Autistic girls are often recognised later than boys, because their differences can be subtle, masked or mistaken for anxiety or shyness. Consultant Child and Adolescent Psychiatrist Dr Athina Zakynthinaki explains how autism can present in girls, the hidden cost of masking, and what a thorough assessment involves.
For many years, autism was understood mainly through research on boys. As a result, many autistic girls have grown up unrecognised, often until adolescence or adulthood. Many were described as shy, sensitive, anxious or “just a bit different”, without anyone understanding why everyday life felt so hard.
In my clinical practice, I meet many girls whose autism was hidden in plain sight. Recognising it can change how they understand themselves, and how others support them.
Why are autistic girls often missed?
Masking (camouflaging). Many autistic girls learn to watch, copy and rehearse social behaviour. They may make eye contact, mirror their peers’ expressions, or prepare scripts for conversations. This can look like ease, but it takes enormous effort.
Interests that seem “typical”. Their intense interests may be in animals, books, a particular band, drawing or fictional worlds. These look ordinary, so the depth and intensity of focus is overlooked.
Quiet rather than disruptive. Autistic girls are more likely to withdraw or try very hard to comply than to show difficulties openly at school.
Friendships that look fine from the outside. Many have one close friend or stay on the edge of a group, so their difficulties with social communication aren’t obvious to adults.
Diagnostic stereotypes. The traditional picture of autism doesn’t always fit girls, and some professionals may still expect it to.
How autism can present in girls
Every autistic girl is different, but parents and teachers may notice:
Social exhaustion: needing long periods alone to recover after school or social events
Working hard to understand unwritten social rules, and finding friendships confusing or intense
Feeling very upset by changes in friendship groups, or by conflict
A strong preference for routine, predictability and knowing what will happen next
Sensory sensitivities, for example to noise, clothing labels, textures, smells, lighting or crowded places
Deep, absorbing interests that bring comfort and joy
Literal thinking, or difficulty with sarcasm, vague instructions or group conversation
Being described as “good as gold” at school, then very distressed or overwhelmed at home
The hidden cost of masking
Masking can help a girl get through the school day, but it often comes at a high price. Constantly monitoring yourself, suppressing sensory discomfort and performing socially is exhausting. Over time it can lead to:
Anxiety, which is often the main reason girls first come to services
Low mood and low self-esteem, sometimes with a sense of never quite fitting in
Autistic burnout: a state of deep exhaustion in which coping skills that used to work no longer do
Difficulties attending school, when the demands of the environment become overwhelming
Meltdowns or shutdowns, often at home, where it feels safe to let go
As with ADHD, girls may receive support for anxiety or low mood while the underlying autism goes unrecognised. When the root of their distress isn’t understood, progress can be limited.
Co-occurring differences
Autistic girls may also experience:
ADHD: the two frequently co-occur, and both can be masked (see my article on ADHD in girls)
Eating difficulties: often related to sensory sensitivities, need for control, or anxiety
Sleep difficulties
Emotional regulation difficulties
Self-harm: some young people use it to cope with overwhelming feelings, so it always needs a prompt, caring response
If you are worried about your child’s immediate safety, contact your GP urgently, call NHS 111 and choose the mental health option, or go to A&E.
Why recognition matters
An autism diagnosis is not about labelling a child as broken. It is about understanding. For many girls, it brings relief, an explanation for why things have felt so hard, and permission to stop pretending. It helps families and schools make reasonable adjustments, reduce unnecessary stress, and build on each girl’s strengths, such as loyalty, honesty, creativity, attention to detail and passionate interests.
What does an autism assessment involve?
A thorough assessment considers the whole young person and pays particular attention to masking. In my practice, this includes:
A detailed developmental history with parents, using a structured interview
A structured observational assessment with the young person, carried out by experienced clinicians
Information from school, as girls often present very differently at home and at school
Careful consideration of co-occurring difficulties such as ADHD, anxiety and low mood
A feedback meeting to talk through the findings and recommendations with the family
The aim is to give families a clear, compassionate understanding of their child and practical recommendations for home and school, whatever the outcome.
When to seek advice
If your daughter seems to be working very hard just to get through each day, or if she is receiving support for anxiety or low mood and something still doesn’t quite add up, trust your instincts. You don’t need to be certain before you ask for an assessment.