🧩 A Qualitative Exploration of the Experiences of Autistic Adolescent Girls and Their Mental Health Difficulties

Malone, A., Keating, C., & Ryan, A. (2025). A qualitative exploration of the experiences of autistic adolescent girls and their mental health difficulties. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-025-07044-y

Abstract

The study highlights how autistic girls are underrepresented in research and often misunderstood by mental health systems. Six Irish adolescent girls, all attending CAMHS (Child and Adolescent Mental Health Services), shared their experiences.

Three main themes emerged:

1. Understanding how autism and mental health overlap.
2. Navigating social environments as autistic girls.
3. Feeling disconnected from the support they receive.

The findings show that getting a diagnosis can foster self-understanding but that services often miss the mark, failing to meet girls’ actual needs.

Introduction

Autism has long been seen as a “male disorder,” but newer evidence suggests the male-to-female ratio is closer to 2:1. Because of this bias, girls are often overlooked or misdiagnosed. This means many struggle without understanding why. They may present differently—masking traits, internalizing distress, or being misread as having other conditions such as eating disorders.

Mental Health in Autistic Adolescents

Adolescence is a sensitive time for all young people, but especially for autistic girls. Around 70% of autistic adolescents experience at least one mental health difficulty—most often anxiety or depression.

Triggers include changes in routine, sensory overload, or social pressure. Autistic girls often mask distress, making it harder for others to notice. Early trauma, bullying, and rejection are major contributors to later emotional difficulties.

The Irish Context

In Ireland, autism diagnosis and mental health services are fragmented and slow. Many families face years-long waiting lists. Girls are particularly affected because their signs of autism are often subtler. As a result, they experience delayed or missed diagnoses, and their mental health can worsen during the waiting process.

Current Study

Few studies focus specifically on autistic girls’ perspectives. This one explored their lived experiences with diagnosis, mental health, and accessing care.

Research questions asked how autistic girls:

1. Access and experience mental health support.
2. Understand their autism diagnosis.
3. Make sense of their mental health challenges.
4. Identify overlapping (“transdiagnostic”) factors that link the two.

Methods

Researchers used Interpretative Phenomenological Analysis (IPA), which focuses on how individuals make sense of their experiences. Six adolescent girls (ages 12–18) attending CAMHS were interviewed. All had autism diagnoses and at least one co-occurring mental health condition, such as anxiety, depression, or OCD.

The interviews were semi-structured—guided but open enough to allow each girl to speak in her own way. The data were analyzed for patterns and common themes.

Results — Three Main Themes (GETs)

1. Understanding the Relationship Between Autism and Mental Health

The girls struggled to separate their autistic traits from their mental health issues. Many described the two as intertwined—autism contributing to emotional overload, which then worsened anxiety or depression.

• They spoke of confusion about what symptoms “belonged” to autism versus mental health.
• Emotional dysregulation was often misread by parents or professionals as rudeness or defiance.
• Several girls experienced multiple misdiagnoses before autism was recognized.
• The lack of clarity created self-doubt and frustration, but understanding both together offered relief and self-awareness.

2. Navigating Social Environments

Social life was a major source of stress and isolation.

• Many girls described friendship difficulties, exclusion, and bullying.
• Transitioning to secondary school intensified these problems, with new social rules and sensory overload.
• Some withdrew or developed school refusal due to anxiety.
• Supportive accommodations (quiet rooms, understanding teachers, flexible routines) helped reduce stress.
• Despite challenges, the girls wanted connection and valued shared interests with peers.

3. Disconnect Between Needs and Support

The participants often felt services misunderstood them.

• Mental health treatment felt “neurotypical,” focused on talking and emotional insight rather than practical strategies.
• Repeated referrals between agencies left them feeling dismissed.
• Several girls said therapy felt confusing or invalidating, while occupational therapy or structured support felt more useful.
• They wished for professionals with lived autistic experience or genuine empathy.
• Families were supportive but sometimes struggled to understand their needs, reflecting wider gaps in awareness.

Discussion

The study shows that for autistic girls, identity, diagnosis, and mental health are deeply linked. Many face years of confusion before understanding themselves. Diagnosis can bring relief but also stigma and internal conflict.

Social challenges—especially bullying—have lasting emotional effects. The mismatch between autistic girls’ needs and service design contributes to ongoing distress.

A transdiagnostic lens helps explain how emotional regulation difficulties, rigidity, and sensory sensitivities cross diagnostic boundaries, linking autism with anxiety and depression.

Clinical Implications

• Services need to better recognize how autism looks in girls—less externalized, more internalized.
• Assessments and therapy should be person-centered and flexible, using clear language and visual supports.
• Clinicians should account for the overlap of autism and mental health rather than treating them separately.
• Involving autistic voices in designing care can improve trust and relevance.

Limitations and Future Directions

This small, specific Irish sample means results can’t be generalized broadly. Future research should include:

• Larger and more diverse samples.
• Autistic girls with intellectual disabilities.
• Transgender and gender-diverse participants.
• Long-term follow-up to see how experiences change over time.