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Autism or ASD and Anxiety in Girls (including non-binary and transgender individuals)

What is the difference between boys and girls and ASD presentations? 

Autism, also known as autism spectrum disorder (ASD), affects individuals regardless of gender. However, girls with ASD may present differently than boys and have historically gone underdiagnosed or misdiagnosed. This is due to many factors, including gender biases in diagnostic processes, as most of the initial research into ASD used data from boys and men. 

Common misdiagnoses in girls and women with ASD include social anxiety disorder, general anxiety disorder, borderline personality disorder, and ADHD. These are seen more commonly as some of the symptoms overlap with ASD, and girls tend to be less ‘overt’ in their presentation, making it harder for professionals to distinguish ASD from any of the other diagnoses above. 

What are some common traits of girls with ASD that may be less seen in boys?

  1. Strong verbal skills and an ability to mimic social behaviours.
  2. Better at ‘masking’ or concealing their difficulties or discomfort in social situations.
  3. A tendency to be overly compliant, which can make these individuals vulnerable. 
  4. High levels of anxiety and depression
  5. Sensory sensitivities (girls are seen to be more sensory avoiding, such as disliking loud noises and certain textures, than sensory seeking, however, this is dependent on the individual and can be seen in boys too).
  6. Boys with autism are more likely to have more obvious repetitive behaviours (or stims), while girls with autism are more likely to have restrictive interests and less obvious stims, contributing to difficulties diagnosing girls. 

What do research findings show about the common traits of girls with ASD that may be less seen in boys?

There have been studies in more recent years into different presentations of ASD, and now more girls are being diagnosed at an earlier age, and adult women are being diagnosed later in life. This research has also led to a wider knowledge of ASD and how it presents as a whole, and studies have found some boys, gender non-conforming people and trans people also present in a way typically seen in ‘girls’. This new research and changes in diagnosis have created a need for support for individuals with ASD that present differently from what we commonly see. One of the biggest challenges girls with ASD face is anxiety. Girls with ASD can experience anxiety for a variety of reasons which we explore below.

Why do people with ASD experience anxiety?

  1. Difficulty understanding and navigating social situations, social cues, and social expectations. This can be challenging for girls with ASD, and lead to social anxiety.
  2. Sensory sensitives, including overwhelming sensory experiences that can trigger anxiety.
  3. Difficulty managing change and unpredictability, as individuals with ASD may experience fear and anxiety when faced with unexpected change.
  4. Fear of failure or negative evaluation, as individuals with ASD may be particularly sensitive to negative evaluation or getting things ‘wrong’ leading to anxiety in performance situations, or things like work avoidance in school-aged children. 
  5. Co-occurring conditions such as ADHD or OCD may also contribute to anxiety.

What supports are available for girls diagnosed with Autism and how can psychology help?

There is no single ‘treatment’ for autism, as it is a multifaceted condition that affects individuals in different ways. There are also common comorbidities that may come with ASD, including OCD, anxiety, depression, language delays and other medical conditions, which will change the way the individual will be supported and treated. Often individuals with ASD engage with a multidisciplinary team of occupational therapists (OTs), speech pathologists, and psychologists. 

What are common interventions psychologists use to support girls with ASD?

  1. Cognitive behaviour therapy, to support individuals to manage symptoms of anxiety and depression, and social anxiety that is a common presentation in girls with ASD. This can also help support with coping with negative evaluation and reduce avoidance behaviours associated with anxiety. 
  2. Social skills training and support navigating social situations to support girls who may not understand social cues and boundaries, teach them self-advocacy, and support them in building meaningful relationships with others. 
  3. Parent coaching using a positive behaviour support approach is used to support parents to understand their child’s individual needs and develop strategies to reduce any behaviours of concern.
  4. Individuals may also engage with an OT to understand and manage sensory needs, or a speech pathologist to explore communication and any language delays.

What about support with an assessment and diagnosis?

Should an assessment be required, the benefits and need for this can also be explored in a session with one of our warm and compassionate psychologists at Positive Wellbeing Psychology. We recommend starting with a session to discuss your needs as the first step.

How can a Psychologist help you?

At Positive Wellbeing Psychology, our private practice matches you with a highly skilled psychologist that can assist your individual difficulties, and therapy goals. Our team of highly skilled psychologists all have a special area of interest in various presentations and continue with ongoing training and professional development in their individual fields of interest to enable experience and expertise.

At Positive Wellbeing Psychology, our psychologists have their own special areas of interest rather than seeing all presentations, our clinic director makes sure each enquiry is reviewed to match you with a psychologist that has experience in the areas in which you are needing added support. You will have peace of mind that you will be matched with a psychologist that understands your individual difficulties, needs, and most importantly your strengths!

Written by Psychologist Megan Tomlinson at Positive Wellbeing Psychology

Megan is a warm and genuine therapist with a special interest in the neurodivergent space. Megan is passionate about delivering a welcoming, accessible, and comfortable therapy experience and encourages individuals to present as their authentic selves.

Megan has a special interest in supporting individuals with anxiety, depression, autism and ADHD, personality disorders (including borderline personality disorder), goal setting and capacity building under the NDIS, and continues to work within the transgender and LGBTQI+ space. Megan adopts a neurodiversity-affirming approach and has extensive experience working with females, including trans female, those assigned female at birth, and non-binary individuals with autism.

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