Are you a woman who struggles with social interactions or relationships? Does an unexpected change in your routine feel really overwhelming? Have you ever felt overstimulated in certain situations?
If so, you might be a woman with high-functioning autism.
In the United States, over five million adults have autism, and over one million are women.¹ Over the past decade, more girls and women are being diagnosed as more people recognize the signs and symptoms.²
But here’s the tricky part–females don’t always have the “classic” symptoms of autism spectrum disorder. This can lead to a late or missed diagnosis, which has negative effects on mental health and daily functioning.
At Iremia Psychiatric Care, we understand the unique symptoms of autism in women, and we’re here to help you get the treatment and clarity you need.
In this blog, we’ll cover:
- Key signs and symptoms of high-functioning autism in women
- The challenges of getting diagnosed
- How autism impacts mental health and social relationships
- Where to find support and resources
What is High-Functioning Autism?
Autism spectrum disorder (ASD) is a type of neurodevelopmental disorder that affects brain development and function. People are born with ASD, and it causes challenges with communication, behavior, and social interactions. Like other mental health conditions, ASD presents in different forms, ranging from mild to severe.
High-functioning autism is a term used to describe people living with a milder form of ASD. And while the term high-functioning autism isn’t an official diagnosis, many people with milder forms of ASD tend to identify with it.
While research is still ongoing, the cause of autism is thought to be a combination of genetics and certain environmental factors during pregnancy.³
The symptoms of high-functioning autism aren’t debilitating like with other forms of autism. Plus, high-functioning autism presents differently in men and women. This makes this type of autism easier to miss and even be diagnosed.
What Are the Signs and Symptoms of High-Functioning Autism in Women?
Women with autism have trouble interacting and communicating with other people. They can be very sensitive to their environment, have rigid behaviors, and have trouble handling emotions.⁴
Social Interaction Challenges in High-Functioning Autistic Women
High-functioning autistic women have problems with social interaction. Some examples include:
- Body language and eye contact: Autistic females have trouble understanding social cues, such as body language or gestures. Keeping eye contact is difficult.
- Trouble making new or keeping old relationships: It may be hard for autistic females to make new friends or be interested in other people. Making small talk is also hard.
- High rates of social anxiety: Some autistic women may also have social anxiety.
High-Functioning Autistic Women Have Communication Differences
This brings us to the next related sign of autism in women–communication differences. Some of these include trouble understanding sarcasm and humor.
It can also be difficult for autistic females to share emotions with others, like excitement or celebrating achievements.
Sensory Sensitivities in Women With High-Functioning Autism
Autistic adult females also have sensory sensitivities. They may feel overstimulated from sounds, lights, and even certain textures. Some examples include:
- Sound and light sensitivity: Lights, sounds and even scents can be overstimulating, which makes day-to-day life difficult.
- Tactile sensitivity: Women with autism may be more sensitive to certain textures of food, linen, furniture, or clothing.
- Physical interactions: Autistic females may not like physical contact with others.
Restricted and Repetitive Behaviors in Autism Spectrum Disorder
High-functioning autistic women often have restricted and repetitive behaviors (RRBs). These behaviors tend to include repeated movements, rigid routines, and interests that are more intense than neurotypical adults. Here are some examples:
- Repeated movements: Women with autism may perform repetitive movements, especially when anxious. Some examples of these movements include rocking, spinning, and hair twirling.⁵
- Intense, restricted interests: Women with autism may have deep passion for specific topics. But these may be considered socially “normal,” such as certain types of books, make-up, etc, which masks the intensity of the interest.
- Rigid routines: Their rigid routines look like rituals. Any unexpected change (for example, taking a different route to work) can be overwhelming.
Women With High-Functioning Autism May Have Trouble Regulating Emotions
Finally, sometimes autistic females can have trouble regulating their emotions. This may lead to meltdowns, emotional shutdowns, and anxiety.
How Does Autism Look in Men vs Women?
As mentioned earlier, autism presents much differently in men and women. Here are a few examples:
Trait | Men | Women |
Behavior differences⁶ | Tend to be more aggressive | May seem to “zone out” |
Restrictive and repetitive behaviors (RRBs)⁷ | More obvious RRBs like hand flapping and rocking | Typically less obvious RRBs like twirling hair |
Hyper-intense interests | Interests tend to be unique and not mainstream such as a specific animal or vehicle | Interests may seem “normal,” like make-up, celebrities, and fitness |
Social interactions | Struggle to start and maintain social interactions. This causes less desire to build relationships. | Typically have a stronger desire for social interactions. However, they struggle to develop deep relationships because of challenges with understanding communication and social cues. |
How Does High-Functioning Autism Affect Mental Health in Women?
People with autism can also have anxiety, depression, ADHD, and obsessive compulsive disorder (OCD).⁸ High-functioning autistic women can also get burned out from masking, or attempting to hide, their autistic traits in social settings.⁷
Females with autism can sometimes be misdiagnosed with another mental health condition.
For example, autism can be mistaken for borderline personality disorder (BPD). This is because it can be difficult to tell the difference between the two conditions, even for some healthcare providers.⁹
Autism can also be mistaken as social anxiety. Though, this can also be tricky to figure out as sometimes people with autism also have social anxiety.
Do Previous Life Experiences Affect Mental Health in People With Autism?
Compared to people who don’t have autism, experiencing trauma can have a greater impact on autistic children. This also increases the chance of having other mental health problems as adults.¹⁰
And any coping skills like masking and RRB’s that were developed as a child tend to carry over into adulthood.¹¹
The Unique Social Challenges Faced by Autistic Women
Neurodivergent women face unique social challenges. One of the main reasons that autistic adult females struggle socially is due to masking. Over time, masking can lead to emotional and social exhaustion and even autistic burnout. This has negative effects on an autistic woman’s mental health, social life, relationships, and workplace.
Trouble understanding social cues and sharing other people’s emotions can be a barrier to cultivating friendships. Some autistic women feel socially vulnerable since they can’t read social situations.¹²
Cultivating Romantic Relationships
Women with high-functioning autism may have trouble reading their partner and will often benefit from predictability in a relationship.
In one study, autistic women saw their romantic partner as their most important relationship.¹² Sometimes their partner served as a “social gatekeeper,” meaning that their partner’s friends would become their friends.
Whether it’s a friendship or a romantic relationship, navigating adult relationships as an autistic woman requires both patience and understanding from both sides. It can be easier with a few strategies like:
- Clearly communicate with each other and be transparent
- Establish a routine like a daily routine or weekly hangout
- Be aware of hypersensitivities and avoid overstimulating environments
- If there’s a big change that’s going to happen, allow enough time to adjust
Autistic women may also have trouble in the workplace as a lot of settings prioritize social and communication skills.
Some work environments are also overstimulating. If an autistic woman also has undiagnosed ADHD, it can feel impossible to focus and complete tasks.
If you’re struggling in the workplace, here are some tips to try:
- Organize daily tasks into blocks of time and arrange according to urgency when possible
- In between these blocks of time, allow yourself short breaks, whether it’s mindful movement or listening to music
- If possible, minimize distractions around your work area. For example, if sound is overstimulating, noise-cancelling headphones can be a game-changer
How Are Women Diagnosed with High-Functioning Autism?
The first steps to getting an autism evaluation include connecting with a qualified mental health provider and completing the self-assessment Autism-Spectrum Quotient (AQ).¹³
The mental health provider you work with will do an interview and observe your behavior. By combining this with the AQ, they’ll be able to tell whether you have autism.¹²
The signs and symptoms of autism in adult females can be hard to notice. And these symptoms can be confused with other mental health conditions like ADHD, social anxiety, or BPD. But if you have any of the above signs and symptoms of high-functioning autism, you should seek evaluation by a trained mental health provider.
It can be hard to sort out on your own whether or not you have autism. It’s important that you work closely with a trained mental health provider to see if you have this diagnosis.
Why Does High-Functioning Autism in Females Often Go Undiagnosed?
One of the biggest reasons why autism is often undiagnosed in women is due to masking. This means that women are better at hiding their autistic traits compared to men.⁶ Some examples of masking include:¹⁴
- Forcing facial expressions when talking with others
- Forcing themselves to make eye contact during conversation
- Consciously suppressing RRBs
- Having a script for social situations
Masking can lead to a late or missed diagnosis of autism for women.
Some other barriers and challenges to getting a diagnosis of autism also include:⁶
- Lack of information/resources: If you aren’t aware of autism, you won’t know to seek help.
- Clinician bias: There are still some clinicians who don’t know the signs and symptoms of autism in adult females. This is largely because many of the tools used to diagnose autism were made using male patients.¹⁴
- Other people’s perceptions: The view of autism as a “boys’ diagnosis” can be difficult for some caregivers to process. This can lead to hesitancy to seek help.
- Compensatory behaviors: Masking can make undiagnosed autistic women appear neurotypical. You may not even realize you’re masking until you’re placed in a new social situation.
If you’re reading this and feel that you’ve been misdiagnosed and may instead have autism, consider seeking another opinion or re-evaluation. When it comes to autism, it’s important to advocate for yourself so you can get the resources you need.
What Treatment, Support, and Resources Are Available for Autistic Women?
Once you have a diagnosis, there are resources and support groups that are there to help you!
Therapy and Counseling Tailored for Autistic Women
Every autistic woman has different healthcare needs, and this is why we offer tailored treatment approaches at Iremia Psychiatric Care. Some of these approaches may include:¹⁵
- Mindfulness-based (MB) Interventions: Therapy based on mindfulness can help manage stress and anxiety.
- Cognitive Behavioral Therapy (CBT): CBT can also help with managing stress and anxiety, and some CBT programs help improve social skills.
- Treatment of other related mental health conditions: Successfully managing other related mental health conditions like ADHD, OCD, and depression can also be helpful in navigating autism.
Managing mental health for autistic women should be individualized, and the above strategies should be done with a trained healthcare professional. In our practice, we pride ourselves on creating treatment plans based on each person’s individual needs.
Online Communities and Support Groups for Late-Diagnosed Women
From co-ed to women-only support groups, there are online communities that can provide a lot of help and support like:
- Autism Empowerment: This organization has a list of several online support groups for women diagnosed with autism
- Autistic Girls Network: A network that provides additional tips for autistic adult females
- Autism Speaks: An organization that lists general support groups for autistic people with diverse backgrounds
Strategies for Self-Care and Embracing Neurodivergence
It’s important to continue self-care as you navigate life with autism as an adult woman. Self-care strategies for high-functioning autistic women include:
- Nurturing the activities or interests that relax you, at least once a day
- If able, fill your home environment with sensory-friendly items for your individual needs
- Mindful movement or meditation can help you refocus and calm anxiety
This list isn’t all inclusive! Remember that your journey with autism is about progress, not perfection. Your neurodivergence should be embraced, not neglected.
Take the First Step With Iremia Psychiatric Care
Recognizing autism in yourself can be a powerful and validating experience. Understanding your adult autistic traits can help you navigate relationships, work, and mental health more effectively and ultimately lead to a more fulfilling life.
Seeking professional support can make all the difference.
At Iremia Psychiatric Care, we specialize in autism assessments and personalized mental health support for women. If you suspect you may have undiagnosed high-functioning autism or are struggling with related mental health concerns, we’re here to help.
Take the first step toward a more balanced, healthier you today.
FAQ: High Functioning Autism in Women
What are high masking traits in female autism?
Masking (or “camouflaging”) in autistic women means suppressing autism-related behaviors and mirroring neurotypical behavior. This may include having scripted responses, hiding repetitive behaviors, and forcing eye contact or facial expressions.
What are the symptoms of high-functioning autism in women?
High-functioning autistic adult females may have rigid routines and feel overwhelmed when there’ is unexpected change. They may be overstimulated by certain sounds, lights, or textures. They may also have trouble making new friends and cultivating relationships.
How to tell if someone is high-functioning autistic?
It can be difficult to tell if you or someone you love has high-functioning autism. If you have trouble interpreting social situations, communication challenges, intense interests, rigid routines, or repetitive behaviors, it could be time to be evaluated. Ultimately, working closely with your mental health care provider can lead to the best diagnosis and personalized treatment plan.
References:
1. National and State Estimates of Adults with Autism Spectrum Disorder – (nih.gov)
2. Autism Diagnosis Among US Children and Adults, 2011-2022 – (jamanetwork.com)
3. Autism Spectrum Disorder – (nih.gov)
4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.) – American Psychiatric Association
5. Barriers to an Autistic Identity: How RRBs may Contribute to the Underdiagnosis of Females – (nih.gov)
6. Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review – (nih.gov)
7. Sex differences in predictors and outcomes of camouflaging: Comparing diagnosed autistic, high autistic trait and low autistic trait young adults – (nih.gov)
8. Adults with Autism: Changes in Understanding Since DSM-111 – (nih.gov)
9. Positive and differential diagnosis of autism in verbal women of typical intelligence: A Delphi study – (nih.gov)
10. Impacts of adverse childhood experiences on individuals with autism spectrum disorder – (nih.gov)
11. When children with autism become adults – (nih.gov)
12. Friends and Lovers: The Relationships of Autistic and Neurotypical Women – (nih.gov)
13. The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians – (nih.gov)
14. Sex/Gender Differences in Symptomology and Camouflaging in Adults with Autism Spectrum Disorder – (nih.gov)
15. Psychosocial therapeutic approaches for high-functioning autistic adults – (nih.gov)