The recent increase in conversations around autism and Autistic Spectrum Disorder (ASD) has been shining a light on misconceptions and stigma around ASD which have existed in society historically.
This post focuses particularly on the issue of a gender bias in ASD conceptualisation, diagnosis and research, which for many years has led to the experiences of autistic girls and women being misunderstood and overlooked.
In the past, autism has been primarily associated with boys and men. Traditional diagnostic criteria and research have largely been based on male presentations of autism, leading to a significant gap in understanding how autism presents in girls and women. This has, in turn, led to the belief that autism is more common in boys/men than girls/women (with a suggested ratio ranging from 4:1 to 7:1).
However, recent studies are suggesting that the true ratio of autistic males to females is actually a lot lower than previously thought (3:1, or even 2:1), and that autistic girls may experience symptoms just as intensely as autistic boys.
One key reason this is missed, is the concept of the “female autism phenotype.” This theory suggests that autistic girls often display traits and behaviours that differ from the stereotypical (male-based) understanding of autism. This leads to autism not being picked up in girls by those around them, such as parents and teachers; it also means that, because diagnostic tools were developed primarily from studies on boys, ASD assessments might fail to accurately capture the ways autism presents in girls.
According to research around the female autism phenotype, some reasons why autism in girls might be missed are the following:
1. Masking and Camouflaging
Autistic girls may be more socially motivated and aware of social norms than autistic boys. They may consciously or unconsciously “mask” their autistic traits—adopting behaviours that help them “fit in” socially, such as forcing eye contact, or mimicking social behaviours. While this helps them navigate social situations, it can be mentally exhausting and may lead to issues such as anxiety, depression, and autistic burnout.
Of course, autistic boys and men mask/camouflage too; however, as girls and women (autistic or not) are typically held to higher social communication standards (e.g., girls may be expected to naturally be quieter, empathetic, less “boisterous”), it makes sense that autistic girls may go to greater efforts to match these societal expectations, and mask any traits that may differ from what society expects of them.
2. Different Social and Behavioural Traits
Autistic girls may display stronger social motivation, and they might be better at forming traditional friendships compared to autistic boys. While autistic boys may show visible social difficulties, girls often develop coping strategies that allow them to blend in. However, this doesn’t mean they don’t face challenges—many autistic girls experience intense social anxiety and emotional exhaustion from “keeping up their social personas”.
Another reason girls may not be flagged for autism is their interests. While autistic boys might develop highly specific interests that seem unusual for their age (e.g., train schedules or mechanics), autistic girls may focus intensely on topics that align with their peers’ interests, such as animals, books, or celebrities. This can make their restricted interests less noticeable to parents and teachers.
3. Internalising vs. Externalising Behaviours
While autistic boys are more likely to show externalising behaviours such as hyperactivity or conduct problems, autistic girls may be more prone to internalising their difficulties (similarly to non-autistic girls). This can lead to autism being missed in girls, as internalising behaviours are not as easily observable from the outside.
4. Bias in Diagnosis and Research
Many standardised autism assessments (used to diagnose ASD, but also to include/exclude participants from ASD research) are based on male-centred criteria, meaning they may fail to capture how autism presents in girls. Additionally, clinicians may hold unconscious biases that influence their ability to recognise autism in female patients. All of this, again, might lead to delayed, missed, or absence of ASD diagnosis.
When autism goes undiagnosed in girls, the effects can be profound. Many undiagnosed autistic women report feeling as though something is “wrong” with them, without understanding why they struggle in certain areas. This may lead to autistic burnout, higher rates of mental health problems such as anxiety, depression and eating disorders, and even self-harm and suicidality.
In recent years, an increasing number of research studies have been focusing on gaining more understanding of the female autism phenotype. Hopefully, this can lead to greater awareness of how autism presents in girls and women, and how this might be different from how it shows up in boys and men. This is really important for improving diagnosis rates and ensuring all autistic individuals receive the support they need. By broadening our understanding and adapting diagnostic criteria to be more inclusive of female presentations, we can help more autistic girls and women gain clarity, validation in their experiences, and the resources they need to thrive.
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(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8
D’Mello, A. M., Frosch, I. R., Li, C. E., Cardinaux, A. L., & Gabrieli, J. D. E. (2022). Exclusion of females in autism research: Empirical evidence for a “leaky” recruitment-to-research pipeline. Autism research : official journal of the International Society for Autism Research, 15(10), 1929–1940. https://doi.org/10.1002/aur.2795
Autism.org – Women in Autism – https://autism.org/women-in-autism/#gender-bias
Author: Valentina Sartore
Psychotherapist
