THE BASICS
What is autism?
Autism is a lifelong neurodevelopmental difference in how a person communicates, relates to others, and experiences the world. These characteristics are present from early development, although they may not become fully apparent until social demands exceed a person's capacity to cope.
Autistic people also bring real strengths, which may include deep knowledge in areas of interest, attention to detail, honesty, a strong sense of fairness, and creative or analytical thinking. A good assessment describes these strengths as carefully as it describes areas of need.
Social communication and interaction
Back-and-forth conversation, sharing interests and emotions, nonverbal cues, and building relationships.
Restricted and repetitive behaviours
Intense or focused interests, a strong preference for sameness and routine, repetitive movements or speech, and sensory differences.
PINK FLAGS
When autism is harder to see
Many verbally fluent children, academically strong students, and many girls present in quieter ways that are easy to miss. Clinicians call these subtler signs "pink flags," in contrast to the more obvious "red flags."
01
Strong language and learning
Early reading or strong grades can lead adults to stop looking for social and sensory differences.
02
Interests that seem typical
Animals, books, art, or a favourite series. What stands out is intensity, not the topic.
03
Quiet repetitive behaviours
Hair twirling, lip biting, skin picking, or repeating phrases silently instead of visible stims.
04
Social interest without ease
Wanting friends, but finding it hard to keep them, repair conflict, or follow group talk.
05
Different at home and school
Holding it together all day, then falling apart at home, sometimes called after-school restraint collapse.
06
Fine in a structured setting
One-on-one with a predictable adult brings out best skills. Open-ended time reveals more.
“
“I was unbearable with my mother, but at school, I was perfect.”
A late-diagnosed woman, in Bargiela, Steward and Mandy, 2016
OFTEN MISSED
Autism in girls and women
Boys are diagnosed about four times as often as girls, yet research suggests the true difference is closer to 3 to 1. Even with the same level of autistic traits, girls are less likely to receive a diagnosis, and those who are identified are often diagnosed later, after years of being assessed or treated for something else.
The diagnostic criteria are the same for everyone. What differs is how autism tends to show up.
Camouflaging or masking: studying and copying peers, rehearsing conversations, forcing eye contact, and hiding stims.
Turning distress inward: anxiety, perfectionism, withdrawal, or low mood rather than disruptive behaviour.
Rich inner worlds: imaginative play that is solitary, scripted, or reenacts real social situations.
Wanting friends, finding it hard: friendships that look typical, but with more conflict and more difficulty repairing it.
The cost of camouflaging
Camouflaging helps a person get through the day, but it is exhausting. Over time it is linked to anxiety, depression, and autistic burnout, which is why autism in girls and women is often first recognized through its consequences.
DIFFERENTIAL DIAGNOSIS
What else could it be?
Many conditions share features with autism, and many occur alongside it. The answer is rarely in a single score. It comes from developmental history, information from more than one setting, and understanding why a behaviour occurs.
Condition
What can look similar
What helps tell them apart
ADHD
Interrupting, distractibility or overfocus, executive functioning difficulties
In ADHD, social skills are understood but not applied in the moment. In autism, expectations stay confusing even when explained. Both can be present.
Social anxiety
Avoiding social situations, limited eye contact, quiet with unfamiliar people
Social anxiety centres on fear of judgement. Autistic anxiety is often about not knowing what to do, and not understanding how others seem to know.
Generalized anxiety
Need for control, distress with change, worry
In autism, distress with change is usually lifelong and tied to routine, predictability, and sensory comfort. Anxiety is also common in autism and may need its own support.
OCD
Repetitive behaviours, rigid routines, distress when things are not right
OCD rituals are unwanted and fear-driven. Autistic routines and interests are often comforting or enjoyable.
Depression
Withdrawal, flat expression, reduced interest
Depression is a change from a person's usual self. In autism it may show as loss of interest in a special interest or increased sensory sensitivity.
Selective mutism
Not speaking at school or with unfamiliar people
Follows setting-based rules, with typical early development. In autism, loss of speech is more often linked to overwhelm.
Language disorder
Difficulty with conversation and expressing ideas
A language disorder affects language itself. Autism affects the social use of language, along with nonverbal communication and repetitive patterns.
Trauma
Withdrawal, emotional dysregulation, hypervigilance
Trauma-related difficulties follow adverse experiences. Autistic traits are present from early development. Both may need to be considered.
Giftedness
Intense interests, advanced vocabulary, feeling different from peers
Gifted children without autism usually adapt their social style to their audience. The two can co-occur, and strong abilities can mask autism.
Conditions that begin in adolescence
Rigidity around food, emotional intensity, relationship difficulties
Eating disorders, bipolar disorder, and borderline personality disorder usually begin later. Autism is lifelong, so early childhood history is essential.
OUR APPROACH
How a careful assessment helps
01
A detailed developmental history
Autistic traits are present from early childhood, even when no one noticed them at the time.
02
Gold-standard tools
The ADOS-2 and ADI-R, interpreted with an understanding of nuanced presentations.
03
More than one setting
Differences between home and school are treated as meaningful, not contradictory.
04
The whole profile
Cognition, attention, anxiety, mood, sensory needs, and learning, so recommendations fit the whole person.
Meet the assessment team
RELATED READING
Keep learning
LEARN MORE
How ADHD presents, including in girls, and what else can look like it.
LEARN MORE
Dyslexia, written expression, dyscalculia, and signs at every age.