8 often-overlooked signs of autism that are most common in women, according to specialists

• Autism spectrum disorder (ASD) is more difficult to identify in women than it is in men.
• This is because diagnostic criteria for autism was historically created with men in mind.

Autism spectrum disorder (ASD) is a neurological and developmental condition that impacts communication, behavior, and learning. It affects about 2.2% of adults in the US and is estimated to be about four times more common in adult men than women, but take this statistic with a grain of salt.

Research on autism was mostly done on boys and men, so it's likely that women are underrepresented among people with autism diagnoses, says Jessica Myszak, a licensed psychologist and director of The Help and Healing Center, which provides autism evaluations and other psychological screenings.

And that's not only a problem for statistical estimates but, more importantly, it's a serious issue for diagnosis.

Important: There is an ongoing debate on whether identity first (ex: autisic people) or person first (ex: people with autism) is more appropriate. Preferences vary from person to person, and keeping this in mind is important to avoid ableist language.

"Adult women and those who are assigned female at birth will likely have a more difficult time finding an adequate autism evaluation," Myszak says.

Up to 80% of women with autism are misdiagnosed, says Sarah Lister Brook, clinical director of the National Autistic Society in the UK. Yet, it's important for adult women who suspect they might have ASD to get a diagnosis, which can feel validating and unlock resources.

"Autistic women and girls often face additional barriers, with many having to live their whole lives without an autism diagnosis, an understanding of who they are, and vital support," Lister Brook says.

Signs of Autism in adult women

The diagnostic criteria for autism is the same for all genders and ages. But those criteria can present differently in adult women, Myszak says.

People may be familiar with symptoms of autism in children, like stimming — self-soothing with repetitive motions like hand flapping or rocking. Symptoms of autism in adults, however, are more subtle and include things like anxiety and or spending more time alone.

Women with autism often also mask their autism symptoms in order to conform to social expectations, says Lister Brook. However, this can be mentally taxing and can lead to burnout, says Sharon Kaye-O'Connor, an autistic psychotherapist and autism educator with Idlewild Intuitive.

Important: Signs of autism — like social withdrawal — can mimic mood disorders or mental illness. People with autism are also at increased risk for certain conditions like anxiety and depression. So, it's important to work with a provider experienced in evaluating multiple mental health conditions. If you're diagnosed with depression but think you also have ASD, get a second opinion.

Masking can make symptoms less apparent to others, but women with autism and people close to them may notice the following symptoms:

Friendships feel tough

Challenges with social interactions are one of the flagship symptoms of autism.

Women with ASD are often able to overcome that to make meaningful friendships, Lister Brook says.

Yet, these friendships "can often feel like hard work and therefore women with autism often need a lot of social downtime," she says.

Social exhaustion

Women with autism often feel like they have to work harder than others to achieve the same results, Myszak says.

That's in part due to masking their symptoms. School, work, and social interactions can leave them feeling exhausted.

Feeling different

Oftentimes, women with autism feel different, or like they have to hide who they really are.

To fit in, women with autism might adopt the mannerisms of other people, or characters on television, Kaye-O'Connor says.

Oftentimes, they can't put their finger on what makes them feel unlike their peers.

Focused interests

Like other people with autism, women with ASD often have hyper focused interests.

"Their special interests may, on the surface, seem pretty typical — horses, reading, particular television shows, doing nails — but their depth of knowledge and time spent on these topics is much more than you see in neurotypical females," Myszak says.

On the flip side, women with ASD might feel uninterested in areas that their peers are interested in, like dating.

Sensory overload

Women with ASD can often become overwhelmed by sounds, sights, smells, and other sensory inputs. Sensory overload can make you feel distracted or irritated. Yet, many women push through due to masking.

At other times, they may not be able to identify that they feel overwhelmed, Lister Brook says. Instead, they focus on solutions that make them feel better, like opting for loose-fitting clothes, only eating certain foods, and avoiding loud spaces.

Emotional dysregulation

Sometimes women with ASD can feel emotionally dysregulated, which means they have trouble controlling their emotions, while other times they have great control of their emotions, Lister Brook says.

They may have trouble identifying what emotions they're feeling, or connecting physical symptoms — like a stomach ache or headache — to their emotional state.

Desire for certainty

Many people with ASD, including women, thrive when they have predictable routines.

It can be difficult for women with ASD to tolerate uncertainty, and they can become anxious when they can't control the outcome of a situation, Lister Brook says.

Mood disorders

Many women with autism are misdiagnosed with mood disorders like depression or anxiety.

Over time, the burnout from masking symptoms can also lead to depression, says Kaye-O'Connor.

How to diagnose Autism in adult women

Getting an autism diagnosis as an adult can be difficult. It's best to reach out to a psychologist or psychiatrist who has specific experience in diagnosing ASD in adults. It can even be helpful to ask about their experience working with adult women specifically, Myszak says.

Many adults with autism self-diagnose after recognizing their symptoms. This can be validating, but in order to get insurance coverage or other support, formal diagnosis can still be important.

Formal diagnosis is made by a mental health professional. The process may or may not involve neuropsychological testing.

While getting a diagnosis can be scary, it's often validating for women with autism, Myszak says.

"Many people who do not have a diagnosis earlier in life worry that they are dumb, not trying hard enough, or going crazy — and peers can be just as cruel," she says. "For many adults who have not known whether they were autistic, learning the reason why they experience the world differently can be an incredible relief."

How to 'treat' Autism in adult women

Many people with autism and experts in the field, including Lister Brook and Kaye-O'Connor, reject the idea that autism requires treatment.

"Autism isn't an illness, and the goal isn't to make autistic people 'less-autistic,'" Kaye-O'Connor says. "It's to help autistic folks discover and grow into their true authentic, autistic selves."

Therefore, before pursuing interventions, women with autism should think about which areas of their lives they would like to change.

For example, perhaps they would like to learn to tolerate uncertainty, treat depression or anxiety, or reduce the impact that ASD has on their career. Then, they can pursue specific interventions and supports to address their needs, including:

• Therapies like cognitive behavioral therapy to manage symptoms.
• Occupational therapy, which can be particularly helpful with managing sensory overload.
• Medication, including ADHD medications and antidepressants.
• Education on ASD in adults.

"The most important support we can offer autistic folks is to help them identify and understand their own specific needs, and then to work together to find ways to meet those needs," Kaye-O'Connor says.

Insider's takeaway

Autism spectrum disorder is often diagnosed in childhood. However, some people aren't diagnosed until adulthood, while others never get a diagnosis.

Research around autism has traditionally focused on boys, so clinicians often aren't familiar with the way that autism presents in adult women.

"Girls and women have been falling through the cracks of autism diagnosis for a long time, and our field still has a lot of catching up to do as far as understanding how autism can present," Kaye-O'Connor says.

In addition, many adult women are adept at masking their symptoms. They've learned to take steps like making eye contact and minimizing their talk about special interests.

Yet, many people who are diagnosed with ASD as adults feel empowered by the diagnosis.

"For adults who have not known whether they were autistic, learning the reason why they experience the world differently can be an incredible relief," Myszak says. "So many of my clients are seeking validation and understanding — they have been told they are less than for their whole lives, and suddenly having an explanation for why things are the way they are is incredibly powerful."