03 Feb 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 and women 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. Autism underdiagnosed in females is a significant concern in autism diagnosis Australia — and it is one of the main reasons many women only recognise their autistic traits in adulthood.

It is important to engage with a professional who can help you identify the difference between autism and social anxiety. Common misdiagnoses in girls and women with ASD include social anxiety disorder, generalised 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 autism in female adults from any of the other diagnoses above.

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

• Strong verbal skills and an ability to mimic social behaviours.
• Better at ‘masking’ or camouflaging their difficulties or discomfort in social situations (explored in more detail below).
• A tendency to be overly compliant, which can make these individuals vulnerable.
• High levels of anxiety and depression.
• Sensory sensitivities. Interestingly, 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.
• 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 in diagnosing girls.

What is autism masking, and why does it affect women more?

Autism masking (also called camouflaging) is the conscious or unconscious effort to hide autistic traits in order to fit in socially. For many women, masking becomes so automatic that they may not realise they are doing it — which is a key reason autism masking in women so often leads to a late diagnosis.

Common masking behaviours include mirroring others’ gestures and expressions, forcing eye contact even when uncomfortable, rehearsing or scripting conversations in advance, keeping strong interests private, suppressing stimming behaviours, and pushing through sensory overwhelm without showing outward signs of distress.

While masking can help high-masking autistic women navigate school, work, and relationships, it comes at a significant cost. Sustained masking is exhausting and is strongly associated with anxiety, low self-esteem, identity confusion, and autistic burnout — a state of deep physical and emotional exhaustion that often prompts late-diagnosed autistic women to seek answers for the first time. If this resonates with you, a psychologist-led autism assessment with a clinician experienced in masked and internalised presentations can help make sense of a lifetime of experiences.

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 autism in female adults, 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 autism diagnosis Australia have created a need for support for individuals with ASD that present differently from what we commonly see. One of the biggest challenges girls and women with ASD face is anxiety. Girls and women with ASD can experience anxiety for a variety of reasons, which we explore below.

Why do people with autism experience anxiety?

• Difficulty understanding and navigating social situations, social cues, and social expectations. This can be challenging for girls and women with ASD and lead to social anxiety.
• Sensory sensitivities, including overwhelming sensory experiences that can trigger anxiety.
• Difficulty managing change and unpredictability, as individuals with autism may experience fear and anxiety when faced with unexpected change.
• 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.
• The ongoing effort of masking, which keeps the nervous system in a heightened state of vigilance during social situations.
• Co-occurring conditions such as ADHD or OCD may also contribute to anxiety.

What are the signs of autism in adult women?

Many women arrive at the question of autism after years of feeling ‘different’ without knowing why. Signs of autism in adult women can include lifelong social exhaustion despite appearing socially capable, intense and deeply focused interests, strong preference for routine and predictability, sensory sensitivities that others don’t seem to share, a history of anxiety or depression that never fully responded to treatment, and a pattern of masking followed by crashing in private. Some women begin exploring an assessment after an online autism test resonates with them, after a family member — often their own child — is diagnosed, or simply because they want to understand their profile of strengths and challenges. An adult autism assessment can provide the clarity and language that self-diagnosis and online quizzes cannot.

What supports are available for girls and women 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 autism engage with a multidisciplinary team of occupational therapists (OTs), speech pathologists, and psychologists.

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

• Cognitive Behavioural Therapy (CBT) supports individuals to manage symptoms of anxiety, depression, and social anxiety, which is a common presentation in girls and women with ASD. This can also help support coping with negative evaluation and reduce avoidance behaviours associated with anxiety.
• Neurodiversity-affirming therapy that helps late-diagnosed women unmask safely, understand their genuine support needs, and rebuild identity and self-compassion after years of camouflaging.
• 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.
• Parent coaching using a positive behaviour support approach is used to support parents in understanding their child’s individual needs and develop strategies to reduce any behaviours of concern.
• 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. Our psychologist autism assessment process ensures you receive an accurate evaluation and the necessary support, including presentations that standard screening tools can miss — such as masked and internalised autism in women. Assessments are available in-person at our Armadale clinic or via telehealth Australia-wide, and our comprehensive reports can also be used to support NDIS applications and workplace or study adjustments.

How can a Psychologist help you?

At Positive Wellbeing Psychology, we match you with a psychologist experienced in addressing your specific needs and therapy goals. Each of our psychologists has a special interest in particular areas and undergoes ongoing professional development to ensure up-to-date expertise.

Our clinic director carefully reviews each enquiry to ensure you are matched with the right psychologist for your concerns. You can feel confident knowing your psychologist will understand your challenges, address your needs, and highlight your strengths.

Frequently Asked Questions