Autism In Women And Girls: Why Is It Often Diagnosed Late?

For many years, autism was considered a condition that primarily affected males. This common misconception has had significant and lasting impacts on the timely identification and support of autistic females.

This article will discuss how autism can present differently in women, the challenges this can present in receiving a diagnosis, and what steps someone can take if they think they might be autistic. As a woman who was diagnosed as autistic well into adulthood, I will also be sharing some of my experiences throughout.

Autism is a neurodevelopmental disorder that affects how people communicate and interact with the world. It is a spectrum condition, meaning that it affects individuals in many different ways and to varying degrees.

There is no single ‘type’ of an autistic person, and the way autism presents can be influenced by a range of factors, including gender. It is likely that our understanding of what autism is is not necessarily representative of how it presents in girls, for instance.

For the purposes of this article, the terms female, girls, and women will refer to cis-gender individuals. More understanding of gender is needed overall for understanding autism as most research uses a binary approach to gender and often does not discuss autistic individuals who are gender non-conforming or transgender.

How Autism Presents Differently in Women and Girls

Autism in females often presents differently compared to males despite meeting the same diagnostic criteria. This difference in presentation can make it more challenging to recognize autism in females, particularly those who have not received a diagnosis.

Here are some ways autism might present in females:

Subtle Social Differences and Camouflaging

Some autistic females may develop sophisticated social strategies, such as mimicking peers or learning social scripts, to mask these difficulties.

This can be different to autistic boys, who may stand out for their lack of interest in socializing, although they can indeed mask too.

🗣 “I used to unconsciously mirror the speech patterns and mannerisms of the people around me, which made me feel like I had no real personality of my own.”

This camouflaging may allow autistic women to pass as neurotypical, but it comes at a cost:

• Exhaustion and social burnout from constantly monitoring interactions.
• Confusion and frustration when socializing feels effortful while appearing easy for others.
• Feeling ‘fake’ or disconnected from one’s true self.

Masking often begins in childhood, as young autistic girls observe their peers and learn how to imitate gestures, facial expressions, and vocal inflections to fit in.

While this helps avoid bullying or exclusion, it can lead to a loss of identity as these learned behaviors become deeply ingrained.

🗣 “When masking, I often unintentionally mirror others’ personalities and mannerisms. I have also found myself observing other people socializing and wishing I could interact as naturally as they do.”

Some women don’t realize they are masking until later in life, when the effort becomes unsustainable, leading to burnout, social withdrawal, or emotional distress.

Different Special Interests

A common stereotype is that autistic individuals are fixated on math, technology, or trains. However, autistic women’s interests often align with socially acceptable or creative fields, such as:

• Psychology, literature, history, or philosophy.
• Arts, music, fashion, or makeup.
• Animals, nature, and environmental causes.
• Media, fantasy worlds, or online communities.

Because these interests seem “typical” for women, they may not raise red flags for parents or teachers.

However, what differentiates an autistic special interest is its intensity—it can become all-consuming and provide a deep sense of joy and focus.

🗣 “There is often a stereotype that autistic people are all mathematically minded and have intense interests in transport and machinery. When speaking to other autistic women and considering my own interests, they can be extremely vast and cover anything and everything.”

Autistic women may also experience intense emotional connections to their interests, which can provide a source of comfort and stability in an overwhelming world.

Internalized Struggles and Co-Occurring Conditions

Unlike the external behaviors often seen in autistic boys (e.g., meltdowns, hyperactivity), autistic women are more likely to internalize distress, leading to:

• Social anxiety and difficulty forming friendships.
• Depression or low self-esteem due to feeling different.
• Eating disorders or self-harm as coping mechanisms.
• Autistic burnout – extreme exhaustion from years of masking.

This is not to say that autistic women and girls do not also externalize their struggles, but they may be more likely to internalize.

🗣 “I had always struggled with social anxiety since I was a child and believed that this accounted for all of my difficulties. However, even with medication and therapy, I still found social situations difficult, even if my overall anxiety levels had reduced. It wasn’t until I started researching autism that I realized I was probably socially anxious because I am autistic.”

Many autistic women experience sensory sensitivities, such as discomfort with certain fabrics, overwhelming noise, or bright lights.

However, because sensory issues are not always discussed in the context of autism in women, they may go unnoticed or be dismissed as “quirks.”

Why does autism often go undiagnosed in females?

1. Gender Stereotypes in Diagnosis

Many autism diagnostic tools were developed based on male behaviors. As a result, professionals may not recognize female presentations of autism.

Professionals may also be more likely to attribute certain behaviors to gender stereotypes, leading to misdiagnosis or underdiagnosis of autism in females.

For example, girls who are quiet, socially anxious, or people-pleasers are often labeled as shy rather than autistic.

2. Misdiagnosis with Other Conditions

Many autistic women are misdiagnosed before receiving the correct diagnosis. Common misdiagnoses include:

• Anxiety disorders – due to social struggles.
• Depression – from years of masking and feeling “different.”
• Obsessive-Compulsive Disorder (OCD) – mistaken for rigid thinking.
• Borderline Personality Disorder (BPD) – when emotional regulation difficulties are misunderstood.

One autistic person stated:

🗣 “When I mentioned the possibility of being autistic to my psychiatric nurse, she actually laughed at me.”

3. The Pressure to Fit In

Society expects women to be more socially adept, empathetic, and nurturing. Autistic women often feel pressured to overcompensate, making their struggles less visible to outsiders.

This expectation leads to years of self-doubt and missed support.

🗣 “Before considering that I could be autistic, I would often set personal goals such as ‘I am going to try to be more social and outgoing.’ Looking back, what I was really aiming for was to mask better (which is not helpful!).”

Many autistic women struggle in romantic relationships, as difficulties with social communication and sensory sensitivities can make dating overwhelming.

Some may also be more vulnerable to manipulative or toxic relationships due to difficulties in recognizing social red flags.

4. Co-existing conditions

Many autistic females experience co-occurring conditions like anxiety, depression, or ADHD, which can obscure the underlying autism.

These overlapping symptoms make it difficult to disentangle autism from other conditions, resulting in misdiagnosis or delayed diagnosis.

For example, an autistic woman who experiences sensory overload in social situations may develop significant social anxiety.

When she seeks help, her anxiety symptoms may be more apparent and lead to a diagnosis of an anxiety disorder, while the underlying autism goes unrecognized.

The Power of Diagnosis

Although a late diagnosis can bring grief for missed support, it can also be liberating. Many women report feeling validated, empowered, and finally able to understand themselves.

Benefits of Diagnosis:

• Relief and self-acceptance – no longer feeling “broken.”
• Finding autistic community – connecting with others who understand.
• Releasing the pressure to mask – embracing authenticity.
• Seeking accommodations – making life easier with workplace or social adjustments.

🗣 “Once I learned I was autistic, I stopped forcing myself into draining social situations. I finally started living on my own terms.”

The Strengths of Autism in Women and Girls

While autism is often discussed in terms of challenges, it is equally important to recognize the many strengths that autistic women and girls possess.

These strengths play a significant role in shaping the unique abilities and perspectives of autistic individuals.

Deep empathy and emotional insight

Many autistic women have a heightened ability to sense emotions, understand others on a profound level, and offer genuine compassion.

This makes them exceptional friends, advocates, and caregivers, as they often excel at offering support and understanding to those in need.

Intense creativity and originality

Whether in writing, music, art, or other creative pursuits, autistic girls and women often bring a unique perspective and attention to detail that allows them to innovate in ways that neurotypical individuals might not.

Strong advocates

Their strong sense of justice and integrity means they are dedicated to fairness and honesty, making them excellent leaders and advocates for social change.

Passion for interests

Additionally, many autistic women possess extraordinary focus and passion for their interests.

They can dive deeply into subjects they love, becoming experts in their fields and making meaningful contributions to their areas of interest.

This ability to hyperfocus often leads to innovative thinking and problem-solving skills that set them apart.

What to Do if You Suspect You Might Be Autistic

If you resonate with the experiences described in this article and believe you might be autistic, here are some steps you can take:

Educate yourself about autism in women

Read books, articles, and personal accounts from autistic women. Understanding the female autism phenotype can help you better understand your own experiences.

Talk to a trusted healthcare professional

Reach out to a doctor, therapist, or psychiatrist who is knowledgeable about autism in adults, particularly in women. They can assess your situation, provide guidance, and potentially refer you for a diagnostic assessment.

Connect with the autistic community

Online forums and support groups can offer a sense of community and shared understanding. Engaging with other autistic people can be validating and empowering.

Write down your experiences

Something that helped me identify that I could be autistic was to write down specific experiences, behaviors, and feelings in a list that I felt may have a neurodivergent explanation.

You can do this in a journal or on your notes app on your phone so then you can easily add to it wherever you are.

Keeping this list can be helpful evidence if you choose to seek an official autism diagnosis, as well as helping you identify patterns and increase self-awareness.

Advocate for yourself

Even if you are not autistic, I think it is also valuable to advocate for your differences anyway.

For example, if you know that you are prone to people-pleasing and it is causing you to burnout, try to communicate boundaries with people and practice saying “no” before you get overwhelmed and prevent more burnouts.

Likewise, if you know that some social events are too overstimulating (e.g., too crowded or loud), you could:

• try to communicate to others that you would prefer to do a less stimulating activity
• explain that you will not be attending this event
• or make accommodations, such as taking earplugs and planning to leave by a certain time

Finally, remember that seeking a diagnosis is a personal decision, and there is no right or wrong answer. The most important thing is to prioritize your well-being, seek support when needed, and embrace your unique strengths and challenges.

References

Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of autism and developmental disorders, 46, 3281-3294. https://doi.org/10.1007/s10803-016-2872-8

Cooper, K., Smith, L. G., & Russell, A. J. (2018). Gender identity in autism: Sex differences in social affiliation with gender groups. Journal of Autism and Developmental Disorders, 48(12), 3995-4006. https://doi.org/10.1007/s10803-018-3590-1

Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders, 7, 306-317. https://doi.org/10.1007/s40489-020-00197-9

Lai, M. C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11-24. https://doi.org/10.1016/j.jaac.2014.10.003

Leedham, A., Thompson, A. R., Smith, R., & Freeth, M. (2020). ‘I was exhausted trying to figure it out’: The experiences of females receiving an autism diagnosis in middle to late adulthood. Autism, 24(1), 135-146. https://doi.org/10.1177/136236131985344