to a bias that overlooks the ways autism manifests in females. This has contributed to fewer diagnoses and less recognition of autism in girls and women.

Importance of Seeking a Diagnosis

Seeking a diagnosis of autism, even if symptoms are mild, is crucial for several reasons:

1. Access to Support and Resources: A formal diagnosis can open doors to various support services, therapies, and educational accommodations that can significantly improve quality of life.

2. Understanding and Self-Acceptance: Receiving a diagnosis can help individuals understand their experiences and challenges better, fostering self-acceptance and reducing feelings of isolation.

3. Mental Health Benefits: Knowing the reason behind their struggles can alleviate anxiety and depression that often accompany undiagnosed autism. It also allows for more targeted mental health support.

4. Community and Connection: A diagnosis can connect individuals with support groups and communities of others with similar experiences, providing a sense of belonging and understanding.

5. Informed Interventions: With a diagnosis, tailored interventions and strategies can be implemented to address specific needs and strengths, helping individuals navigate social, academic, and occupational settings more effectively.

At Oxford CBT, we understand the unique challenges faced by individuals with mild autism and those who receive a late diagnosis. Our team is committed to providing comprehensive evaluations and personalised support to help you or your loved ones thrive. If you suspect that you or someone you care about might be on the autism spectrum, we encourage you to seek professional guidance to explore potential diagnoses and the support available.

Self-Assessment Tips

Recognising autism in oneself can be challenging, especially if symptoms have been masked. Here are some tips for self-assessment:

1. Reflect on Childhood Behaviours:

   – Consider your social interactions, play patterns, and communication styles during childhood. Were you more comfortable playing alone? Did you struggle with making friends?

2. Observe Current Behaviours:

   – Pay attention to how you interact with others now. Do you find social situations draining? Do you often rehearse what to say before conversations?

3. Identify Sensory Sensitivities:

   – Notice any strong reactions to sensory stimuli. Are there certain textures, sounds, or lights that you find particularly bothersome or comforting?

4. Consider Emotional Responses:

   – Reflect on how you handle changes and unexpected events. Do you feel anxious or overwhelmed easily? Do you have frequent meltdowns or shutdowns?

5. Seek External Perspectives:

   – Talk to trusted friends or family members about your behaviours and interactions. They might provide insights that you haven’t considered.

6. Use Online Tools:

   – Several online self-assessment tools and questionnaires can help identify signs of autism. While these are not diagnostic tools, they can be a useful starting point.

If you find that many of these signs and symptoms resonate with your experiences, it may be beneficial to seek a professional evaluation. At Oxford CBT, we offer comprehensive assessments and personalised support to help individuals understand their unique needs and strengths. Our goal is to provide a welcoming environment where you can explore your concerns and receive the guidance you need.

Seeking Help and Support

When to Seek Professional Advice

Recognising when to seek professional advice is crucial in managing autism effectively. Here are some indicators that it might be time to consult with a healthcare professional:

1. Persistent Challenges: If you or someone you know experiences ongoing difficulties with social interactions, communication, or sensory sensitivities that interfere with daily life, seeking professional guidance is important.

2. Emotional Distress: Experiencing frequent anxiety, depression, or significant emotional distress related to social situations or sensory issues is a strong sign that professional support may be needed.

3. Impact on Daily Functioning: When challenges related to autism affect work, school, or personal relationships, it is beneficial to seek an evaluation and tailored support.

4. Unexplained Behavioural Patterns: If there are consistent behaviours that seem unusual or unexplained, such as intense routines, repetitive actions, or specific sensory preferences, a professional assessment can provide clarity.

5. Previous Misdiagnoses: If there have been previous diagnoses of other conditions like anxiety, depression, or ADHD without significant improvement, it may be helpful to explore the possibility of autism, especially in females where symptoms might have been overlooked.

Resources and Support Networks for Autistic Females

Accessing resources and support networks can provide invaluable assistance for autistic females and their families. Here are some key resources:

Support Groups

  • Local and Online Groups: Joining support groups can offer emotional support, practical advice, and a sense of community. Look for local meetups or online forums where you can connect with others who share similar experiences.
  • Organisations: Groups like the National Autistic Society or Autism Women’s Network offer specialised support and resources tailored to females with autism.

Educational Resources

  • Books and Articles: There are numerous books and online articles that provide in-depth information about autism in females. Titles like “Women and Girls with Autism Spectrum Disorder” by Sarah Hendrickx can be particularly insightful.
  • Websites: Reliable websites such as the National Institute of Mental Health (NIMH) and the Autism Research Institute offer comprehensive information on autism.

Professional Services

  • Therapists and Counsellors: Seeking support from therapists or counsellors who specialise in autism can provide tailored strategies to manage symptoms and improve quality of life.
  • Occupational and Speech Therapy: These therapies can help address specific challenges related to sensory processing and communication.

Community Resources

  • Local Autism Centers: Many communities have local autism centres that offer resources, workshops, and support services for individuals and families.
  • Educational Programmes: Programmes that focus on social skills, vocational training, and independent living can be highly beneficial.

Online Tools

  • Self-Assessment Tools: Online self-assessment tools can help identify potential signs of autism and serve as a starting point for seeking professional advice.
  • Webinars and Online Courses: Participating in webinars and online courses can provide education on various aspects of autism, from understanding symptoms to developing coping strategies.

Seeking help and support is a vital step in managing autism effectively. At Oxford CBT, we are dedicated to providing compassionate care and personalised support to help you navigate the challenges of autism. Our team of experienced professionals is here to guide you through the process, offering comprehensive evaluations and tailored interventions. If you suspect that you or someone you care about might be on the autism spectrum, we encourage you to reach out and explore the support available.


Understanding and recognising autism in females is crucial due to the different ways it can manifest compared to males. Females with autism may exhibit less obvious symptoms, making it more challenging to diagnose. Key signs include social challenges, unique communication styles, intense but socially acceptable interests, and high sensitivity to sensory stimuli. Masking, or camouflaging symptoms to fit in, is common among autistic females and can lead to significant mental health impacts. Mild autism and late diagnosis are also prevalent, underscoring the importance of seeking a professional evaluation if you suspect autism. 

If you or someone you care about exhibits signs of autism, especially if these symptoms interfere with daily life, it is important to seek professional guidance. Early diagnosis and intervention can significantly improve quality of life by providing access to tailored support and resources. Even if the symptoms are mild, understanding the underlying cause can lead to better self-acceptance and mental health outcomes. 

How Oxford CBT Can Help

At Oxford CBT, we are committed to supporting individuals with autism through comprehensive evaluations and personalised treatment plans. Our team of experienced professionals provides a warm and welcoming environment where you can explore your concerns and receive the support you need. We offer evidence-based treatments, resources, and ongoing support to help you navigate the challenges of autism and improve your overall wellbeing. Whether you are seeking help for yourself or a loved one, Oxford CBT is here to assist you every step of the way. Contact us to learn more about our services and how we can help you on your journey towards better mental health.


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2. Hiller, R. M., Young, R. L., & Weber, N. (2014). Sex Differences in Pre-Diagnosis Concerns for Children Later Diagnosed with Autism Spectrum Disorder. Autism, 18(4), 466-478.

3. Mandy, W., Chilvers, R., Chowdhury, U., Salter, G., Seigal, A., & Skuse, D. (2012). Sex Differences in Autism Spectrum Disorder: Evidence from a Large Sample of Children and Adolescents. Journal of Autism and Developmental Disorders, 42(7), 1304-1313.

4. Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 466-474.

5. Hull, L., Petrides, K. V., & Mandy, W. (2020). The Female Autism Phenotype and Camouflaging: A Narrative Review. Review Journal of Autism and Developmental Disorders, 7, 306-317.

6. Sedgewick, F., Hill, V., Yates, R., Pickering, L., & Pellicano, E. (2019). Gender Differences in the Social Motivation and Friendship Experiences of Autistic and Non-Autistic Adolescents. Journal of Autism and Developmental Disorders, 49, 2779-2792.

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