Teen & Adult Autism Information and Resources

Signs and Symptoms of Autism in Males and Females

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)

Autism Spectrum Disorder Severity Levels (DSM-5)

Level 1: Requiring Support

• Social Communication: Without supports in place, deficits in social communication cause noticeable impairments. Individuals may have difficulty initiating social interactions and demonstrate atypical or unsuccessful responses to social overtures. They may appear to have decreased interest in social interactions.

• Restricted, Repetitive Behaviors: Rituals and repetitive behaviors (RRBs) cause significant interference with functioning in one or more contexts. Individuals may resist attempts by others to interrupt RRBs or to be redirected from fixated interests. (American Psychiatric Association, 2013)

Level 2: Requiring Substantial Support

• Social Communication: Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place. Limited initiation of social interactions and reduced or abnormal responses to social overtures from others.

• Restricted, Repetitive Behaviors: RRBs and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRBs are interrupted; difficult to redirect from fixated interests. (American Psychiatric Association, 2013)

Level 3: Requiring Very Substantial Support

• Social Communication: Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning. Very limited initiation of social interactions and minimal response to social overtures from others.

• Restricted, Repetitive Behaviors: Preoccupations, fixated rituals, and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interests or returns to them quickly. (American Psychiatric Association, 2013)

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Autism Speaks. (n.d.). What are the levels of autism? https://www.autismspeaks.org/levels-autism