Autism manifests differently in boys and girls, leading to significant differences in how symptoms appear, are recognized, and diagnosed. Boys are diagnosed with autism spectrum disorder (ASD) more frequently and often earlier than girls, but this disparity is influenced by differences in symptom presentation and social behaviors rather than a true difference in prevalence.
One key difference is that girls with autism often show **less obvious or milder symptoms** compared to boys. For example, girls tend to have **fewer difficulties with eye contact**, which is a common early sign of autism in boys. Girls may also have stronger language and social skills relative to boys with ASD, which can mask or camouflage their challenges. This means girls might be better at imitating social behaviors or adapting to social situations, making their autism less noticeable to parents, teachers, and clinicians.
Girls with autism are more likely to engage in **masking** or **camouflaging** behaviors, where they consciously or unconsciously hide their autistic traits to fit in socially. Masking can involve mimicking peers’ social interactions, forcing eye contact, or suppressing repetitive behaviors. While this can help girls avoid social exclusion, it often leads to delayed diagnosis because their struggles are less visible. Many girls are diagnosed much later than boys, sometimes not until their teenage years or adulthood.
In terms of symptom severity, some studies show that when girls are finally assessed, they may present with **more severe symptoms** than boys at the time of diagnosis, possibly because their milder symptoms were overlooked earlier. Girls may also display heightened sensitivity to sensory inputs such as taste, smell, and touch, and may show stronger reactions to changes in routine or environment.
Social communication differences are also notable. Girls with autism might have difficulty understanding social cues like tone of voice or body language, but they often develop coping strategies that mask these challenges. They may have trouble maintaining conversations or interpreting sarcasm, but these difficulties might be subtler than in boys. Girls may also prefer solitary activities but often have intense interests that are more socially acceptable or less stereotypical than the restricted interests seen in boys.
Behaviorally, boys with autism often show more overt repetitive behaviors such as hand-flapping or rocking, while girls might engage in repetitive behaviors that are less obvious or more socially typical, such as collecting dolls or focusing on animals. This difference in behavior can contribute to underrecognition of autism in girls.
Sensory sensitivities are common in both boys and girls with autism, but girls may exhibit stronger or more specific sensory responses, such as aversions to certain textures or foods. These sensory issues can affect daily functioning and social participation.
Overall, the differences in how autism presents in boys and girls contribute to a **gender bias in diagnosis**. Traditional diagnostic criteria and screening tools were developed primarily based on male presentations of autism, which means girls who do not fit this pattern are often missed or diagnosed late. This has led to calls for new diagnostic approaches that account for sex-based differences, including sex-specific thresholds and more nuanced understanding of female autism traits.
Because girls with autism are often underdiagnosed or diagnosed late, they may miss out on early interventions and supports that could improve their quality of life. Increased awareness of these gender differences is critical for better identification, support, and understanding of autism in girls and women.
