AUTISM IN GIRLS 1

Autism in Girls

Student’s Name

Institution

Author’s Note
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Abstract

Autism Spectrum Disorder (ASD) represents a complicated developmental disorder typically

known for affecting more males than females. Recent studies examining the ASD differences

between females and males show an increased instance of underdiagnosis of the disorder in

female candidates. This study examines some of the specific types of struggles and

mannerisms in females that differ from their male counterparts that contribute to

underdiagnosis and late diagnosis of the disorder in women and girls. This work aims to

explore the unique challenges that girls with autism face, such as social isolation and stigma,

and how they can be better supported. To examine the subject of interest, I conducted a

review of the literature on autism in girls, looking at both clinical and community-based

studies. The review of the literature is conducted from the perspective of understanding some

of the causes of underdiagnosis or late diagnosis of ASD in females including the ability of

girls to effectively camouflage ASD traits and differences in the manifestation of the

disorder. The study also explores the unique challenges for girls with ASD including the

physical, emotional, and mental problems and how they complicate the way girls experience

ASD.

Keywords: autism spectrum disorder, autism in girls, emotional, physical, mental

challenges, support.
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Autism in Girls

Introduction

Autism spectrum disorder (ASD) represents a neurodevelopment problem in which

the affected individuals experience impaired social communication and social reciprocity, as

well as instances of repetitive, restricted behavioral patterns (Loomes et al., 2017). ASD may

persist across an individual’s lifespan and is inheritable. Approximately one percent of the

people in the world have ASD. One of the notable features and striking aspects of ASD is its

more common diagnosis among males than females. ASD has typically represented a largely

male-associated issue with up to four times more diagnosis cases in males than female

subjects across the board (Davis, 2019). Recent studies in the area of interest acknowledge

the level of underdiagnosis of the disorder in the girls' population. This study contributes to

the current body of knowledge on ASD in females by exploring some of the unique

challenges and problems faced by girls with the disorder. It also explores some of the

possible differences in struggles and mannerisms in males and females to understand the

reasons for underdiagnosis in females. Increasingly, most of the underdiagnosed girls do not

receive the needed help exposing them to several secondary challenges (D’Mello et al.,

2022). ASD in girls presents a range of unique challenges in terms of mental, emotional, and

social problems an aspect that is complicated by the growing underdiagnosis of the disorder

in females compared to males.

Underdiagnosis/Late Diagnosis of Autism in Girls

Girls suffering from ASD are likely to be undiagnosed or may get a late diagnosis for

the condition. The development of early and accurate diagnosis for ASD in girls represents an

essential consideration as a means of ensuring optimized emotional and social development

of the affected persons. Past investigations such as that of Davis (2019) demonstrate that girls
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that failed to receive the required diagnosis by the age of eighteen years or older have an

increased chance to experience more struggles during their adult life. Part of the struggles of

undiagnosed or instances of ASD late diagnosis emanate from the understanding that the

patients lack access to the required professional help (CDC, 2022). The undiagnosed cases of

ASD in girls also imply that they are unlikely to access the necessary treatment for the

disorder that they ought to have gotten during the early years of life. The instances of ASD

underdiagnosis and late diagnosis are implicated in the perception that the disorder is a

largely male problem (Gray et al., 2021). In girls, the cases of late diagnosis and

underdiagnosis not only expose them to more unique struggles and challenges but also

excludes them from receiving appropriate medical attention complicating their young and

adult life.

Causes of ASD Underdiagnosis in Girls

Camouflaging

Females with autism possess a greater camouflaging ability for the various ASD

features than males with the same disorder. Camouflaging involves behaving and the

presentation of people in ways assuming the neurotypical order as a means of fitting into the

bigger society. Persons with camouflaging abilities can minimize the presentation of

abnormal behaviors, develop nonverbal communication, and imitate behaviors around other

individuals (Gupta & Chaudhary, 2021). Many females camouflage in terms of behaviors

enabling masking of some of the common ASD characteristics. In one investigation,

researchers established that girls and women reported having hidden some of the traits

associated with ASD successfully by maintaining the required amount of eye contact and

familiarizing themselves with some of the common stock phrases (Gupta et al., 2017). In

addition, a section of females with ASD report that camouflaging in the face of the disorder
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assists in the development of easy connections with friends and loved ones (Loomes et al.,

2017). Camouflaging autism traits seeks to help girls and females to effectively avoid the

spotlight, have dates, get employment, and come across as neurotypical in various social

settings.

In investigations in which the persons with autism completed a questionnaire, the

findings show that a large proportion of females try camouflaging tactics compared to males.

For instance, Myles et al. (2019) showed that over 90% of females with autism camouflage

the characteristics of the disorder compared to 89% of males who also tried to camouflage

autistic traits as a means of enabling them to appear normal in society. Whereas both male

and female patients try to keep the traits associated with autism hidden, the scores registered

among girls and women are significantly higher than those of individuals from the male

population. The foregoing findings suggest that females have a greater ability to camouflage

the effects of ASD in most settings than males (Davis, 2019). The consequence of the

camouflaging problem in girls relates to the growing cases of underdiagnosis and late

diagnosis of the disorder in some situations.

Differences in ASD Manifestation in Females and Males

The different characteristics associated with autism have a unique presentation in

females and males suffering from the disorder. The differences in the level and type of

presentation result in a range of false negative diagnosis outcomes in females evaluated for

ASD (Rujeedawa & Zaman, 2022). Current evaluation methods for diagnosing ASD are

tailored and calibrated according to the male-specific considerations including instances of

aggression, hyperactivity, the development of styles of interaction, as well as a range of

highly obsessive interests. The application of the male-specific diagnosis evaluations in

females with ASD is attributed to the generation of potentially false or misleading diagnosis
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findings for ASD in females. Research demonstrates that girls and women may not manifest

some of the autistic tendencies typical in males. Consequently, the cases of autism in girls go

undiagnosed or causes them to receive a late diagnosis (Davis, 2019). The late diagnosis

often results from instances in which the affected individuals present with severe impairments

in terms of learning abilities or behavioral challenges.

On the contrary, male persons displaying the hallmark traits associated with ASD

such as aggression and hyperactivity display concerning behaviors that cause teachers,

physicians, parents, and caregivers to seek medical evaluation increasing the chance of early

detection (Turnock et al., 2022). In a different direction, the females with the disorder are less

likely to display instances of aggression and hyperactivity seen in males despite the instances

of emotional impairment due to ASD. Similarly, persons suffering from autism often develop

interaction styles with a level of peculiarity to them. The peculiar styles of interaction among

male patients result in visible struggle in terms of developing and sustaining meaningful

relationships making ASD suspicion and subsequent diagnosis easier. For instance, males

with autism mostly display detachment and withdrawal characteristics in social settings as

opposed to girls and women who tend to look for social relations (D’Mello et al., 2022).

When females and male participants are assessed for aspects such as quality friendships and

empathy in ASD, fascinating findings emerge. While female patients post lower scores

compared to neurotypical individuals on quality friendships and empathy, their scores match

neurotypical males their age. Conversely, the males with ASD registered alarmingly poor

scores on all measures underscoring the differences in ASD manifestation in males and

females that lead to late diagnosis or underdiagnosis of the disorder (Gray et al., 2021). With

boys with autism appearing less neurotypical than girls in key social measures, it becomes

challenging for professionals to distinguish ASD cases in female subjects.

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The development and display of a range of obsessive tendencies represent one of the

hallmark factors for autism diagnosis among males. The findings from a recent investigation

demonstrate that the presentation of obsessive tendencies is one of the highly male-oriented

ASD features that their female counterparts develop less regularly (Davis, 2019).

Furthermore, most of the females suffering from autism with a marked display of obsessive

behaviors have fewer or present uniquely different obsessions than boys. The differences in

the obsessive passions between males and females are attributable to the increased likelihood

of overlooking the characteristics among girls during the process of diagnosis (Davis, 2019).

The gender-biased procedures for ASD evaluation have an impact of undermining the

potential of a true diagnosis among female subjects presenting for an autism assessment.

Unique Challenges Faced by Females with Autism

Proneness to Sexual Abuse among Females

Studies assert that autistic females experience a significantly higher risk in terms of

cases of sexual abuse (Davis, 2019). In a study in which investigators interviewed over 1050

women with characteristics consistent with autism, they established that a large proportion of

the candidates with higher autistic tendencies had suffered sexual abuse in the past. In

particular, the cases of sexual abuse were 40% in persons with higher autism-related

symptoms than those with fewer characteristics at 26% (Davis, 2019). The women receiving

late ASD diagnoses have been studied in which researchers asked the individuals about their

adolescent sexual experiences (Gray et al., 2021). Despite reviewing the findings from a

small sample of fourteen participants, a total of 9 women reported an experience of sexual

abuse. The greater level of sexual abuse in girls with autism is partly due to their level of

vulnerability as well as the inability to perceive danger (Gray et al., 2021). Often, female
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individuals with the disorder may also feel a growing obligation to fit in through the

development of unwanted sexual relations.

As earlier established, the girls with the disorder make a targeted attempt to

effectively camouflage the condition in ASD (Davis, 2019). The ability to camouflage

predisposes them to an increased risk of experiencing instances of sexual exploitation. As

females on the spectrum make an effort towards the prevention of potential social rejection,

the level of vulnerability to dangerous and sexually abusive situations increases. For example,

if a normal girl develops a sexual relationship with a male counterpart, an ASD female may

also develop a growing desire to establish a similar relationship increasing the risk level for

sexual abuse. Similarly, a patient that has to seem male persons expressing an interest in

female-male sexual relations can easily develop the perception that sexual promiscuity is a

way of getting oneself a partner (Mademtzi et al., 2017). The findings help in showing the

extent to which females on the autism spectrum have a greater level of vulnerability to cases

of sexual abuse than boys.

Greater Risk for Secondary Mental Health Problems in Females

Girls with ASD have an increased chance of having a range of other concerns and

disorders. The development of the resulting secondary issues including sexual disorders,

psychological disorders, and in some cases eating disorders has the potential to worsen ASD

characteristics (Davis, 2019). In some other instances, the secondary disorders can contribute

to the masking of the common ASD traits in female patients who have not received a

diagnosis for the condition. The development of a greater understanding of the association

between autism and the various secondary conditions may play a pivotal role in the process

of assisting healthcare professionals in the provision of well-targeted and holistic care

Psychological Disorders
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Clinical research data suggests that females with ASD possess an increased risk for

the development of instances of anxiety and depression (Myles et al., 2019). The

manifestation of mood disorders in anxiety and depression have been shown to occur even

before one receives an autism diagnosis. In addition, females with autism develop significant

suicidal tendencies more than males with the same disorder. As many as 74% of females with

autism report a suicidal self-injury history compared to 53% of their male counterparts with a

similar history (Davis, 2019). The predisposition of females to more secondary psychological

issues is complicated by the issues around late diagnosis and underdiagnosis.

Miniscalco and Carlsson (2022) present several case studies involving girls with

autism that help in demonstrating the issues around underdiagnosis and the unique challenges

experienced by girls with the disorder. A case example involves a girl aged six years, pseudo

name, Anna. At her initial assessment, the girl was 3.8 years without any family history of

autism in which her parents reported instances of typical word development and babbling

(Miniscalco & Carlsson, 2022). Anna had several older siblings in the family and her

challenges were not noticed early by her parents. The parents of the child reported during the

assessment that Anna displayed marked satisfaction with herself and could not show or share

any interests with any of her siblings or other children. At home, the girl would like to play

with small animal toys where she would line the toys up in long lines and thereafter sort the

toys by color. Following a multidisciplinary assessment effort, they determined that the girl

of interest met the autistic disorder and ID with a performance intelligence quotient (PIQ) of

77 and a score of 6 on the Autism Diagnostic Observation Schedule (ADOS) severity scale

(Miniscalco & Carlsson, 2022). The case of the girl is unique because she did not camouflage

the features of autism to the extent of leading the practitioners to dismiss the potential for

having ASD.
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The case report demonstrates that the girl talked a great deal in which she largely

employed what the investigators term as echolalia. The girl could read a story verbatim from

a well-established book although she demonstrated a lack of understanding of any

instructions or words from the test focusing on her receptive language (Miniscalco &

Carlsson, 2022). The receptive language of the girl remained below average with an average

level of vocabulary in which she could speak sentences consisting of up to four words.

Whereas the child’s autistic presentation had increased over time, the adaptive functioning of

Anna seemed like other neurotypical girls. At age 7.3 years, a marked reduction in word

comprehension and language occurred (Miniscalco & Carlsson, 2022). The foregoing case

helps in showing that if the girl’s case could receive a late diagnosis, she would probably face

more challenges given the worsening situation between 3-7 years.

Sexual Disorders

The current body of research in this area indicates that females with ASD present a

greater risk for experiencing sexual disorders such as instances of poor sexual functioning,

discomfort, and related difficulties (Davis, 2019). One investigation found that female

participants with ASD experienced an increased level of sexual issues than their male

counterparts and neurotypical women (Whitlock et al., 2020). Reported difficulties not only

involve limited sexual functioning such as challenges in attaining the required level of

arousal and lubrication but also discomfort in terms of sustaining sexual relationships.

Investigators suggest several reasons behind the idea of women with ASD experiencing

sexual challenges. One of the notable issues relates to the problems that patients have in

terms of initiating and maintaining productive social communication (Davis, 2019). Females

with ASD also have the problem of developing an appropriate understanding of different

social signals contributing to the development of different sexual problems than males. The

highlighted challenges limit the ability of women to effectively address the dynamics
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concerning sexual relations which, is a usually complex undertaking (Turnock et al., 2022).

The development of sensory challenges including touch hypersensitivity and sensory

integration issues contribute to the sexual problems unique to female patients.

The females suffering from ASD may also have instances of anxiety and discomfort

concerning sexual encounters and sexual relations than neurotypical women or even males.

The resulting level of discomfort is implicated in the limited level of knowledge and

awareness about existing social expectations and norms about sexual conduct (Rujeedawa &

Zaman, 2022). Girls with autism are most likely to experience poor regulation of emotions

and feelings that complicates the requirement of navigating situations involving greater

emotional intensity. Furthermore, investigations demonstrate that girls with ASD have self-

advocacy challenges in which one finds it difficult to effectively communicate desires and

needs regarding sex and sexual situations. Consequently, limited satisfaction or pleasure may

result contributing to the already existing sexual problems faced by women. Whereas females

or girls with the disorder in autism face a greater risk of presenting different sexual disorders,

challenges, and difficulties, some may not develop notable problems (Myles et al., 2019). The

provision of the necessary interventions and support may offer a strong basis for women to

develop largely satisfying and healthy sexual relations.

Eating Disorders

The development of eating disorders represents one of the key comorbidities in girls

with ASD. Whereas the problem of eating disorders has typically been associated with

women, recent research demonstrates that more individuals from the male gender also suffer

from a variety of eating challenges (Myles et al., 2019). Despite the foregoing consideration,

girls with ASD still present a greater risk for the development of eating disorders compared

to normal peers. One study showed that a greater eating disorders prevalence occurs in

females with ASD. The estimated prevalence in females with ASD and the general
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population was 14.8% and 5.5% respectively an aspect that suggests a bigger risk for girls

(Davis, 2019). Part of the reason for the increased risk for eating disorders relates to the

understanding that most females get a late ASD diagnosis and treatment. In addition, another

large proportion goes underdiagnosed rising the risk of developing problems in their adult life

including eating challenges (Maniscalco & Carlsson, 2022). Females develop more serious

issues associated with ASD coupled with a comorbidities risk including instances of eating

disorders.

Females with ASD suffer from different forms of eating disorders. The literature

identifies issues such as binge eating, bulimia nervosa, and anorexia nervosa disorder

specifically associated with ASD in female patients (Whilock et al., 2020). The problem of

anorexia nervosa has hallmark features involving the development of a weight gain fear

leading to the use of restrictive eating patterns. People may also create a negative body image

in instances of anorexia nervosa. On the contrary, in bulimia nervosa, the affected individuals

embrace binge eating accompanied by behaviors such as excessive exercise, and induced

puking (Mademtzi et al., 2017). Individuals will in most cases develop recurrent eating

patterns involving increased consumption of food with limited control.

Several factors exist that contribute to the eating disorders risk in girls with ASD.

Sensory sensitivity is a key factor in which females with ASD express considerable

sensitivity to tastes, smells, and textures adding to the problem of having tolerable foods. The

foregoing results in girls with ASD displaying a range of restrictive habits in terms of eating

limiting the variety of foods that an individual can consume. The various challenges

associated with social situations in persons with ASD particularly females may make it

difficult for individuals to eat with others or to consume food in public places (Loomes et al.,

2017). Females with ASD develop loneliness and isolation feelings resulting in poor eating

habits.
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In addition, the growing emphasis concerning social expectations and cues about an

individual's body image contributes to different eating disorders. Many females with the

disorder in autism may have challenges in terms of developing the required understanding of

body image and social cues. Females with the disorder become increasingly vulnerable to the

growing pressures from the social realm about aspects such as physical appearance and

thinness. Consequently, one is likely to have a distorted poor image contributing to the

involvement of disordered food patterns and habits as a means of controlling one’s weight

(Gupta & Chaudhary, 2021). Furthermore, females with ASD may develop deficiencies in

executive functions due to late diagnosis and treatment of the condition in ASD. The patient’s

ability to organize, plan, and execute complex activities such as the preparation and planning

of meals becomes difficult. The executive function issues contribute to the problems suffered

by the girls with ASD to manage and plan meals leading to the potential to develop irregular

meal patterns as well as binge eating or meal skipping.

A range of unique challenges exist for girls with ASD associated with the process of

treating the various eating problems that may arise in the course of the illness. One of the

notable considerations entail the need for developing an accurate assessment and diagnosis of

the eating disorder and related co-occurring issues including instances of depression and

anxiety (Gray et al., 2021). Addressing eating problems requires different approaches to

assist females with ASD to develop better outcomes. Overall, the risk of girls with autism for

presenting eating disorders is evident in their increased likelihood of a range of different

challenges and difficulties. The challenges that affect girls include social problems, sensory

sensitivity, and deficits in the executive functions that influence meal planning and

subsequent eating patterns.

Social Isolation and Stigma

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The challenges associated with social interaction and communication in girls with

autism predispose them to instances of significant social isolation and stigma. Autistic girls

experience problems in terms of making friendships, social cues awareness, and social

activities engagement (D’Mello et al., 2022). The foregoing may result in feelings of social

isolation and the feeling of being sidelined in social settings and groups. Similarly, females

with autism face the challenge of communication including problems with maintaining and

initiating productive conversations (Davis, 2019). The patients also struggle with proper non-

verbal cues interpretation increasing the feeling of isolation complicating the aspect of

developing effective connections with others in social settings.

The special interests of girls with autism expose them to stigma and isolation. While

the expression of passion about an activity or topic is not a problem, the development of

obsessions through a strong interest in given aspects in autistic girls can be challenging. Girls

with autism may become highly fixated on a particular interest causing others to feel

excluded (Davis, 2019). The fixation leads to situations where one experiences social

isolation when other societal individuals fail to share intense interests in particular things. In

addition, some people may not share such a strong fascination as is the case with some girls

with autism (Davis, 2019). Since girls with ASD have problems with effective

communication, they may share interests in ways that other societal people do not relate

complicating the issue of social isolation and stigma.

The gender factor also comes into play as a contributing factor to discrimination and

stigma against girls with ASD. Recent findings from the research suggest that ASD is largely

framed and perceived as a dominantly male problem (Whitlock et al., 2020). Consequently,

beliefs that females with autism are virtually non-existent may develop. The underdiagnosis

of female autism also reinforces the perception that males are more affected by the disorder

than females. The result is that females with ASD are likely to be dismissed or overlooked
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not only in the social realm but also by healthcare practitioners. Professionals may fail to

notice the features and symptoms of the disorder due to camouflaging abilities of girls. In

addition, cases of stigma and isolation arise due to the mental issues associated with ASD that

some girls may display. Mental conditions are common in girls with autism including

depression and anxiety compared to normal girls or even males. The stigma concerning the

mental challenges of ASD among girls limits their ability to seek assistance (Turnock et al.,

2022). The mental challenges are likely to remain unaddressed, an aspect that adds to the

issue of stigma for girls with ASD.

Education presents unique challenges to females with ASD. In addition, the

individuals experience difficulties in social settings and relations such as communication

causing issues around participation in collaborative and group tasks with other persons.

Similarly, girls with autism have problems with the development of executive functions such

as organization and planning skills leading to lower academic attainment in school (Davis,

2019). The girls also suffer from sensory problems including sensitivity to noise making it

hard to sustain the required level of attention in school settings. The resulting academic

problems for girls with autism contribute to social stigma and isolation.

Interventions for Girls with Autism

Behavioral and Psychological Interventions

Behavioral interventions in autistic girls seek to mitigate the various challenges while

promoting well-being and development in the patients. Several behavioral interventions have

been developed including applied behavior analysis (ABA), social skills training, cognitive

behavioral therapy (CBT), and visual support (Frost et al., 2020). In ABA, the professionals

focus on the use of a comprehensive strategy against the condition of autism in which the

focus is on examining behaviors and skills by breaking them into sizeable components. The
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different behaviors and skills are taught to the girls systematically. Strategies such as positive

reinforcement may assist in ABA to encourage the girls with the disorder to behave in the

desired way while limiting some of the challenging behaviors associated with instances of

autism in girls. On the contrary, the social skills training focus on girls is based on the

understanding that most girls with ASD face challenges with communication and the

development of social interactions. In social skills training, the emphasis is on assisting girls

by teaching them socially appropriate behaviors including the initiation of conversations,

turn-taking, and the use of eye contact (Frost et al., 2020). The social skills training

interventions implementation relies on the use of a variety of approaches including individual

coaching, role-playing, and related group activities.

CBT forms a notable behavioral intervention in ASD among girls. The intervention's

aim relates to assisting the affected girls with developing an understanding as well as

identification of one's behaviors, emotions, and thoughts. The primary focus of CBT is on

helping individuals in the process of replacing potentially negative and undesired thoughts

with a range of adaptive, positive thoughts and mental states (Loomes et al., 2017). The use

of CBT in girls with autism is associated with numerous benefits including improved

depression and anxiety management. CBT also assists with addressing the challenges with

emotional regulation in girls with autism. In a different direction, the use of visual supports in

ASD girls including visual cues, social stories, and visual schedules has been shown to with

the process of environment navigation and a better understanding of one’s surroundings

(D’Mello et al., 2022). The application of visual aids offers a highly structured and

predictable approach that supports the aspects of organization, communication, and increased

expectations of understanding in girls with autism.

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Behavioral interventions also include pivotal response treatment, or PRT (Davis,

2019). The intervention represents a child-led, realistic intervention focusing on

developmental areas of the affected individuals such as self-regulation, motivation, social

initiation, and the development of multiple cues responses. PRT has been employed in the

literature to increase the level of motivation in girls with ASD in terms of communicating and

learning through the use of interests while giving individuals a range of natural learning

opportunities. Apart from PRT, the application of highly predictable and structured settings

may assist with many of the challenges experienced by girls with ASD. Several benefits

could be derived from the use of predictable and clear environments among girls with ASD

(CDC, 2022). For instance, researchers suggest that the development of clear expectations for

girls with the disorder together with consistent routines play a role in assisting with anxiety

reduction and enhancing one's security sense. The approach plays a role in assisting girls to

gain increased confidence while limiting potential anxiety. One of the notable

recommendations relates to the need to develop well-organized and calm spaces for girls with

autism.

In sensory integration therapy as part of behavioral interventions, the approach is

informed by the idea that most patients with the disorder display a heightened sensory

sensitivity, particularly girls. In addition, girls with ASD face marked challenges during the

sensory information process activities (Gray et al., 2021). The use of sensory integration

therapy may assist girls' ineffective sensory information processing. The goal of the therapy

is achieved through the provision of exercises and activities seeking to enhance sensory input

integration and regulation. The intervention assists in limiting the challenges in sensory

regulation among girls while enhancing instances of self-regulation. Similarly, family and

parent training has been used as a means of supporting girls with autism. Families and parents

receiving training on the key approaches for supporting girls with ASD help in understanding
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and improving how girls manage ASD-challenging behaviors (Gupta & Chaudhary, 2021).

Family and parental training in ASD help in developing supportive and consistent settings for

girls with ASD to thrive.

Interaction and communication skills challenges represent the common challenges in

ASD. Despite the underdiagnosis of the disorder in girls more than in boys, different

beneficial psychological interventions help in managing the challenges of ASD. Apart from

CBT and ABA, approaches such as occupational therapy have been effective in helping ASD

patients including girls in gaining important adaptive skills and independence in their daily

living (Frost et al., 2020). The main focus of the intervention is on self-care ability, motor

skills, and improvement of the sensory integration of individuals with ASD. The therapy also

plays a pivotal role in limiting the various sensory sensitivities suffered by autism. Research

on ASD interventions indicate the need for a specific intervention combination to rely on

patient-specific conditions and needs in terms of developmental level, strengths, and disorder

manifestation (Gupta & Chaudhary, 2021). In addition, the implementation of an ongoing

assessment process and intervention adaptation to the changing needs of patients is required

to support better management and improved wellness of girls with ASD.

Educational Interventions

Researchers like Frost et al. (2020) suggest that recognizing the uniqueness of each

girl in terms of requiring individualized strategies plays a pivotal role in intervention

formulation and implementation. As earlier discussed, ASD manifests differently in girls and

boys and also presents individual differences in its development and presentation among girls

in terms of symptoms such as behavioral difficulties. Different educational interventions exist

for ASD that might assist in addressing the disorder's challenges among girls. The use of

individualized education plans (IEPs) represents one of the highly used educational
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interventions in autism (Gupta et al., 2017). IEP represents a document that offers a range of

specific support and educational goals for disability learners including ASD challenges. IEP

involves a collaborative effort among parents, educators, and related stakeholders. IEP

provides girls with instances of ASD with benefits including educational support,

modifications, and accommodations. Some girls have received other educational

interventions such as language and communication therapy. Also known as the speech-

language intervention, the strategy focuses on improving the language skills of the affected

individuals as well as functional communication abilities (Gupta et al., 2017). The speech-

language intervention is associated with greater speech clarity using alternative systems for

communication such as electronic devices and picture symbols.

The provision of executive functioning support falls under educational interventions

in which the focus is on aspects such as time management, planning, and organization skills.

The provision of instruction and training in executive functions has been shown to promote

skills related to the areas of planning (Davis, 2019). Together with interventions such as peer-

mediated strategies, the educational approaches present notable improvements in the aspect

of autism management. In peer-mediated approaches, the goal is to offer an opportunity for

improved social interaction development with greater inclusion of individuals with ASD. In

the school setting, educators can engage in the process of training normal classmates in terms

of interaction and support of peers with ASD (Rujeedawa & Zaman, 2022). The peer-

mediated training is particularly important in the process of improving one’s level of social

participation, development of greater understanding, and the demonstration of qualities such

as empathy.

In addition, inclusive education has been employed as part of an educational

intervention for ASD. The mainstream classroom inclusion of girls with autism coupled with
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relevant accommodations and support is pivotal in ensuring that girls gain an opportunity to

learn with their neurotypical counterparts. The intervention and approach as been associated

with benefits such as increased acceptance, better social interactions, and improved

understanding an aspect that boosts social confidence (Rujeedawa & Zaman, 2022). The

combination of inclusion of ASD girls in education with strategies for emotional regulation is

particularly crucial given how ASD girls experience consideration dysregulation of emotions,

stress, and anxiety. The focus on teaching girls effective self-regulation techniques such as

mindfulness, deep breathing, and problem-solving may increase their ability for emotional

management. Girls with ASD also require support through collaboration. Collaboration

entails working together and partnership development of therapists, parents, and other

stakeholders including educators (Turnock et al., 2022). The use of strategy sharing, regular

communication, and the establishment of constructive support networks ensures a holistic and

consistent approach to girls' education in ASD.

Pharmacological Interventions

Girls with autism may require pharmacological interventions seeking to address the

various ASD symptoms and other co-occurring illnesses. In most cases, interventions may

not assist in providing a cure or treatment of the disorder's core features (Frost et al., 2020).

While each girl may have unique presentations of the disorder, the development of treatment

plans has to be tailored to individual needs based on the determination of healthcare

practitioners. Common considerations include the use of antipsychotics in autism. The

medications include aripiprazole and risperidone which have been used in managing potential

aggression, irritability, and self-injury tendencies in some individuals with autism. The

development of severe tantrums can also be mitigated using psychotics that assist in
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neurotransmitter regulation within the brain (Turnock et al., 2022). The medical intervention

using antipsychotics assists in limiting disruptive behavior development.

Mood stabilizing, Selective Serotonin Reuptake Inhibitors (SSRIs), and stimulants are

variously used in autism. Mood stabilization in ASD relies on agents such as valproic acid

(Davis, 2019). The medications are crucial in the process of managing instances of mood

changes in ASD as well as the potential for aggressive tendencies. The development of the

aforementioned challenges in girls with the disorder may call for the need to use medications

seeking to achieve increased mood stabilization. Mood stabilizations are also associated with

effective mood regulation and assist in instances of heightened mood disturbance (Frost et al.,

2020). On the contrary, the literature also identifies SSIR therapeutic agents such as

sertraline, an antidepressant agent that helps with depression, anxiety, and compulsive-

obsessive behaviors that may arise in girls with autism. SSRIs act by rising the serotonin

levels in the brain in terms of its availability. Stimulants may also be used in ASD among

girls. Some of the notable stimulants include amphetamines that are known to assist in

comorbidities management in autism. Stimulants in girls with autism enhance the level of

impulse control, attention, and one’s focus (D’Mello et al., 2022). In some instances, the

patients may require the administration of sleep aids. A notable therapeutic agent used as a

sleep aid in ASD includes melatonin known to boost sleep quality through sleep pattern

regulation.

Ways of Providing Impactful Support for Girls with Autism

The provision of impactful support for girls with autism relies on the use of well-

tailored and comprehensive strategies that recognize the various individual-specific and

gender-specific challenges and needs of girls. The literature identifies several support

approaches that could be used on girls diagnosed with autism (Davis, 2019). The efforts to
AUTISM IN GIRLS 22

ensure an early diagnosis and identification of the disorder in girls are crucial consideration in

the process of ensuring the affected individuals receive the necessary support in a timely way.

For instance, Davis (2019) suggests that the identification of an instance of autism early on in

girls is necessary given the understanding that girls largely camouflage the symptoms of

ASD. In addition, girls may display slightly different disorder symptoms compared to their

male counterparts, calling for the need for an increased effort for ensuring that girls with the

disorder do not go undetected. It is necessary for governments and agencies seeking to

address the problem of autism to make a targeted effort to ensure healthcare professionals,

teachers, and parents remain highly aware of the unique autism manifestations in girls (Gupta

& Chaudhary, 2021). The identification of the signs of ASD early enough forms a key

foundation for ensuring early diagnosis to inform the development of well-tailored support.

The development of individualized education plans (IEPs) offers a pivotal support

strategy for girls with autism in a variety of ways. IEPs not only support the affected

individuals in realizing greater educational outcomes but also contributes to their overall

development (Loomes et al., 2017). The design and implementation of tailored plans for

educating girls with ASD are vital in offering appropriate support while enhancing their

probability of increased academic success. The significance of IEPs as a means of supporting

girls with ASD is underscored by the need to resolve a range of gender-specific

considerations for the persons of interest (Mademtzi et al., 2017). Girls with the disorder in

autism experience unique mental, social, and emotional challenges complicated by the

different manifestations of the disorder in most girls. The integration of IEPs plays a pivotal

role in terms of permitting educators to come up with highly comprehensive tools and

procedures for evaluating the areas of strength and weakness in girls with autism (Davis,

2019). Both support teams and educators gain an increased ability to offer a range of targeted
AUTISM IN GIRLS 23

interventions as a means of addressing the various unique problems experienced by girls with

ASD.

As a support tool, IEPs assist in the development of personalized goals for girls

suffering from ASD. The support of the need for individualized learning plans in IEPs assist

girls with special needs to access tailored support. In autism, the personalized plans for

learning targeted for girls may include accommodations and strategies that take into

consideration aspects such as potential communication, sensory sensitivity, and learning

problems (Miniscalo & Carlsson, 2022). IEPs help in fostering a learning setting that

supports inclusivity using structured and tailored approaches that may contribute to the

efforts to maximize the potential of girls in social and academic life.

The support for girls with autism may also focus on the development of their skills

concerning the area of social interactions and development. The literature identifies the issue

of communication and social interaction as notable problematic areas for girls with autism.

Whereas the communication and social interaction challenges for girls with ASD may vary

significantly from those displayed by boys, they still need support in that area (Myles et al.,

2019). The use of IEPs that seek to address the social skills considerations for girls with the

disorder may use a range of different strategies. Some of the notable strategies in the area of

interest may include the use and incorporation of role-playing activities, the aspect of social

stories, and the inclusion of girls with ASD in various programs for peer mentorship (Davis,

2019). The described interventions have been shown to contribute variously towards ensuring

that girls with ASD develop a greater ability to navigate challenging situations within their

social life (Whitlock et al., 2020). In addition, the support frameworks focusing on

communication and social skills for the girls may offer crucial support required to develop
AUTISM IN GIRLS 24

strong and meaningful relationships and friendships with both neurotypical and disabled

peers to different extents.

Conclusion

This research highlights the unique challenges for girls with ASD, the problem of

underdiagnosis of the disorder, and potential avenues for support and interventions for the

identified challenges. The findings from the work help in shedding light on the significance

of understanding and recognizing the distinct presentation of ASD in girls coupled with the

emotional, physical, and mental issues occurring throughout one’s life due to autism. A

notable finding from the investigation relates to the need to ensure early diagnosis of ASD

and increased awareness of the potential prevalence of the disorder in the population of

interest. The effort for ASD diagnosis in girls is complicated by their masking or

camouflaging ability which majorly contributes to delayed intervention or diagnosis. Key

stakeholders such as healthcare practitioners, educators, and parents require to demonstrate

awareness concerning the unique challenges and features of ASD in girls to enable the

development of appropriate support and early disorder detection. The development of

continued research focusing on the problem of ASD in girls will assist in advancing current

knowledge and understanding to inform refinement of the diagnosis and intervention

strategies specifically designed to address girls' challenges in ASD.

Method

Participants

The participants in the study involve girls aged 18 years or below. In terms of race,

this demographic is highly varied with the participants coming from diverse racial

backgrounds including whites and people of color given the diverse nature of the reviewed

research. Similarly, the ethnicity of the participants in the study varies and includes Asians,
AUTISM IN GIRLS 25

Hispanics, whites, and African-Americans (Davis, 2019). Each of the included research

studies employed a different approach for participant selection and recruitment. In one

investigation, participants were obtained from a Social Spectrum Study, a prospective

multicenter cohort involving clinically referred girls with an ASD focus. While the maximum

age of the subjects was set at 18 years, the studies involved participants with different ages.

Some researchers used subjects with ages 2.5 to 10 years who underwent routine screening

for ASD (D’Mello et al., 2022). The girls with an ASD diagnosis were also included in the

study.

Materials

The reviewed studies used different materials to explore autism in girls. Some studies

employed surveys and interview tools. For instance, Gray et al. (2021) used the algorithm

items derived from the Autism Diagnostic Interview Revised (ADI-R) to investigate the issue

of ASD in young girls. Additional materials include the standard diagnostic tool for autism.

The standard diagnostic tool together with the interviews provided the basis for

understanding the development of real-life cases and examples of behavioral changes and

effects due to ASD in girls.

Review Criteria

A literature review of clinical and community-based peer-reviewed studies was

conducted for this study. The peer-reviewed studies published within the past five years

reporting on primary data and case studies published in the English Language were eligible

for synthesis. The studies in consideration were mainly focused on ASD in girls reporting all

or one of the outcomes of interest. Key outcomes included underdiagnosis or late diagnosis of

ASD in girls, challenges of ASD in girls including the emotional, mental, and social
AUTISM IN GIRLS 26

challenges, or the interventions and supports for girls with ASD (Gupta & Chaudhary, 2021).

Studies not reporting on any of the identified themes were excluded from the review.

Search Strategy and Article Screening

The search terms “autism in girls,” “autism challenges in girls,” "autism

interventions," and autism support in girls" were used to search MEDLINE, PsycINFO,

Scopus, Google Scholar, and Web of Science databases. The Boolean terms (and, or) were

used in combination with the identified search terms in the various databases. In addition to

conducting the electronic searches, the reference lists of articles provided potential articles

fulfilling the developed search criteria. A rigorous screening approach was applied on the

studies fulfilling the inclusion criteria after which any duplicate studies were removed. A

total of twelve studies met the inclusion criteria for review.

Synthesis

A thematic synthesis approach was used for the identified studies. Some of the key

thematic areas included the causes of ASD underdiagnosis in girls that focuses on instances

of camouflaging, and the differences in ASD manifestation in girls and boys that make it

challenging to diagnose the disorder in girls (Loomes et al., 2017). The next thematic area

covered in the synthesis focused on the ASD unique challenges in girls including

susceptibility to sexual abuse, mental health issues risk, eating disorders, sexual disorders, as

well as social stigma and isolation (Davis, 2019; Mademtzi et al., 2017; Miniscalo &

Carlsson, 2022). The case studies looking into some of the addressed themes were also

reviewed.
AUTISM IN GIRLS 27

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