I'm a psychiatrist - here are five little-known signs of autism in women

Daily Mail​

27-04-2025

A psychiatrist has revealed five signs that may be indicative of autism spectrum disorder (ASD) in women.
Professor Ahmed Hankir, a professor in the UK and a consultant psychiatrist in Canada, took to TikTok to reveal common signs to look out for.
Characteristics of autism in girls and women may differ from those of other autistic people, according to the National Autistic Society.
This means it is more difficult to diagnose women and, as a result, far fewer receive an official diagnosis and, according to researchers at Durham University, nearly 80 per cent are misdiagnosed with other conditions, such as anxiety.
Girls, for example, are more likely to 'mask' certain traits in an attempt to fit in with neurotypical people in society.
The male-to-female ratio for autism has long been estimated to be 4:1, but some research suggests that, with more effective diagnosis, this could be closer to 2:1, per Embrace Autism.
There are currently over 170,000 people in the UK are waiting for a doctor to assess whether they have the condition, a figure that is five times higher than before the pandemic in 2020.
Professor Hankir advised people to seek an official diagnosis if they resonated with any of the signs in his video, which he said is just for educational purposes.
1. Stimming
Professor Hankir said one common trait in autistic women is 'stimming' - which stands for self-stimulatory behaviour - which he described as 'repetitive or ritualistic movements'.
These may include rocking, hand flapping or skin picking, feet rubbing or hair twirling.
'The familiarity with the sensation associated with stimming behaviours can be soothing, and can provide comfort to autistic women, who often feel intense discomfort and distress, triggered by certain situations and stimuli,' he explained.
These behaviours may often come in useful in social gatherings, which can feel overwhelming.
'It's the behaviour that a lot of people do as a form of self regulation,' one autistic person explained, in a Channel 5 documentary that aired earlier this month.
In addition to helping cope with high concentrations of stimuli, it can also be used to express a range of emotions including anxiety and even joy.
Stimming has in the past been associated with severe behaviours, such as head banging, but it can be something as little as twirling hair or playing with jewellery
However, it can also lead to bad habits, such as skin picking and nail biting.
Dr Kim Sage, a California-based psychologist, emphasises that everyone 'stims to some degree' and 'doing these does not make you autistic'.
However, autistic people are more likely to find the behaviours calming and regulating.
2. Emotional disregulation and meltdowns
@profahmedhankir
#autisminwomen #autism #neurodivergent #stimming 5 symptoms of autism in women [1] Stimming. Stimming or self-stimulating behaviours refers to repetitive or ritualistic movements such as rocking, hand flapping, skin picking, feet rubbing and hair twirling. [2] Emotional dysregulation and meltdowns. [3] Camouflaging. Camouflaging also known as masking is when a person hides or conceals signs that they have autism to blend in or adapt to the neurotypical world. [4] Sensory sensitivity. [5] Intense interests.
♬ original sound - Professor Ahmed Hankir
Women with autism may find it difficult to regulate their emotions, Hankir explained.
This may lead to feelings of an overwhelming intensity, which can lead to a meltdown.
A 'meltdown' is a physical reaction to an overwhelming emotional or sensory experience and all adults across the spectrum can be vulnerable to them.
The loss of control may be shown through crying, screaming or even physically lashing out.
After an episode ends, many adults may have difficulty remembering it.
Emotional disregulation is one of the main reasons why women are often misdiagnosed, and subsequently receive the wrong treatment.
Some of the common conditions it is mistaken for include bipolar disorder, depression and obsessive compulsive disorder.
3. Camouflaging aka 'masking'
Many autistic women engage in 'camouflaging' or 'masking', which mean they hide or conceal the common signs of autism in order to blend in with the neurotypical world.
It's something women are thought to engage with more than with men, and also makes it difficult for women to be diagnosed, as they are 'good at' masking the symptoms.
Professor Hankir explained that these can include imitating facial expressions in social situations.
But, he explained: 'Camouflaging or masking can come at a great psychological cost for autistic women as it can drain their social battery and result in emotional, physical and mental exhaustion, which can then lead to burnout.'
Autistic women and non-binary people may be more likely to mask, potentially due to stereotypes of how people should behave
Women are more commonly encouraged to be well behaved and socially sensitive than men, so are more likely to imitate expected social behaviours.
Masking can help women in social situations, such as school and work, and can even be an unconscious behaviour.
It's carried out by mirroring the behaviour of other people in their life, or people seen on TV and in books.
Autistic people may hide their needs, preferences, opinions and interests based on the anticipated reactions of others.
It can include scripting responses, managing facial expressions, and changing their tone of voice.
4. Sensory sensitivity
One common neurodiversity trait is sensory sensitivity which makes people super sensitive (or conversely particularly insensitive) to smells, tastes, textures, pressure, touch and sounds.
As Professor Hankir explains, autistic people, especially women, 'perceive their environments differently than neurotypical people do'.
This often causes a heightened awareness of stimuli, such as scents, sights, sounds and textures.
Autistic women may find discomfort in certain fabrics of clothes or if they're faced with a strong smell, such as petrol.
They may refuse to wear certain fabrics, or become overwhelmed in noisy environments.
This again can cause sensory overload, which Hankir said can be 'unbearable'.
Dr Sohom Das is a forensic psychiatrist and described it as 'a hyper sensitivity to sensory stimulation, such as sounds or smells that don't seem to bother other people, or bright lights'.
He explained 'So this can manifest insensitivities - to not just sounds, but also even textures and smells. So basically, it's almost like you're a human mood ring.
'So here's an example. You and your friend, you go into a cafe, and you both get a double mocha cappuccino and you both get a croissant each, and you both enjoy it. But your friend, she's taking some huge bites like a slob.
'She's speaking with a mouthful. Bits of crumbs are flying out everywhere, and she's just droning on [...] She's spitting crumbs all over the table, and it's sacrilegious, and it's kind of ruining your vibe, because from your experience, the smell, the textures, that flakiness in your mouth [...] are all amazing to you, and you want to savour it.'
5. Intense interests
Autistic women may have 'intense interests', which may in fact be 'perfectly normal'.
Professor Hankir said one of his patients has an intense interest in reading literature and learning about autism, meaning she's very eloquent.
This can also develop into an 'intense interest', which manifests differently to just a typical passion or hobby for a non-autistic individual.
The differences lies in the fact that passion for a non-autistic person 'is almost always enjoyable', whereas an intense interest can become 'almost necessary rather than optional'.
In comparison to autistic men, who often have focused interests in niche topics such as transport links, girls' intense interests may be more 'socially acceptable'.
Examples can include intense interests in animals, books, celebrities - and autistic women will tend to collect extensive information about each.
When it comes to treating adults with autism, there are various approaches that can help address individual needs and challenges.
Treatment options can include psychotherapy and counseling, cognitive-behavioral therapy (CBT), social skills training, and occupational therapy.