Why autism in girls is often missed until adulthood

  • Young girls with autism may fly under the diagnostic radar.

    Young girls with autism may fly under the diagnostic radar. Stock Photo

By Dr. Shubhrajan Wadyal
Amita Health
Posted8/28/2021 7:00 AM

While the needs of those with an autism spectrum disorder are better understood than ever, many of the struggles they face are caused by the biases of the people around them. This is perhaps most true for girls and women with autism.

At the Amita Health Behavioral Medicine Institute, we frequently see how girls with autism fly under the diagnostic radar until they've reached adulthood. While such women might be functional, holding a job and sustaining themselves, they may deal with mental struggles that could hinder them personally and professionally.


Though boys are estimated to be four times more likely to have autism, many girls are not diagnosed as children despite demonstrating several symptoms. Boys with autism tend to be more visible, especially when they reach adolescence and their systems are flooded with testosterone. They sometimes act out aggressively or inappropriately, demanding immediate attention. Girls with autism, however, could be experiencing the same stress and sensory overload without drawing as much attention to themselves.

The following are the signs that may indicate your child is at risk for an autism spectrum disorder:

• No smiling or showing joyful expressions by 6 months of age.

• No sharing of sounds or recognizing facial expressions by 9 months.

• No babbling or gestures (e.g., pointing, reaching or waving) by 12 months.

• No speaking complete words by 16 months.

• No meaningful, two-word phrases by 24 months.

• Loss of speech, babbling or social skills at any age.

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It's unfortunately true that many of the feminine values our society prizes mirror how autism expresses itself in girls. Because many autistic people like routines and order, autistic girls might thrive in rules-based environments. Being quiet, not asking questions and keeping to herself can all be seen as admirable, or at least acceptable, traits in a young woman. That can blind people to the pain she may be feeling.

Even if a girl is brought to a medical professional, biases may stand in the way of a diagnosis. Autism is commonly thought of as a male disorder, an obstacle physicians are trying to change. In truth, girls and adult women don't receive the same level of care as men do across the board, and the failure of health care practitioners to diagnose autism in girls is an extension of that disparity. These challenges are often magnified for girls of color.

Autism spectrum disorders are genetic conditions, so it is not unusual for one or both parents of an autistic child to also demonstrate symptoms of the condition. I once saw a case where it was clear the mother of my patient, a child with autism, was also struggling with an autism spectrum disorder. She was struggling to bond with her child, and that only exacerbated his challenges. I can't help but wonder how much easier her and her family's lives might have been if she had been diagnosed when she was younger.

Again, if you feel your daughter or son is showing signs of autism spectrum disorder, check with their doctor right away. And don't be afraid to ask questions.

• Children's health is a continuing series. Dr. Shubhrajan Wadyal is a psychiatrist with the Amita Health Behavioral Medicine Institute, which operates the Autism Spectrum & Developmental Disorders Resource Center for the treatment of children and adults on the spectrum.

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