‘Puberty is a true crossroads – particularly for the female profile of autism’

In my new book with Annyck Martin, The Female Profile of Autism, we address a fundamental and often overlooked aspect of the autistic female profile: puberty, sexuality, and their impact on the psychological and social development of autistic girls. This important period of life, marked by bodily, emotional, and relational transformations, is particularly complex for these young girls, whose autistic characteristics profoundly influence how they experience these changes.

In chapter five, we explore the specificities of pubertal development, the adaptation strategies employed, the difficulties encountered in the sexual and affective spheres, and the resulting clinical consequences. Understanding these elements is crucial for better diagnosing, supporting, and assisting autistic girls in their transition to adulthood.

A multidimensional upheaval

Puberty in autistic girls is not limited to physical changes related to sexual maturation. It is accompanied by cognitive and emotional modifications that can be particularly destabilising. These young girls, often characterised by anxiety around change, must cope with a rapidly evolving body, which can generate anxiety and incomprehension. The bodily transformation can be perceived as foreign, even hostile, especially when accompanied by amplified sensory sensations, common in autistic individuals.

On a social level, puberty introduces new expectations, particularly in terms of appearance, behaviours, and relationships with peers. The autistic adolescent may find it difficult to align with these expectations, which accentuates her sense of isolation. Sometimes, in an attempt to integrate, she adopts stereotypical feminine behaviours, such as a marked interest in makeup or fashion. However, this attempt at integration can be ambivalent: it sometimes leads to a rejection of traditional feminine norms or an identification with marginalised groups and often to more neutral gender identities.

Sexuality: A complex and nuanced domain

Contrary to certain prejudices, these girls may show an interest in sexuality, but their way of experiencing it is often different. They encounter difficulties in interpreting the implicit social codes related to seduction, consent, and romantic relationships. Their heightened sensory sensitivity can make certain physical experiences uncomfortable, even painful.

Some girls develop specific interests around femininity and sexuality, which can be a way to explore their identity or attempt to integrate socially. However, this exploration is often fragile and can be a source of confusion or rejection, especially if social norms do not suit them or if they feel misunderstood.

Interpersonal and affective relationships

Relationships with peers, which become central during adolescence, are particularly difficult for autistic girls. Their ability to decode social cues, understand the emotions of others, and interact spontaneously is limited, which can isolate them or expose them to misunderstandings. To compensate, they often develop strategies of observation, imitation, and camouflage, which allow them to mask their difficulties but at the cost of great emotional fatigue.

These young girls may prefer relationships with adults or animals, which offer them a more predictable and secure framework. Their need for affection and recognition remains, but their way of expressing it can be atypical, which further complicates their social integration.

Adaptation strategies and social camouflaging

A specific adaptation strategy is often observed in autistic girls: social camouflaging. This strategy consists of carefully observing social interactions, analysing the behaviours of others, and then imitating these behaviours to fulfil expectations. This mechanism, although very effective in avoiding social rejection, is cognitively very costly and can lead to psychological exhaustion, known as 'autistic burnout'.

Camouflaging can delay diagnosis because it masks autistic traits in the eyes of professionals. It also generates an identity conflict, as the young girl must suppress her authentic characteristics to conform to social expectations. This phenomenon is often the cause of associated disorders, such as anxiety or depression.

Clinical issues and recommendations

Far from being a simple biological stage, puberty is a true crossroads where bodily transformations, social expectations, and identity construction intersect, all in a context marked by autistic particularities. We emphasise the importance of recognising this to adapt diagnosis and support.

Puberty is a risky period where difficulties can worsen, particularly under the effect of social pressures and expectations related to femininity and sexuality. Professionals should offer comprehensive support, including adapted sex education, assistance in understanding social relationships, and emotional support to strengthen self-esteem. The goal is to enable these young girls to flourish while respecting their specific way of functioning, while preventing psychological complications.

Understanding the dimensions we've mentioned here is fundamental to improving diagnostic recognition and providing support that values the strengths of autistic girls while addressing their vulnerabilities. Let's move beyond stereotypes and recognise the diversity of female experiences in the autism spectrum, in order to better support these young girls on their path to adulthood.

Isabelle Hénault has a Master's degree in Sexology and a Doctorate in Psychology from the Quebec University in Montreal. She has a private practice that provides assessment and therapy for individuals, couples and families, and acts as a consultant to a variety of organisations and schools.

Read an extract – Annyck Martin on her own search for answers over the female profile