Autism in women and girls

[InSlovakiaTheCapitalOfCourseIsBratislava]

If something has different symptoms, it is generally regarded as a different illness / condition
Expert and developmental psychologist Uta Frith made some observations about the symptoms of autism often being very different in women and girls to how it often presents in men and boys.
So would it unreasonable for it not to be something totally different? Still a form of neurodivergence but not what is actually autism
You obviously get girls/women with the “classic” symptoms (eg Temple Grandin), and presumably there are boys who aren’t being diagnosed with whatever the neurodivergence actually is, because their symptoms are the same as those more common in women and girls - which aren’t being looked for in a lad

Different presenting symptoms do not necessarily mean the underlying impact of autism is different- it’s just how it shows itself .

But it it’s “presenting differently” is it actually the same thing?

Heart attacks feel like crushing chest pain in men where women are more likely to feel decentralised pain and fatigue.

Yet again women and girls having their autism presentation belittled.

It still has to meet the diagnostic criteria, it's just that girls tend to have a more subtle presentation and tend to try to mimic other girls more to fit in, so their coping strategies fail later than boys who typically don't make such efforts.

You'd have to unpick societal expectations of girls from it all to see what is nature/nurture in the presentation.

For heart attacks, we know the underlying cause is blocked blood vessels around the heart.

for autism, we have no idea of the underlying mechanisms in the brain. We only have collections of symptoms and behaviours. So when that collection looks very different in different people, it is sensible to ask the scientific question- are these really the same thing.

unfortunately, autism is often seen as an identity as well as a diagnosis, and people hate any ideas that don’t align with their identity

Not belittling, just asking

It seems with radically different presentations it makes no sense that it’s the same thing.
im not saying it’s not neurodivergence and it can be utterly crap.

Show me brain scans and I’ll not disbelieve, but based on history? They’re like anorexia and bulimia.

The short answer is no, it is definitely autism but there are structural differences in the brain which explain the differences in behaviours for women.

When AI and neuroimaging tools identify sex-based brain differences, researchers test those models against other conditions (such as ADHD or neurotypical controls). The results consistently show that these brain patterns are highly specific to autism, meaning they represent a genuinely unique female profile of the condition rather than a different disorder entirely.

Large-scale AI and functional MRI (fMRI) studies show that autistic females have unique functional connectivity patterns in motor areas (such as the primary motor cortex and supplementary motor area), language systems, and visuospatial attention centers.

Traditional male-dominated research models assumed underactivity in social brain networks. However, scans of autistic females often reveal higher activity or distinct connectivity in social reward and motivation networks, which strongly links to camouflaging (hiding or "masking" autistic traits in social situations) and specific activation in the anterior cingulate cortex.

Some adult neuroimaging studies note that certain brain regions in autistic females display structural patterns more similar to typical males, reflecting potential influences from prenatal hormones or sex-linked genetics.

For decades, over 70% of neuroimaging and diagnostic research focused almost exclusively on males (mirroring a ~4:1 male-to-female diagnosis ratio). Insights from specialized research like the Brain & Behavior Research Foundation demonstrate that male-based brain models do not automatically apply to females, which explains why many autistic women and girls experience delayed or missed diagnoses.

So the brain scans show that they present differently? So it really is a different thing????
Not only did the symptoms present differently the brains were different, despite diagnosis of all parties as ASD
And, girls with more ‘typical’ autistic behaviours had brains more like the boys

“among the girls with autism, differences in motor areas were linked to the severity of their repetitive behaviors. Girls with autism usually have fewer repetitive behaviors than boys with autism, which may contribute to delays in their diagnosis, the team suggested.
The team's results suggested that girls with autism whose brain patterns were more similar to those in boys with autism tended to have the most pronounced repetitive behaviors”

FFS, please tell me what the different presentations are in men and women?

What would you call those different presentations and why would you call them autism in men and not in women?

Yes it can be the same thing- autism.

if we look at the criteria:
sensory difference- one person could be sensory seeking and the other sensory avoidant

communication- one person could be non-verbal and another might talk incessantly about their own interests

social skills- one might prefer to be alone whereas another seeks high levels of interaction (but perhaps inappropriately)

non verbals- one person might avoid eye contact and another gives it intensely to the point of staring.

all still autistic presentations but just different and not ‘neurotypical’.

"The results consistently show that these brain patterns are highly specific to autism, meaning they represent a genuinely unique female profile of the condition rather than a different disorder entirely."
No, it is autism but we can see from brain scans why men present with repetitive behaviours because their brains are wired to present that way whereas girls with autism have stronger control over this. Boys brains more often, not always, can't control the motor tics. Obviously that makes them easier to diagnose.

Autism is a spectrum and will display in various ways for both men/boys and women/girls.

We know men can react with violence and aggression more so than women because their left amygdala is usually highly triggered at any perceived threat. The prefrontal cortex acts as the brain's "brakes," responsible for logic, empathy, future planning, and suppressing aggressive urges. Violent behaviour occurs when the emotional drive from the amygdala overrides the rational control of the prefrontal cortex. So men with less control over violent behaviour often show weaker or a damaged prefrontal cortex in scans.

We don't say that because their brains scan differently these men aren't human. Some are less humane perhaps but it shows how the brain wiring affects behaviours and traits between the sexes.

I think the difference in how autism can present in girls and women is interesting, but I’m not sure that means it’s a completely different condition. Autism is already a very broad spectrum, and people can present very differently depending on things like personality, environment and masking. It’s probably more useful to recognise those differences rather than create another diagnosis for them.

I have read that diagnostic tests have historically been designed to identify typically male presentation, and this is a reason why autism in women and girls has often been missed.

Note, I say 'typically male' rather than exclusively male.

A useful point to consider is how differences in presentation can influence recognition and diagnosis, particularly across genders. Greater awareness of varied autistic traits may help ensure that both girls and boys are assessed more accurately and supported appropriately.

The different presentation isn’t because of different “symptoms “ let’s call them or condition.

It is because girls (generally) are much better at masking/camouflaging and also , girls tend to internalise behaviours , while boys tend to externalise them.

I just don’t get how the same diagnosis can be given to manifestations opposing one another one (eg sensory seeking, sensory aversion) . They’re totally different. I know they get lumped under sensory processing but it’s processed in different ways
it’s also compare and contrast someone someone who is the life and soul of the party (who goes home and collapses in a heap) with someone who can’t make eye contact and speaks on a monotone. Masking is usually used as the explanation but it doesn’t really account for it.

On the sensory thing it’s because either presentation tends to be extreme/above the norm/unhealthy.

For example sensory aversion. Things, textures , sounds etc being too much, so much so some experience it as physical pain. So they avoid it, or get very distressed, or get massively overwhelmed by sensory overload.It can manifest as meltdowns, running away, refusing to do/touch things etc.

Sensory seeking it’s when they get a “nice” input from certain things, so they use objects in the “wrong “ way or break them, they rub their hands on a peer’s/teacher’s clothes because they feel nice,or their hair, sniffing, touching, eating things that they shouldn’t ,they can’t help themselves touching things in stores, there might be inappropriate self touching, rubbing on chairs etc., getting too close to someone etc.

They’re two different sides of the same coin; sensory difficulties. Some kids can even have both.

It's two sides of the same coin. It's still a processing difficulty. The sensory system is not regulated and therefore the person either receives too much feedback (sensory sensitive) or doesn't receive enough (sensory seeking).

Similarly, the person who doesn't interact with others is missing social cues, but so is the person whose interactions are overwhelming.

Cerebral palsy can cause high muscle tone, low muscle tone or fluctuating muscle tone. It's still cerebral palsy. Epilepsy can cause tonic clinic seizures, partial seizures, drop attacks, etc., - it's still epilepsy.

Autism is a condition characterised by deficits in social interaction and restricted patterns of behaviour or interests that manifested in childhood and cause functional impact. The way that presents can be extremely variable, which is why it can be graphically represented as a 'constellation'.

DD1 is very verbal, but with limited understanding of the subject she's talking about. She doesn't have the social awareness to know that she shouldn't join in with a private conversation happening at the next table. She doesn't realise that she should wait for a gap in conversation to change the subject. She has increasingly fixed routines, highly sensory seeking, etc. She has autism.

DD2 is very reserved, will be silent in a group, sensory sensitive so withdrawn. Largely uses WhatsApp to communicate with us. Introduces speech with "I have a question...' then waits for us to say 'Ok....' before she continues. Fixed routines. She has autism.

Thing is, autistic traits are human traits. There might be a better way to divide up the cluster of traits and struggling - many have argued for and against various ways of doing this - but I don't think it's going to be sex and I don't think doing it by sex would be that helpful even if we consider the issues around many girls being better at masking.

Part of the issue of this is that many people view boys and girls' behaviour differently even when they do the same thing.

I've four autistic kids. There are many things they all have in common. Small sample size, I know, it's an oversimplified demonstration.

DS1 and DD2 present pretty much in the same way - when they were little, I used to say they had the same personality. They were the elopers, the ones who would physically lash out when overwhelmed, the ones who struggle with eating, who will walk away if someone asks an uncomfortable question or starts a topic they don't want to talk about.

People see DS1 now and think he's obvious 'classically' autistic (back when he was small, his communication issues were all blamed on me, now it's 'obvious'), DD2 can do the exact same behaviour and it got dismissed, it got 'she's just trying to be different to her sister, she's just trying to fit in with her guy friends, she's socially anxious, what has she been wanting online, she's just an animal person.' - Maybe, but she's also autistic and doing the exact some things her brother is doing.

I've had similar with DD1 and DS2, they present similarly, have very similar personalities. They're the ones who question why other people aren't following the rules, they get emotionally overwhelmed more easily, they dress in bright clashing clothing and don't care as long as the fabric feels nice, very visibly stim, also space out easily. When DS2 moved to his secondary school and I told them he was on the waiting list for an assessment, no one questioned it beyond asking what supports he'd had previously, was given support from the start. DD1 basically spent all of secondary being told she's too much, but just needs to try harder to not be bothered by things. She was a shell of herself by the end of Y11.

Autism is a spectrum disorder. That doesn't mean, as people wrongly think, that there's a spectrum from "very autistic" to "little bit autistic". It means there are a variety of aspects to autism that each individual can experience to a greater or lesser extent, meaning no two people with autism are likely to have exactly the same presentation.

So, no, there isn't one "correct" way to have autism, regardless of gender, and no, people who present differently to the autistic person you know aren't not autistic.

it’s also compare and contrast someone someone who is the life and soul of the party (who goes home and collapses in a heap) with someone who can’t make eye contact and speaks on a monotone.

This presumes these are different people.

Some days I am the life and soul of the party who will collapse in a heap, some days I can't make eye contact and have a completely flat affect (monotone, no facial expression). Sometimes I can't make eye contact, but my face is totally giving me away. It's been noted at work that I don't look at people if they're yelling at me, I will stare at the nearest surface. I sometimes will intentionally stare at the floor cause I can't trust my face.

Sometimes I seek out audio stimulation, sometimes I get irritated at the slightest sounds. Sometimes these are at the same time - I want a specific kind of sound and the other sounds are bothering me.

Similar with touch - I think it's a pretty normal human experience to have some touch you like and seek out, some touch you don't and you avoid, and that this can vary at times over various factors. We may experience it at different thresholds, have different reactions, we may be processing it differently - wrong touch can make my brain scream and I've done everything from lock in place to start sobbing uncontrollably. Sometimes wrong touch is simply a hand on the shoulder I wasn't expecting.

That's the thing with autism - what makes it a condition is when those human traits cross the diagnostic threshold into causing a significant amount of problems in daily life. Dividing it up differently is only going to be useful if that leads to better support and options for making it less disabling. It's why PCOS has become Polyendocrine Metabolic Ovarian Syndrome (PMOS) - the language shift to more fully explain the condition is to hopefully lead to better support.

I have two autistic DC and they both present differently.
One much more "classic", hyperfixates and talks incessantly about the current obsession, thrives on routine and structure, has sleep and food issues and struggles with a lot of sensory issues.
The other is basically a chaos demon, quite unpredictable, needs variety and novelty and is very sensory seeking.
Both undeniably autistic.