Female Presentation

Girls on the Spectrum

We have included this section on female presentation as the way girls and women can present as autistic can be different from males and the ratio of diagnosis reflects this. In 1993 a study of Asperger syndrome in mainstream schools in Sweden, Ehlers and Gillberg found a boy to girl ratio of 4:1 and in 2017, a study by Loomes and other researchers analysed existing prevalence studies and found that the male-to-female ratio was nearer 3:1. Many professionals now believe the ration is nearer to 1:2.

Why the difference in male/female ratio?

The difference between male and female diagnostic ratios is mainly due to the diagnostic criteria, not taking into account how females present. Instead, it focuses more on the recognised way males present, especially in the ADOS2. This can lead to females either not receiving an accurate diagnosis or no diagnosis at all.

There are also some recognised differences in the presentation of their ASC characteristics:

  • Girls are much better as masking – mimicking what those around them are doing to try and fit in
  • Girls are generally better at ‘holding it together’ at school or in other social situations, with the explosion then occurring at home in their ‘safe space’ 

The impact of this, results in some diagnostic challenges, with 50% of boys receiving an autism diagnosis by the age of 11, whilst only 20% of girls receive their diagnosis by this age.

This situation gives rise to a higher proportion of undiagnosed females which in turn can lead to other problems manifesting themselves in poor mental health:

  • High anxiety
  • Self-harm
  • OCD behaviours
  • Eating disorders e.g. Anorexia
  • Depression

It is not right that is still happening, but this is changing for the better as more and more people and medical professionals begin to understand autism and how it presents. 

What are the main differences in the presentation in females?

Below are some key generalisations on differences. By no means are we saying this is always the case, but it is a helpful insight into understanding our girls/females.


  • Girls on the spectrum tend to dress and do their hair for comfort rather than for fashion
  • Much effort is often made to avoid drawing attention to themselves and making sure they fit in
  • Extreme shyness is often an issue, and there tends to be a reliance on others making the first social contact
  • Tend to have intense friendships with 1 or maybe 2 people, rather than aa circle of friends
  • Within play they tend to control what is happening as this then makes it feel safer
  • Girls are often more able to manage a reasonable level of eye contact and more likely to use gestures thought these may be exaggerated
  • Usually, girls want to have friends and are therefore socially motivated, but find it difficult to understand the rules and interactions needed for success. Extreme shyness is often an issue and there tends to be a reliance on others making the first social contact


  • While a good range of vocabulary may be present, it may be expressed in a scripted way
  • Maintaining two-way (reciprocal) communication is often challenging
  • Mimicking of mannerisms and social behaviours in an effort to fit

Behaviour Differences

  • Girls tend to hold things together and then explode then they get home
  • Perfectionism is a common feature
  • May have intense interests, but they tend to be for more typical subjects
  • May opt for playing with things for younger children. On closer observation, mimicking or re-enactment may be more at play than imagination.

Case Study

Photo of founder Diane


A Personal Story - ASD Diagnoisis

En-Fold’s founder shares some of her own personal journey to an adult diagnosis and how it has influenced her passion to make a difference.

Childhood was a place of confusion and isolation. Intense bullying and difficulty fitting in and understanding the world made life a challenging and rather miserable experience. To the onlooker, there was a slightly odd young person, but one who was achieving; after all school was for learning! Diagnosed with clinical depression by the age of 9, but no mention of why I didn’t seem to fit.

Read more