Autism in women and girls
Understanding how gendered expectations shape the autism diagnosis gap.
Published 30 June 2025. Written by Leeds Autism Practice Staff.
Autism is not a "boy thing". While historically we thought this was the case, both life stories shared by autistic women and an increasing volume of research demonstrates that autism is present in all genders.
Unfortunately, due to a lack of understanding of non-stereotypical presentations, many women and girls have been missed. In this article, we will explore the experience of autistic women and girls.
Gender differences in autism
First, it is important to say that the experience of being autistic is the same for men and women. That is to say, the same differences in social communication and preference for routines occur across all genders.
What changes is the way autism presents. Which means the visible ways we might recognise autism when looking at it from the outside.
Boys tend to have externalising presentations. This might involve stimming, deep engagement in passions, differences in eye contact, meltdowns, and other behaviour that is clearly different from neurotypical peers.
Girls are more likely to have internalising presentations. This might involve social withdrawal, shyness, masking or camouflaging autistic traits, and imaginative play that occurs inside their brain.
It is important to note that these are common but not exclusive. Some girls present with more visible signs, and some boys present with internalised presentations, especially those identified later in life.
Why is it different for girls?
Girls are typically more heavily socialised: encouraged to "play nice", make friends and behave in socially acceptable ways. Girls also often typically feel a greater need to fit in than boys do.
As a consequence, where autistic boys are not worried about standing out, girls often engage in masking and camouflaging behaviour in an attempt to hide their autistic traits. This might include:
- Mimicking the social behaviour of popular girls
- Preparing scripted responses for small talk and rehearsing conversations
- Practising facial expressions in the mirror
- Watching TV shows and reading books to better understand social situations
- Developing passions that will help them fit in, such as fashion, clothes and make-up
- Being on the periphery of games and conversations to avoid being noticed
- Suppressing stimming, sensory needs and passions
- Playing with boys or fitting into the "tomboy" stereotype
What are the consequences?
Not being able to express our true selves has a significant impact on our mental health.
Autistic girls can spend a huge amount of energy trying to mask their autistic traits, leading to burnout and exhaustion. Many women and girls are misdiagnosed with a mental health condition, including:
- Anxiety
- Social anxiety
- Obsessive-compulsive
- Bipolar
- Borderline personality
One of the difficulties is that the masking is often partially successful. Teachers and medical professionals may miss the signs, while parents find their "model student" comes home and has a meltdown in the safety of their home.
Historical context: how did we get here?
The idea that girls might be autistic is nothing new. Early researchers on autism, including Grunya Sukhareva and Leo Kanner profiled austistic girls in among their clinical cases.
But despite the inclusion of girls, much of the research focused on boys. The idea of a 4:1 ratio of boys to girls emerged, and this started a self-fulfilling prophecy. Researchers assumed it was a boy thing and therefore did research on boys, reinforcing the existing bias.
Diagnostic tools, such as Autism Diagnostic Observation Schedule (ADOS) and Diagnostic Interview (ADI), were calibrated to look for autism in the way boys present. Therefore, many autistic girls were screened out of research unless they presented in the stereotypical male way, again reinforcing the bias.
Recognising autism in women and girls
Given that autism presents differently in women and girls, how do we ensure this is factored into the assessment process?
First, it is important to remind ourselves that there is no one way to be autistic, nor is it a gender binary, either. Applying a separate male and female test is insufficient because autism is a spectrum of presentations.
Throughout the process, we focus on internal experience rather than observable behaviour. "Did you have friends at school?" tells us nothing. "What was your experience of friendships at school?" opens up a highly informative conversation.
Explore masking and camouflaging. Many autistic women report that they tried to fit in but found it difficult or impossible. Again, this could be missed if we relied on observable behaviour rather than asking about internal experience.
Prize personal experience over collateral information. While involving family members and schools can be useful, for a variety of reasons, they may be unable to see the internal difficulties a person is facing.
Ask about other diagnoses. As autistic women have often been misdiagnosed, as discussed above, exploring these experiences, and often unfruitful attempts to "treat" whatever label they were given, can be insightful.
Exploring sensory needs. Differing sensory needs has only recently been added to the medical definition of autism, but clinical experience suggests that women are more likely to have differing sensory needs than men.
Conclusion
Many women and girls are autistic. However, these signs are often missed because the male stereotypical presentation was assumed to be the norm. It is vital to consider how women and girls may present differently to ensure they can access the identification and supports they need.