Autism and girls: Friendships and relationships

I have struggled with trusting too much and not wanting to ever give anyone else any reason to dislike me. This can mean overextending myself, not expressing my needs, and not having boundaries (what are boundaries, anyway?!). I have been taken advantage of by people with ill intent and did not immediately recognize what was happening. It is unfathomable to me that people lie and manipulate, as I tend to take others at their word. I end up internalizing deliberate harm by others as a personal failure and inability to discern, which has at times shaken my confidence in myself and in the goodness of the world.

KD, autistic woman

Friendship has been a very difficult thing to navigate, and as a result I now have a small friendship circle. Quality over quantity of friends is the way to go (well, for me, at least). I can only manage a low level of socializing and it takes a lot to be trusting of someone (due to past experiences). My friendships would look very different if I wasn't autistic. I also think that my choice of friends would be very different too.

SB, autistic woman

Asked to describe an autistic person, many would probably paint the reductive picture of someone who is isolated, has no friends and is altogether uninterested in socializing with others. So crucial is this supposed lack of social skills and withdrawal from social life to our stereotypical image of autism that the very name of the condition is derived from it – the roots of the word lie in the Greek 'autos', meaning 'self ', suggesting someone showing no interest in the world outside of themselves. However, having firmly established itself in the popular imagination, this simplistic stereotype may have made it harder to spot autism in the many autistic people who do not conform to it. While some autistic people might fit this profile, there is a lot more subtlety and variability from one autistic person to another. Some may not have an interest in friendships at all, others may desperately want friendships but struggle to initiate those, and there are also many autistic people who seek, have and enjoy friendships. And, when it comes to the 'internalized' or 'masked' presentations of autism, autistic girls' experiences of socializing are often markedly different from those of autistic boys.[27] This pattern is also seen in neurotypical children. It is important to note at this point, however, that as with any research looking at gender differences, this is bound to be reductive and many people will not fall neatly into these supposedly discrete binary categories. Research findings will be presented here, with the caveat that the reality is bound to be much more complicated and nuanced than what can be observed in the context of social and psychological research. All autistic people, regardless of gender, should be treated as individuals first and foremost, but it is useful to have a generic overview of some of the common patterns that tend to emerge.

Are there any gender-specific differences in social relationships that we can see in autistic girls?

For many years, little was known about autistic girls' friendships and social communication patterns, as most research in this area was carried out with boys.[28] However, this was a major oversight and omission, as we now know that there are some major differences in autistic girls and autistic boys' friendships and socializing patterns. Indeed, some researchers have questioned whether those differences can offer a partial explanation for the delayed – or lack of – diagnosis commonly seen in autistic girls with no learning or language difficulties.[29] Similarly, the very fact that an autistic child has a friend – or a small group of friends – can wrongly be interpreted as a sign that they cannot be autistic if it is (incorrectly) assumed that autistic people do not want or have friends.

Research looking at autistic girls' social skills and relationships, particularly when compared to 1) neurotypical girls, and 2) autistic boys, has found some interesting common themes and key differences. For example, autistic girls' social interaction tends to be more conversation-based, whereas autistic boys' social interaction tends to be more play or activity-based.[30] Additionally, autistic girls are less likely to play on their own compared to autistic boys,[31] which goes against the common stereotype of autistic people as preferring self-led, solitary activities. Again, this could offer a partial explanation as to why some autistic girls' needs go unrecognized for a number of years – the research and, by extension, professionals' knowledge and expectation of how autistic children should – or shouldn't – socialize is based on a profile more commonly seen in boys.

A particularly illuminating study was carried out in the UK by Felicity Sedgewick and colleagues and was published in 2019. Their findings indicated that it is 'gender, rather than diagnosis per se', that determines the differences in friendships and socializing commonly seen in autistic boys and girls. Specifically, what they found was that while autistic girls have very similar friendship patterns to non-autistic girls, at least on surface level, those tend to be very different to how autistic boys approach social relationships. For example, both neurotypical and autistic girls with no accompanying intellectual difficulties tend to value emotional closeness and support in friendships,

whereas boys, regardless of diagnosis, value shared interests and activities. Interestingly, however, there were also some key qualitative differences they found in terms of how autistic and non-autistic girls approach and see their friendships. Specifically, they found that:

autistic girls lacked wider social networks and the friendships they reported were much more intense, with individual best friends often becoming the sole focus of their social lives. Autistic girls also found it much more difficult to understand and manage conflict in their relationships and with their peers generally, and were exposed to more relational bullying (i.e., behaviors such as gossip and being excluded, which are far more predominant in adolescent girls' relationships than any other group).[32]

Additionally, they also found that neurotypical and autistic girls respond differently to those conflicts – while non-autistic girls tend to retaliate in a similar manner, autistic girls 'assume they are entirely to blame for the problem (and do whatever they can to resolve it) or assume that the friendship cannot be rescued (and so withdraw from the relationship)'.[33]

An important aspect of autistic girls' friendship patterns is that they may prefer to have a small group of friends, or one close friend with whom they have a very close and intense relationship.[34] It is possible that this feels more manageable for them compared to having to manage different and changing dynamics in friendships with multiple people; it is also possible that this is because the social aspects of friendships can be difficult to navigate for them, and, as such, they may only have the emotional or social 'battery' for one, rather than multiple close friendships.

However, this raises a couple of important questions – close and intense relationships that involve spending a lot of time together also provide more opportunities for conflict. As we found out previously, managing conflict in friendships can be very difficult for autistic girls and they can withdraw from the friendship. This, in turn, could be highly distressing if they had just one friend – losing the friendship could feel catastrophic in its enormity for the autistic young woman, as she would have lost her main friend, source of support and potentially a neurotypical 'ally' helping her navigate social aspects of school that she would otherwise find challenging. The possible impact of this should not be underestimated and trivialized as typical friendship issues that many young people go through – losing such a major person in her life, even if temporarily, could have a significant negative effect on her mental health, as well as on her ability to attend school, if the friendship was school-based and the friend has moved on and is developing friendships with other people.

In safe, secure relationships, something like telling a friend that I was hurt by something small they said or did feels like an end-of-the-world conflict. I'm in a place in my life and relationships where I'm beginning to do this, even though my nervous system tries its best to make me clam up and run the other way. In therapy, I'm learning to recognize my feelings and wants, which is something I so wish I had been able to do earlier in life.

KD, autistic woman

Stability, control and anxiety: Reflections from practice

There have been a number of instances in my practice where I have heard highly distressed autistic girls be referred to as 'controlling', 'manipulative' and 'dominating' at worst, or 'unkind' and 'needy' at best, for wanting to have one close friend or to maintain proximity to another child – or, in other words, for wanting to have their emotional needs met. Even well-meaning professionals – and adults in general – can resort to simplistic explanations that, intentionally or not, position the 'blame' firmly within the child, with little to no regard to the broader context and the underlying reason for the child's behaviour. For example, if an autistic girl appears to be 'fixated' on one friend and becomes extremely distressed when her friend also wants to explore playing with another child, attributing malicious intent to her reaction is not only simplistic, but it also fails to consider the root cause of the behaviour. 

What is often not considered in those cases is that maybe this is the child she feels the safest with or she can only tolerate socializing with one person and having other children join in makes the dynamics too complicated and the conversations too hard to follow. Similarly, a desire to stay in control of a social situation by directing other children's play can be seen as 'domineering', when maintaining a degree of control over the interaction is likely to serve a very specific purpose for some autistic children – keeping the interaction focused on topics that they are familiar with and can comfortably navigate; similarly, this would also ensure a level of predictability and reduce the anxiety usually associated with uncertainty. 

Maintaining control is a key tool many autistic people use to manage their anxiety and it should be understood and treated with respect. This does not mean that other children's needs shouldn't be considered and respected, or that the autistic girl shouldn't be supported to explore alternative reactions and ways of approaching the same situation. However, in order to do this effectively, we need to first understand what is causing the underlying anxiety.

We also need to acknowledge the very real power adults hold in shaping narratives around individual children and their needs. Labelling a child as 'manipulative' and 'controlling', rather than exploring the reasons behind their presentation, can easily become an unquestioned, commonly accepted narrative seen as 'the truth' about who they are as a person. Once ingrained, those narratives can be surprisingly resistant to challenge – the adults could then notice or seek out information that seemingly confirms that the child is 'controlling' (a psychological phenomenon known as 'confirmation bias'), which could further consolidate the view that this is who she is in their eyes. Therefore, regardless of the underlying intent, it is important that these narratives are challenged and corrected – behaviour is a form of communication, and labelling the behaviour without trying to understand what it is trying to convey could detract from the child's actual needs – and the support they may need.

• Dr Emilia Misheva is a Chartered member of the British Psychological Society, a practitioner psychologist and author.
• Under the Radar: An Essential Guide to Autism and Girls is published by Jessica Kingsley Publishers.

References

27 Sedgewick, F., Hill, V., Yates, R., Pickering, L. & Pellicano, E. (2016). Gender differences in the social motivation and friendship experiences of autistic and non-autistic adolescents. Journal of Autism and Developmental Disorders, 46, 1297–1306.

28 Sedgewick, F., Hill, V. & Pellicano, E. (2019). 'It's different for girls': Gender differences in the friendships and conflict of autistic and neurotypical adolescents. Autism, 23(5), 1119–1132.

29 Sedgewick, F., Hill, V., Yates, R., Pickering, L. & Pellicano, E. (2016). Gender differences in the social motivation and friendship experiences of autistic and non-autistic adolescents. Journal of Autism and Developmental Disorders, 46, 1297–1306.

30 Kuo, M.H., Orsmond, G.I., Cohn, E.S. & Coster, W.J. (2013). Friendship characteristics and activity patterns of adolescents with an autism spectrum disorder. Autism, 17(4), 481–500.

31 Dean, M., Harwood, R. & Kasari, C. (2017). The art of camouflage: Gender differences in the social behaviors of girls and boys with autism-spectrum disorder. Autism, 21(6), 678–689.

32 Sedgewick, F., Crane, L., Hill, V. & Pellicano, E. (2019). Friends and lovers: The relationships of autistic and neurotypical women. Autism in Adulthood, 1(2), 112–123.

33 Sedgewick, F., Crane, L., Hill, V. & Pellicano, E. (2019). Friends and lovers: The relationships of autistic and neurotypical women. Autism in Adulthood, 1(2), 112–123.

34 Sedgewick, F., Hill, V. & Pellicano, E. (2019). 'It's different for girls': Gender differences in the friendships and conflict of autistic and neurotypical adolescents. Autism, 23(5), 1119–1132.