The Girls Looked Like They Were Coping

What the research found

This 2021 study set out to test a simple but uncomfortable idea. If autistic girls are often missed by clinicians, perhaps it is because they behave in ways that mask the underlying difficulty. The researchers wanted to see whether autistic girls show more socially fluent behaviour than autistic boys, even when the core features of autism are just as present.

The sample was small. Eighty-four children and adolescents, aged 8 to 14, took part: 18 autistic girls (or girls with high autistic traits), 22 autistic boys, 22 neurotypical girls, and 22 neurotypical boys. Each child completed a task called the Interactive Drawing Test, in which the child and a researcher take turns adding to a shared drawing. It sounds trivial, but it captures something real. A smooth exchange requires reading the other person, responding to their move, and offering something back. The test scores this reciprocal turn-taking on a simple scale.

The central result is a contrast. Neurotypical boys scored much higher on reciprocity than autistic boys, and the gap was large (t(42) = 3.19, p = 0.003, d = 0.96). Among the girls, there was effectively no gap at all. Autistic girls and neurotypical girls scored almost identically (t(37) = -0.17, p = 0.870, d = 0.05). In the drawing task, the autistic girls looked like their non-autistic peers. The autistic boys did not.

The important part is what sat underneath that behaviour. On a parent-reported measure of autistic traits, the autistic girls and boys were comparable (d = 0.08). On a test of theory of mind, the ability to infer what another person is thinking, the girls were no stronger than the boys. So the girls were not less autistic, and they did not have a better underlying grasp of other minds. Yet their observed social behaviour was noticeably smoother. The researchers call this compensation, or camouflaging: an improved outward presentation that sits on top of a difficulty that has not gone away.

They also noted a suggestive pattern around ability. Children who appeared to compensate most had higher full-scale IQ scores on average (M = 96.73 versus M = 87.25), though this difference was not statistically significant (d = 0.64). It hints that camouflaging may draw on general cognitive resources, but the study cannot confirm it.

The authors are careful about the limits of their own work. The autistic children had lower verbal IQ than the neurotypical group, which complicates the comparison. The theory of mind test did not distinguish the autistic children from the others, which suggests the measure may not have been sensitive enough. The reliability of the drawing test was only moderate, and the reliability checks were not spread evenly across the groups. And, by design, the children who camouflage most successfully may never reach a clinic to be studied at all.

What it means for you and your child

The message worth taking from this study is a cautious one. It offers evidence for something many parents of autistic girls already sense: that a daughter can appear to manage socially while still finding it genuinely hard. Here, the girls took turns as fluently as their peers without any matching advantage in reading other minds. The competence you see may be effortful, not effortless.

Be careful, though, about how far this goes. This is one small study of 84 children, using a single drawing task in a single sitting. It shows an association between being an autistic girl and behaving more reciprocally in that task. It does not prove that all autistic girls camouflage, that camouflaging is uniquely female, or that boys never do it. Group averages hide enormous variation. Plenty of autistic boys will camouflage, and some autistic girls will not. Your individual child is not a data point in a chart.

Nor does the study establish cause. We cannot say from this work why the girls behaved as they did, whether it is deliberate, learned, socially pressured, or something else. The IQ hint is interesting but did not reach significance, so it should not be treated as a finding. Read it as a question for future research, not an explanation.

What the study does usefully sharpen is a practical point about assessment. If a child’s difficulties are hidden by capable-looking behaviour, standard observation may understate them. A daughter who makes eye contact, takes her turn, and gets through the school day can still be exhausted by the effort and struggling underneath. If your instinct says something is being missed, that instinct is consistent with what this line of research suggests. It is a reason to ask for a thorough assessment from someone experienced with how autism can present in girls, not a reason to accept a quick reassurance that she seems fine.

For day-to-day support, the honest takeaway is about the cost of coping. Behaviour that looks smooth may be expensive to produce. A child who holds it together at school may unravel at home, not because home is the problem, but because home is where the mask can finally come off. Watching for that pattern, and giving her room to recover, is a sensible response whether or not the label of camouflaging turns out to be exactly right.

Finally, keep the science in proportion. A single well-conducted study earns your attention, not your certainty. This one adds a careful brick to a growing wall of evidence that autism can look different across sexes and can be under-recognised in girls. That is a reason to look more closely at the individual child in front of you, which was always the better guide than any average.