How ABA Can Better Support Autistic Girls and Women

Key Takeaways

• Autism in girls and women is often underdiagnosed due to differences in presentation and societal expectations. 
• Applied Behavior Analysis (ABA) can provide effective, personalized support. 
• Support and self-understanding are crucial for well-being. 

Primary Reasons for Underdiagnosis

Autism in women and girls is frequently undiagnosed.

Research increasingly indicates that diagnostic bias in childhood contributes to this issue, as autism often manifests differently in girls than in boys. Historical biases in diagnosis, societal expectations, and gender-specific symptom presentation all play a role, resulting in many girls and women being overlooked, misdiagnosed, or diagnosed later in life.

• Male-Centric Diagnostic Criteria: Early autism research primarily focused on boys, shaping diagnostic criteria around male presentations, such as externalized behaviors or intense fixations on niche topics like trains or numbers. As a result, girls whose symptoms manifest differently are often overlooked or misdiagnosed.
• Masking and Camouflaging: Autistic girls and women frequently develop strategies to “mask” or “camouflage” their traits to fit in socially. They may imitate peers, maintain forced eye contact, or mimic social interactions, making their autism less visible to parents, teachers, and clinicians. While these strategies can help them navigate social situations, they often come at the cost of emotional exhaustion, anxiety, and delayed diagnosis.
• Different Special Interests: The restricted and intense interests of autistic girls often align with socially acceptable or typical pursuits, such as literature, animals, celebrities, or fictional characters, rather than stereotypically male interests. Because these passions seem normative, clinicians may overlook them as potential signs of autism, even when the intensity or focus is unusual.
• Stronger Verbal and Communication Skills: Many autistic girls display strong verbal abilities from an early age, which can mask underlying difficulties with social communication. Despite being articulate, they may struggle with sarcasm, non-literal language, or understanding group dynamics.
• Co-occurring Conditions and Misdiagnosis: Autistic females are more frequently diagnosed initially with other mental health conditions, including anxiety, depression, obsessive-compulsive disorder (OCD), or eating disorders. Clinicians may focus on these visible symptoms and miss the underlying autism, leading to misdiagnosis or delayed recognition.
• Societal Expectations: Cultural and societal pressures for girls to be nurturing, empathetic, and socially skilled can push autistic girls to exert extra effort to meet these norms. When they fall short, their differences are often attributed to shyness or introversion rather than autism, further complicating accurate diagnosis.

Autism Presents Differently in Girls and Boys

According to the National Library of Medicine (2023), autistic girls' signs can manifest differently than boys due to a combination of biological and social factors. These differences contribute to boys being diagnosed more frequently, even when prevalence rates may be similar.

Boys are diagnosed roughly four times more often and often display more externalizing behaviors, whereas girls are more likely to mask their symptoms through social imitation and may present with internalizing conditions such as anxiety or depression.

Girls may show a stronger desire for social connection but still struggle with interpreting social cues, while boys are more likely to exhibit overt challenges with repetitive behaviors or sensory sensitivities.

How Autism May Present Differently for Boys and Girls:

Research shows that autistic behavior might differ between girls and boys in the following ways:

Social Interaction

Girls: May appear more socially motivated, use social mimicry to hide challenges, and be better at understanding social cues, although they still struggle with interpreting them.

Boys: May show more obvious social communication difficulties.

Repetitive and special interests

Girls: May have special interests that are socially acceptable, like celebrities or horses, making them less noticeable.

Boys: Often have interests that are more unusual or easily stand out, like a specific object.

General behavior

Girls: More likely to internalize their difficulties, leading to higher rates of anxiety, depression, and social withdrawal.

Boys: More likely to display externalizing behaviors like aggression or hyperactivity.

Diagnosis and masking

Girls: Often mask their symptoms, which can lead to later diagnoses. Masking involves behaviors like imitating peers, using social scripts, or trying to blend in. 

Boys: Are diagnosed more frequently, partly because their behaviors are often more noticeable and align more with early diagnostic tools.

Common Autistic Girls Signs

• Masking/Camouflaging: Imitating how others speak, act, or dress to fit in, often using rehearsed phrases or “social scripts.”
• Difficulty with unstructured time: Struggling during free play, recess, or lunch breaks; preferring structured social interactions.
• Intense friendships or social withdrawal: Having a small number of close, intense friendships, struggling with social boundaries, or preferring to spend time alone.‍
• Quietness or selective mutism: Appearing unusually quiet or shy in certain situations, sometimes unable to speak due to anxiety.‍
• Difficulty expressing emotions: Finding it hard to verbalize feelings, even with a strong vocabulary.
• Literal thinking: Struggling to understand sarcasm, jokes, or non-verbal cues like body language and facial expressions.‍
• Intense, focused interests: Developing deep passions for socially acceptable topics such as books, animals, music, or fictional characters.‍
• Need for routine and predictability: Becoming anxious or distressed when routines are disrupted or changes occur unexpectedly.‍
• Sensory sensitivities: Strong reactions to sounds, lights, smells, or clothing textures, which may be hidden in public but distressing at home.‍
• Perfectionism and rule-following: Feeling a strong need to do things “correctly,” often driven by anxiety and fear of making mistakes.‍
• Subtle repetitive behaviors (stimming): Engaging in actions like hair twirling, fidgeting with objects, or specific movements, often suppressed in public.‍
• High levels of anxiety and depression: Masking efforts can lead to chronic anxiety, exhaustion, and secondary mental health concerns.
• “After-school” meltdowns or shutdowns: Releasing pent-up emotions or withdrawing completely once in a safe environment after holding them in at school.
• High emotional sensitivity: Experiencing emotions intensely and reacting strongly to perceived rejection or criticism.

If you observe any of these signs, it’s helpful to keep detailed notes and consult a healthcare professional experienced in autism in girls. Early diagnosis can provide access to the right support and resources. For additional information and assistance, visit Grateful Care.

ABA For Girls With Autism

Applied Behavior Analysis (ABA) can be an effective intervention for girls with autism, supporting the development of communication, social skills, and strategies for managing challenging behaviors.

ABA involves breaking skills into small, manageable steps and reinforcing desired behaviors. Modern approaches often incorporate the child’s interests, frequently using play-based methods. For girls, ABA can be especially beneficial for improving social interactions in group settings and addressing behavioral challenges such as tantrums.

How ABA Can Help Girls with Autism

• Improves communication and social skills: ABA helps develop both expressive and receptive language, as well as social skills needed for school and playgroups. This can be especially helpful since girls with autism may interact differently in social settings.
• Manages challenging behaviors: ABA reduces behaviors such as tantrums or aggression by teaching replacement behaviors and using positive reinforcement to encourage desired actions.
  
• Teaches life and adaptive skills: The therapy can support a wide range of skills, including daily living tasks like hygiene, academic abilities, and motor skills.
• Incorporates natural interests: Modern approaches, including Pivotal Response Training (PRT), use the child’s own interests to motivate learning and make therapy more engaging.
• Adaptable for all ages: While often used with young children, ABA can also benefit adolescents by supporting emotional regulation, social interactions, and life skills, including career preparation.

Components of ABA Therapy

• Positive reinforcement: Rewarding desired behaviors to increase the likelihood they will occur again.
• Breaking down skills: Dividing complex skills into smaller, manageable steps and reinforcing mastery at each stage.
• Functional Communication Training (FCT): Teaching individuals to express their needs and communicate effectively.
• Tracking progress: Regularly monitoring skills to adjust teaching methods and ensure therapy remains effective.

Autism in Women

Autism in girls is often underdiagnosed, which can result in delayed diagnoses for women later in life.

Research from the National Library of Medicine (2023) highlights several reasons why autistic females may go undiagnosed. For instance, girls are less likely to be referred for specialist assessment (Øien et al., 2018) and may not be recognized as having ASD even when their symptoms are as severe as those seen in males (Giarelli et al., 2010; Lai et al., 2015; Russell et al., 2011).

Additionally, autistic females may display difficulties that differ both quantitatively and qualitatively from those observed in males (Lockwood Estrin et al., 2021).

This issue is compounded when ASD assessment tools and diagnostic frameworks are biased toward typical male presentations (Kreiser & White, 2014; Rutter et al., 2003). As a result, only females whose traits closely match the male-centric model are likely to receive an ASD diagnosis.

Consequences of Delayed Diagnosis

A delayed or missed autism diagnosis can profoundly affect mental health and well-being, often contributing to heightened anxiety, depression, low self-esteem, and challenges in forming relationships.

Receiving a diagnosis, even in adulthood, can be transformative, offering clarity, self-understanding, and access to tailored support and resources.

Strategies for Help: Autism in Women Support

Support for autistic women can involve working with therapists or coaches experienced in neurodivergence and connecting with online or in-person communities to share strategies and experiences.

Equally important is cultivating self-understanding, developing personalized coping strategies, and creating environments that accommodate each individual’s unique needs.

How ABA Therapy Can Help Women with Late Diagnosed Autism

ABA therapy can be highly beneficial for women with autism, supporting the development of communication, social skills, and strategies for managing challenging behaviors through positive reinforcement.

This data-driven approach creates personalized plans that teach new skills, increase helpful behaviors, and reduce harmful or unwanted ones, with an emphasis on practical, real-world application. ABA can also address challenges specific to many women with autism, including the mental and emotional strain of masking, by:

• Improving life skills: Teaching essential daily living skills, promoting independence, and breaking complex tasks into manageable steps.
• Boosting communication: Enhancing language and social communication abilities.‍
• Increasing focus: Supporting attention, memory, and academic performance.
  
• Reducing challenging behaviors: Decreasing behaviors that are harmful or interfere with learning and quality of life.‍
• Addressing masking: Providing a safe space to express autistic traits and manage the emotional exhaustion and stress associated with camouflaging.
• Enhancing emotional well-being: Using techniques such as positive reinforcement and antecedent modifications to manage challenging emotions and develop effective coping strategies (Apex ABA Therapy).

Late Diagnosed Women: Autism Help

Women with autism should remember that masking and sensory processing differences are common, and it’s perfectly okay to seek support, gradually unmask, and prioritize self-care. Grateful Care offers resources and guidance specifically for women with autism.

It’s also important to understand that late diagnosis is frequent. While it may come later in life, a diagnosis can bring clarity, a deeper understanding of past experiences, and validation of struggles. Prioritizing personal needs and finding a balance between expectations and self-care is essential for overall well-being.

Key points to keep in mind:

• Masking and camouflaging are common: Many autistic women hide their traits to fit in, which can lead to misdiagnosis or being overlooked. This often results in exhaustion and anxiety.
• Sensory sensitivities may be internalized: Some sensitivities, like discomfort with certain fabrics, lighting, or sounds, can be subtle and suppressed, leading to overwhelm or burnout.
• Late diagnosis is frequent: Stereotypes and masking contribute to delayed recognition. Receiving a diagnosis, even later in life, can provide relief and new insight into past challenges.
• Executive functioning challenges are real: Difficulties with planning, organizing, and managing tasks are common but may be misunderstood as being “emotional” or “dramatic.”
• Prioritize self-care and boundaries: Balancing personal needs with external expectations is crucial to prevent burnout.
• Unmasking is gradual: You don’t need to reveal everything at once. Safe environments, like trusted friends or supportive social groups, are ideal for gradually unmasking.
• Finding community is beneficial: Connecting with other autistic women offers support, understanding, and a sense of belonging.
• Your interests are valid: Deep, focused interests are normal and valuable, even if they differ from those of autistic males.
• Be yourself: Your traits are not a problem to be fixed; they are an important part of who you are. You are complete and valuable as you are.

FAQ’s

1. Why are girls and women often undiagnosed with autism? Autism can look different in girls than boys. Girls may mask their challenges to fit in socially. Their interests, like books, animals, or celebrities, may seem typical. Strong verbal skills can hide social difficulties. Co-occurring conditions such as anxiety, depression, or OCD can mask autism. Societal expectations for girls to be socially skilled may hide struggles.

‍

2. How does autism show up differently in girls compared to boys? Girls often mimic peers and appear socially motivated, even if they struggle with social cues. Boys usually show more obvious social communication difficulties. Girls’ interests often seem typical, while boys’ interests are often unusual or very specific. Girls tend to internalize difficulties, leading to anxiety or depression. Boys often display external behaviors like aggression or hyperactivity. Masking in girls can delay diagnosis, while boys’ behaviors are more easily noticed.

‍

3. What are common signs of autism in girls? Imitating peers or using social scripts to fit in, difficulty with unstructured time like recess or lunch, few but intense friendships, quietness or selective mutism, trouble expressing emotions, literal thinking and difficulty understanding sarcasm or jokes, deep focus on socially acceptable interests, need for routine and predictability, sensory sensitivities (clothing, sounds, lights), perfectionism and rule-following, subtle repetitive behaviors (stimming), anxiety, depression, or after-school meltdowns, and high emotional sensitivity.

‍

4. How can ABA therapy help girls with autism? ABA builds social and communication skills, reduces challenging behaviors like tantrums or aggression, teaches life skills including hygiene, routines, and academic or motor skills, uses the child’s interests to make learning engaging, supports emotional regulation and independence, and works for all ages, including adolescents and adults.

‍

5. What are the key components of ABA? Positive reinforcement to encourage helpful behaviors, breaking skills into small, manageable steps, Functional Communication Training (FCT) to express needs, and regular progress tracking to adjust therapy as needed.

‍

6. How can ABA help women diagnosed later in life? ABA develops daily living and life skills, improves social communication and relationships, supports focus, attention, and memory, reduces challenging behaviors, provides a safe space to express autistic traits, helps manage stress from masking, and enhances emotional well-being.

‍

7. Tips for autistic women: Masking and sensory differences are common; prioritize self-care. Late diagnosis is normal and can bring clarity and relief. Executive functioning challenges like planning and organizing are real. Gradually “unmask” in safe spaces. Connect with other autistic women for support and community. Your interests are valid, and your traits are part of who you are.