Why Autism Level One Looks Different in Girls—and Why That Matters

When people think of autism, they often picture the classic traits: a child who avoids eye contact, struggles with social interactions, and has intense, specific interests. But autism is a spectrum, and for many, especially girls, these stereotypes don’t always fit. Autism Level One, often referred to as “high-functioning autism” (a term many find misleading), is especially tricky to define because it doesn’t always look the way people expect.  

Girls with Autism Level One often fly under the radar, going undiagnosed well into adulthood. Why? Because the diagnostic criteria were developed based on how autism presents in boys. That means many girls (and some boys, too) who mask their symptoms or express them differently aren’t recognized as autistic. Instead, they’re labeled as “shy,” “quirky,” “sensitive,” or even “socially anxious.” But just because someone isn’t struggling outwardly doesn’t mean they don’t need support. 

Autism Spectrum Disorder (ASD) is divided into three levels based on the amount of support a person needs. Autism Level One refers to individuals who require minimal support but still experience significant social and sensory challenges. These individuals typically have average to above-average intelligence, but they struggle with social communication, emotional regulation, and sensory sensitivities.  

The problem with the term “Level One” is that it implies a mild form of autism, when it just means the person isn’t as outwardly affected as someone who needs more intensive support. Many girls with Level One autism become masters of masking, learning to imitate social behaviors, suppress their natural responses, and push through sensory overload just to fit in. This effort can be exhausting and often leads to anxiety, depression, and burnout.  

Girls and women with Autism Level One often don’t match the stereotypical presentation of autism. Some key differences include:  

● Masking and Camouflaging: Many girls develop coping mechanisms to blend in, such as mirroring social behaviors, memorizing scripts for conversations, or forcing eye contact even when it feels unnatural. This makes it much harder for doctors, teachers, and even parents to recognize their struggles.  

● Special Interests That Seem "Typical": While boys with autism might have niche interests like train schedules or mathematics, girls often fixate on socially acceptable topics like animals, books, or fictional characters. This makes their autism less obvious. 

● Struggles with Friendship (But Not Always in an Obvious Way): Many autistic girls are desperate to fit in and may form intense friendships, but they often struggle with social nuance, group dynamics, and emotional reciprocity. Some may seem overly social but feel disconnected beneath the surface.  

● Sensory Sensitivities in a Subtle Form: Rather than obvious reactions to loud noises or bright lights, many autistic girls experience sensory discomfort internally, leading to headaches, fatigue, or shutdowns later.  

● Internalized Anxiety and Perfectionism: Many girls with Level One autism develop extreme perfectionism, people-pleasing tendencies, or anxiety disorders to cope with their difficulties in social situations.  

The way we talk about autism shapes how it’s understood and diagnosed. Many autistic women today weren’t diagnosed until adulthood, if at all, because they didn’t fit the “traditional” mold. Misdiagnosis is common, with many being told they have ADHD, anxiety, or borderline personality disorder instead of autism.  

This is why some argue that the classification of Autism Level One needs to be revisited. Calling it "mild autism" or assuming it’s less impactful just because someone is intelligent or can hold a conversation misses the real struggles that come with it. Girls with Autism Level One may not need the same kind of support as someone with higher support needs, but that doesn’t mean they don’t need any. Many benefit from therapy, accommodations in school or work, and simply the validation of knowing why they experience the world differently.  

The good news is that awareness is growing. More researchers are studying autism in girls, and more clinicians are recognizing the signs beyond the male-centered diagnostic models. But there’s still work to do. Teachers, parents, and doctors need to be better trained in recognizing the subtle ways autism shows up in girls. More women and girls need to feel safe seeking an autism diagnosis without fear of being dismissed. And we, as a society, need to redefine what autism looks like, not just in medical textbooks, but in everyday life.  

Because for many girls with Autism Level One, the struggle isn’t about whether they can “function.” It’s about whether they can be understood.