An expert has shared his top five most common signs of autism in girls. Conor McDonagh is the owner and director of Caerus Therapies, which offers autism assessments and support.

He is also a specialist occupational therapist, with sensory integration certification and expertise in occupational therapy and applied social studies. Conor frequently shares advice on his TikTok account - from sensory processing issues to how to support an autistic child.

Among his videos, Conor shared a two-part series on his top five most obvious signs of autism in girls. The video is captioned: "These are just some of the signs of autism in females from my perspective."

In part one, he asks viewers to "remember that autism is a spectrum so there is a wide range of signs and symptoms, these are just a few and in my experience, the most common." In the video, Conor added: "My top five most obvious signs of autism in girls, from the point of view of an autism accessor.

"Now, bear in mind that research has demonstrated that girls on the spectrum are very good as masking so it's not always as obvious, but here we go. My name is Conor McDonagh from Caerus Therapies, we complete autism assessments for children and adults."

Top five common signs of autism in girls

Difficulties with change

Conor said: "So, the first one is a girl who is very rule bound and has difficulties with change. They often like to fit in and don’t make a big fuss..

"But sometimes what tends to happen is they internalise these anxieties but you will recognise that they struggle when the routines change, that they get very upset when other children don’t play in the way that they’d like to do. They always like to be early and on time, but although they have these difficulties they don’t like to draw attention to themselves and make a fuss, as I mentioned."

Difficulty processing sensory information

He added: "The second difficulty that we frequently see is when a girl on the spectrum has difficulties with processing sensory information. So there are many ways that we see this but for example a girl on the spectrum may have difficulties with tolerating loud and sudden sounds.

"They may struggle to focus and concentrate in a busy environment like a classroom, they might be very fussy in particular about the type of clothes that they wear because of how they feel, or they may be poorly coordinated and quite resistant to engaging in sports because they realise maybe they’re not as good as their peers so they choose to stay away from these."

Difficulty with intense interests

Conor said: "The third issue that we often see is difficulties with intense interests. So we know that girls on the spectrum often choose interests that are socially acceptable, so it can be things like Barbie and girls programmes and maybe as they’re older it's clothing and makeup for example.

"But you will recognise that they have an intense interest in these subjects so they want to talk about it all the time, they want to read about it and explore it at every opportunity."

Difficulty building relationships

He said: "The fourth difficulty we often see in girls on the spectrum is when they struggle with building and maintaining relationships. So girls will often tend to put themselves in a position where they’re around their peers but they will struggle with the finer skills, so initiating conversations, and having a to and from conversation.

"They will often have difficulties with understanding when there’s problems in relationships and how to sort these out effectively. And in situations where it’s less structured they have difficulties with navigating social interactions to build friendships and relationships."

Difficulty with nonverbal communication

Conor added: "The fifth most obvious sign of autism in girls that I often experience is when they struggle with nonverbal communication, so it's very difficult to determine how they are feeling based on their facial expressions because they don’t give much away, they tend not to use many gestures like waving hello and goodbye, or beckoning people into a room for example."

What does the NHS say?

According to the NHS, historically, many girls with autism have not been recognized or diagnosed due to:

  • More subtle presentation.
  • Clinicians not recognising girls.
  • Other diagnoses being used to explain difficulties – autism not being considered as an explanation.

Mental health problems have often been the primary diagnosis which may have masked the underlying autism. This can result in lack of appropriate support which in turn can result in loneliness, depression, and social isolation, increased vulnerability in terms of emotional well-being, i.e. self-harm, eating disorders, lowered grades and reduced opportunities in the future.

The National Autistic Society also says there are many theories to explain the diagnosis gap have been put forward, but none have been conclusively proven. Some of the theories are:

  • a potential 'female autism phenotype' – in other words, autistic women and girls have characteristics that don’t fit with the traditional profile of autism
  • autism assessments are less sensitive to autistic traits more commonly found in women and girls
  • women and girls are more likely to ‘mask’ or camouflage their differences
  • autistic traits in girls are under-reported by teachers
  • a range of biological and environmental factors may mean men and boys have a higher prevalence of autism
  • the 'extreme male brain' theory of autism, which focuses on the effects of foetal testosterone on brain development

It is important to remember that research and knowledge about autism changes constantly. Some of these theories may not reflect how we think about autism today.