Teen & Adult Autism Information and Resources

Signs and Symptoms of Autism in Males, Females, and Transgender Youth

A. Core Diagnostic Criteria (DSM-5)

• Deficits in social-emotional reciprocity

• Difficulty interpreting nonverbal cues

• Rigid routines, repetitive behaviors, and intense interests

• Sensory sensitivities or reduced response to input
  (American Psychiatric Association, 2013)

B. Gender Differences in Presentation

1. Male Presentation of Autism

• Externalized behaviors such as stimming, echolalia, hand-flapping

• Restricted interests often focused on topics like vehicles, video games, or mechanical systems

• Less concern with social masking; may appear aloof or disinterested

• More likely to be diagnosed early due to disruptive or visible behaviors

• Increased rates of co-occurring ADHD and behavioral issues

2. Female Presentation of Autism

• High rates of camouflaging and social mimicry to blend with peers

• Internalizing symptoms including anxiety, depression, and eating disorders

• Special interests often appear socially normative (e.g., animals, literature, celebrities) and go unnoticed

• More likely to be verbally fluent, masking pragmatic communication deficits

• Often misdiagnosed with borderline personality disorder, anxiety, or mood disorders

• Sensory issues often manifest in response to clothing textures, hygiene routines, and social touch
  (Lai et al., 2015; Hull et al., 2020; Mandy et al., 2012)

C. Transgender Youth Presentation of Autism

General Trends

• Transgender and gender-diverse youth are significantly more likely to meet criteria for ASD than their cisgender peers

• Traits include heightened sensory sensitivities, rigid thinking, and social communication challenges

• Elevated risk of anxiety and depression due to compounded gender dysphoria and neurodivergence

• Frequently face barriers in receiving affirming diagnostic care
  (Warrier et al., 2020; Strang et al., 2018; Glidden et al., 2016; Pecora et al., 2020)

Trans Boys (Assigned Female at Birth)

• May display more “male-typical” autistic traits such as repetitive motor behaviors and reduced social masking post-transition

• Often heavily camouflaged pre-transition due to socialization pressures

• Frequently misdiagnosed with eating disorders, mood disorders, or social anxiety
  (George & Stokes, 2018; Warrier et al., 2020)

Trans Girls (Assigned Male at Birth)

• May show more internalized symptoms such as anxiety and depression

• Engage in masking behaviors similar to cisgender girls

• May avoid overt stimming or intense restricted interests

• Sensory sensitivities often linked to gender dysphoria (e.g., discomfort with clothes, body contact, or vocal tone)
  (Glidden et al., 2016; van der Miesen et al., 2018)

D. Impact of Gender and Racial Biases on Autism Diagnosis

1. Gender Bias

• Diagnostic tools were developed primarily with cisgender boys, contributing to underdiagnosis in girls and trans youth

• Girls are more likely to mask symptoms, complicating detection

• Autistic girls and women are frequently misdiagnosed with personality disorders, generalized anxiety, or major depression
  (Lai et al., 2015; Mandy et al., 2012; Rynkiewicz et al., 2019)

2. Racial Bias and Misdiagnosis

• Black and Hispanic children are diagnosed with autism at lower rates and at older ages than White peers

• Instead of ASD, they are more frequently misdiagnosed with:

  • Conduct Disorder

  • Oppositional Defiant Disorder (ODD)

  • Adjustment Disorder

  • ADHD

  • Intellectual Disability

• Systemic racism, clinician bias, and lack of access to culturally responsive developmental assessments contribute to delays or inaccuracies

• Black autistic girls face compounded underdiagnosis due to intersectional erasure
  (Mandell et al., 2007; Bishop-Fitzpatrick & Kind, 2017; Tek & Landa, 2012; Constantino et al., 2020; Walker et al., 2022)