Hulya MehmetFor decades, autism has been viewed as a condition that predominantly affects boys. Statistics consistently show that boys are diagnosed with autism at rates of 3 to 4 times higher than girls. But recent research is revealing a more nuanced story – one that suggests we may have been missing autism in girls and women for far too long.
The Numbers Tell Only Part of the Story
Current diagnostic (UK) data shows approximately 1 in 100 children are identified as autistic, with boys significantly outnumbering girls in these statistics. In the U.S. the figures are significantly higher at 1 in 43. However, researchers and clinicians are increasingly questioning whether these figures reflect the true prevalence of autism across genders, or simply highlight gaps in our understanding and diagnostic practices.
The discrepancy becomes even more telling when we look at late diagnoses. Growing numbers of women are receiving autism diagnoses in their twenties, thirties, and beyond – often after their own children are diagnosed, or after learning about autism through media representation that finally resonates with their experiences.
In my clinical practice, I often observe this pattern firsthand. When taking case histories and exploring family dynamics, particularly the mother-daughter relationship and the mother’s own childhood experiences, I frequently recognise signs that suggest the mother may have had undiagnosed autism growing up. Often, what has been labelled as anxiety or depression throughout their lives may actually stem from undiagnosed autism. Sometimes these signs become apparent even during our consultation – in the way they communicate, process information, or respond to certain topics.
When I gently explore this possibility with mothers, helping them understand and validate that what they’ve experienced might be more than ‘just anxiety’ but potentially undiagnosed autism, it can be profoundly revelatory. Many tell me they’ve always wondered about themselves, and having a professional recognise and acknowledge these patterns can be incredibly validating. Whilst I’m not there to diagnose parents, understanding their own experiences and how they grew up helps me better comprehend how this may be affecting them and their approach to parenting.
Why Girls May Be Flying Under the Radar
In my professional experience, I’ve found that when working with girls, I can spot the early signs of autism that others might miss. This comes from years of understanding how differently autism can present in girls compared to boys. One of the key reasons girls often go undiagnosed is that they typically don’t display the overt behavioural issues that draw attention in classroom settings. Instead, they may appear to be coping well on the surface whilst struggling internally.
Different Presentations, Same Condition
Autism in girls often looks different from the stereotypical presentations that diagnostic criteria were built around. While boys might display more obvious repetitive behaviours or intense interests in trains or dinosaurs, girls may:
- Have special interests in animals, celebrities, books, or art – interests that appear more socially typical
- Engage in repetitive behaviours that are less noticeable, such as hair twirling, skin picking, or arranging objects
- Show social difficulties in more subtle ways, perhaps appearing shy rather than obviously struggling with social interaction
The Art of Masking
Many autistic girls become skilled at “masking” – consciously or unconsciously copying social behaviours they observe in others. They might:
- Rehearse conversations in their heads
- Study social situations like scripts to be learned
- Suppress stimming behaviours in public
- Force themselves to make eye contact even when it feels uncomfortable
This masking can be exhausting and often leads to mental health challenges, but it also means their autism goes unrecognised by parents, teachers, and even healthcare professionals.
Internalised vs. Externalised Behaviours
Research suggests that autistic girls are more likely to internalise their struggles, leading to anxiety, depression, or eating disorders, rather than displaying the externalised challenging behaviours more commonly seen in autistic boys. This means their difficulties may be attributed to mental health conditions rather than recognised as stemming from underlying autism.
The Consequences of Late or Missed Diagnosis
When autism goes unrecognised, particularly in girls, the consequences can be significant:
- Academic struggles may be misunderstood as laziness or lack of ability
- Social difficulties can lead to isolation, bullying, or inappropriate friendships
- Mental health challenges may develop without understanding their root cause
- Self-esteem issues often arise from feeling different without knowing why
- Missed support opportunities mean children don’t receive the accommodations and strategies that could help them thrive
Recognising Autism in Girls: What to Look For
Parents, educators, and healthcare professionals should be aware that autism in girls might present as:
- Intense friendships with one or two people rather than broader social groups
- Perfectionism and high anxiety about making mistakes
- Difficulty with transitions and changes to routine, even if not obviously expressed
- Sensory sensitivities that might be dismissed as being “picky” or “sensitive”
- Special interests that are age-appropriate but pursued with unusual intensity
- Social exhaustion after school or social events
- Difficulty understanding unwritten social rules
- Strong sense of justice and difficulty when rules aren’t applied fairly
Moving Toward Better Understanding
The autism community, researchers, and clinicians are working to address these diagnostic disparities through:
Improved Assessment Tools
New diagnostic instruments are being developed that better capture how autism presents across different genders, ages, and cultural backgrounds.
Professional Training
Healthcare professionals are receiving updated training on recognising autism in girls and understanding the impact of masking behaviours.
Community Awareness
Increased representation of autistic girls and women in media and advocacy is helping families recognise signs they might have previously missed.
Research Focus
Studies specifically examining autism in females are providing crucial insights into how the condition manifests differently across genders.
Supporting All Autistic Children
Regardless of gender, all autistic children benefit from:
- Early identification and support – the earlier autism is recognised, the sooner appropriate support can be provided
- Understanding and acceptance of their unique strengths and challenges
- Accommodations that help them succeed at school and in social situations
- Mental health support to address anxiety, depression, or other co-occurring conditions
- Celebration of their interests and talents, however they manifest
Looking Forward
As our understanding of autism continues to evolve, we’re moving away from a one-size-fits-all view of the condition toward a more nuanced understanding that recognises the diversity within the autism spectrum. This includes acknowledging that autism can look very different in girls compared to boys, and that many individuals may have been overlooked by traditional diagnostic approaches.
For families, this means staying informed about the various ways autism can present and advocating for comprehensive assessments if they have concerns about their child’s development. For professionals, it means continuing to expand knowledge and refine diagnostic practices to ensure no child is missed.
The goal isn’t to diagnose more children with autism, but rather to ensure that all autistic individuals – regardless of gender – receive the recognition, understanding, and support they need to thrive. As we continue to broaden our perspective on autism, we create opportunities for more children to be understood, supported, and celebrated for who they are.
If you’re concerned about autism in your child, speak with your GP or contact your local autism assessment service. Remember that autism presents differently in every individual, and professional assessment is always recommended for accurate diagnosis and support planning.
