Social life does not come naturally. Girls may painstakingly study people to imitate them, developing a greater ability to hide their symptoms – yet another reason girls with autism may be hiding in plain sight.
In addition, the criteria for an autism diagnosis in girls is often masked by overlapping diagnoses. Autism and ADHD frequently occur together – and because people diagnosed with ADHD tend to have higher levels of autism traits then typical people do – girls who seem easily distracted or hyperactive may get the ADHD label, even when autism is more appropriate.
A misdiagnosis for girls on the spectrum can be particularly difficult, especially as they enter adolescence. Meeting the “mean girls” of junior and senior high school (and trying to decipher this new behavioral code) can be incredibly painful. Moreover, puberty involves unpredictable changes (horrifying to those with autism) that include breast development, mood swings, and menstruation.
The world is more dangerous for girls with autism as they develop sexually. Their tendency to take things literally, their social isolation, and their deep desire to connect and to belong, can make girls and women easy prey for sexual exploitation.
People with autism who do not seem interested in social life may not obsess about what they are missing – but those who want to connect socially and cannot are tormented by loneliness. In this way, autism may be much more painful for girls – and for women. 71% of adult women with Asperger’s reported suicidal thoughts; more than 10 times higher than the general population (Cassidy, et al., 2014).