Recognising autism in girls within the education context: reflecting on the internal presentation and the diagnostic criteria

It is widely acknowledged that girls are less likely to receive an autism diagnosis compared to boys (Gould, J. 2017. “Towards Understanding the Under-Recognition of Girls and Women on the Autism Spectrum.” Autism 21 (6): 703–705), with growing recognition that girls are underserved by the current clinical diagnostic criteria, potentially due to differences in presentation (Duvekot, J., J. van der Ende, F. C. Verhulst, G. Slappendel, E. van Daalen, A. Maras, and K. Greaves-Lord. 2017. “Factors Influencing the Probability of a Diagnosis of Autism Spectrum Disorder in Girls Versus Boys.” Autism 21 (6): 646–658). Lack of awareness of the female profile of autism among teachers and other professionals can have implications in terms of recognition, diagnostic referrals, formal identification and support. A narrative review approach was adopted to review extant literature pertinent to sex differences in autism, using the diagnostic criteria outlined in DSM-5 as a framework (American Psychiatric Association. Citation2013. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington: American Psychiatric Association). The aim of this paper is to raise awareness of the varied presentation exhibited by some autistic girls. The findings reveal differences in the presentation of autism characteristics among girls with a more internal presentation apparent. The findings of the review indicate the need for revisions to diagnostic tools to reflect the more nuanced female presentation, increased training and guidance for professionals working with autistic girls and continued research. It is hoped that this review will further knowledge in this area to support the recognition of autism in females and mitigate the risk of females being missed, misdiagnosed or diagnosed later in life.