High Achieving, Socially Successful, and Still Autistic: Understanding Autism in Girls

If you are reading this blog, perhaps you have known her and have been puzzled by her. She makes eye contact. She has friends. She gets good grades or is successful in her work. She is articulate and thoughtful. She seems mature beyond her years. She may even be the person other people come to for advice.

But someone is suggesting she may have autism?

What you may not know is that she goes home exhausted. She replays conversations for hours, evaluating what she did or didn’t say. She has learned exactly how much eye contact is "normal." She studies other people to figure out how to respond. She desperately wants friends but struggles to know how to maintain friendships. Her anxiety is overwhelming and constant. Changes in plans can derail her entire day.

For many females, their autism may not be apparent, but that comes at a significant cost.

One thing that is clear is that our current understanding of autism is shaped by decades of research that has disproportionately focused on boys and men. This means that the “stereotype” that we associate with autism is heavily influenced by behaviors more readily observed in males. While true for both genders, it is especially true for females that a “first impression” is not enough. It is critical that evaluation of autism consider developmental history, context, a woman’s internal experience, and what types of compensatory strategies she may be using.

So What Does ASD Look Like in Girls?

By now, perhaps you are picking up on the fact that especially for bright females, the presentation of symptoms can be far more subtle and often what we actually see is the secondary symptoms of their own efforts to cope with autism. Consider her:

She wants friendships intensely but struggles to initiate or maintain them. She watches other girls and copies how they talk, dress, laugh, or interact. She understands social rules intellectually but that understanding may not be natural or intuitive to her, meaning that it takes constant effort to interpret her social world. She may be excellent at one-on-one conversation but struggle in groups. She may miss sarcasm, hidden meanings, or subtle social expectations. She frequently worries about whether she said the "right" thing. She may have a history of feeling like she doesn't quite fit in. This leads to ongoing efforts to camouflage (or mask) her symptoms.

What is Camouflaging? 

Camouflaging refers to strategies people use to hide, compensate for, or work around their autistic traits. Specifically, masking involves covering up or hiding these traits. This includes behaviors like rehearsing conversations in advance of having them, memorizing “scripts” that can be used for specific situations (“I’m well, thank you, and how are you?”), copying other people’s facial expressions or practicing them in the mirror, practicing eye contact, suppressing stimming behaviors that help one to calm, pretending to understand something that they don’t, and generally, spending an enormous amount of energy to appear “typical.” 

Research suggests that autistic women report substantial camouflaging, and that this can make autistic characteristics less visible during brief clinical or social interactions.

It’s important to note that social challenges associated with autism are not evidence that someone does not have social motivation, but rather that they lack social intuition. These individuals are often highly empathetic and capable of having a close friend or two, though group situations are inherently more complex, and their ability to read, accurately interpret, and respond to all that complexity is just too much.

The Cost of Masking

When individuals with ASD spend so much time and energy in their efforts to mask their symptoms, there are a number of very common outcomes. They are susceptible to developing chronic anxiety, which is often focused on social situations. They experience social exhaustion and need significant time to “recharge” following social experiences. They can become highly perfectionistic and suffer from shame and low self-esteem. This also contributes to difficulty forming a personal identity as these individuals spend so much energy conforming to the settings around them instead of exploring their own thoughts, values, ideas, and interests.

Research has linked camouflaging with chronic psychological distress and internalizing emotional problems. This is why females often are provided other diagnoses first. These other diagnoses may not be wrong, but tend to describe the secondary symptoms instead of the source of the problem. 

Why Do These Skills Seem to Emerge in Adolescence or Young Adulthood?

Another important point in understanding female presentations of ASD is that often female diagnoses do not come until much later than most males. Often, girls can compensate effectively when the social environment is relatively predictable. But then they enter the wild world of adolescence where they suddenly face more complicated social relationships, dating, cliques, shifting social rules, more demanding academic and executive functioning demands. This all happens while young people are spending less structured time with their parents and developing relationships on their own. The strategies that worked at the age of eight don’t work so well at 14.

And college/young adulthood can be another major turning point because the external structure disappears. It is not that autism “suddenly appears,” but that the demands during these major transitions simply become greater than the person's ability to compensate.

What a Good Evaluation Assesses

If you or someone you know or love is wondering if they might show some symptoms of autism, we strongly recommend getting evaluated. Especially in the case of symptoms of ASD, insight is so powerful. If you can understand your own neurotype better, you can more effectively learn to cope with or even overcome some of the barriers to success.

Frankly speaking, evaluations are just not created equal. There are very good evaluations, pretty poor ones, and about everything in between. Following are the components we believe make up a quality ASD evaluation:

History, history, history: I argue that you cannot make an appropriate ASD diagnosis in more subtle cases (Level 1 presentations) without collecting a comprehensive developmental history. This means collecting information about a person’s early social development, play behaviors, friendships, social interactions, response to change, level of overall flexibility, and sensory-related behaviors.

It also involves understanding the client’s emotional regulation skills, interests, and current social relationships and friendships as well as current mental health symptoms.

Quality evaluations gather information from multiple informants, using both direct and indirect data as well as interviews (the client and parents or caregivers) to gather a comprehensive picture. These evaluations take time and are very thorough.

Without the proper sources of information, you may not get accurate results. 

Maybe You've Seen This Girl.

Maybe she's your daughter. Maybe she's the college student who looks successful but is barely holding things together. Maybe she's the woman who has spent her entire life wondering why everyone else seems to know the rules. Maybe she's the teenager who has been diagnosed with anxiety, depression, ADHD, or OCD but still feels like something doesn't quite fit. Maybe she's the girl who has become exceptionally good at appearing okay. She may be exhausted, worn out, and have a fairly fragile sense of self. Send her our way! We specialize in both evaluation and next steps for females (and males) with autism.

About Wasatch Learning & Wellness

At Wasatch Learning & Wellness in Sandy, Utah, we provide comprehensive psychological evaluations for children, teens, and adults, along with compassionate therapy services for ADHD, autism, anxiety, depression, learning differences, and other mental health concerns. Our mission is to help individuals and families better understand themselves through expert, evidence-based care that leads to lasting growth.

Clear Insight. Meaningful Change.

Whether you're seeking answers through a psychological evaluation or looking for ongoing therapeutic support, our experienced team is here to help you move forward with confidence, clarity, and compassion.

Not sure where to begin? Schedule a free consultation with our Intake Coordinator, Dr. Kara Peterson, to discuss your concerns, ask questions, and determine which services may be the best fit for you or your child.