- Research finds a diagnostic gender bias: girls who meet criteria are more likely to be missed.
- Autistic women report more camouflaging, and girls get labeled shy, quirky, or anxious instead.
- Many are identified later, and camouflaging is linked to more anxiety and depression.
- Trust the instinct and seek an evaluator experienced with masked presentations.
Far more boys than girls are diagnosed with autism. A 2017 meta-analysis of 54 studies found the true male-to-female ratio is closer to 3:1 than the often assumed 4:1, and concluded that there appears to be a diagnostic gender bias: girls who meet criteria for autism are at disproportionate risk of not receiving a clinical diagnosis.
Girls and women who are autistic often present differently. Many mask extensively, and in research using a self-report questionnaire, autistic women reported more camouflaging than autistic men. They develop sophisticated scripts and social camouflage. They are described as "shy," "quirky," "anxious," or "overly sensitive" but not autistic.
The result: many are identified later. In a Dutch survey of 2,275 autistic people, some groups of females were identified later than males. And camouflaging is not free: in a 2021 study of autistic adults, more camouflaging was linked to more anxiety and depression.
Late diagnosis carries a specific kind of grief, for the girl who struggled without language for what was happening, for the years of trying to fix herself rather than understand herself.
Autistic women, researchers, and clinicians have been working to correct this, but not every evaluator has caught up.
If you are a woman who suspects you are autistic, or a parent raising a daughter who doesn't fit the profile the school describes, trust the instinct. Seek an evaluator who has experience with women and masked presentations. You are not wrong for wondering.
More from WeBearish
- Sensory Tools Guide, Tools the autism community actually recommends - Getting a Diagnosis: A Parent's Guide, Step by step, plain English - Join the WeBearish Community, $3/month. No tragedy narratives.
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Helpful Tools & Resources
Sensory tools, books, and resources that support autistic people and their families:
- Noise-Canceling Headphones for Kids, One of the most impactful sensory tools for many autistic people - Weighted Blankets, Deep pressure support for regulation - Fidget Tools, Tactile regulation tools for hands and focus - Identity-First Books About Autism, Books that celebrate autistic identity - The Explosive Child, Ross Greene, Collaborative problem-solving, respected by autism advocates
Frequently Asked Questions
Why are girls and women with autism diagnosed later than boys?
A 2017 meta-analysis concluded there appears to be a diagnostic gender bias, with girls who meet criteria for autism at disproportionate risk of not receiving a diagnosis. Girls and women often present differently, and autistic women report more camouflaging than autistic men. As a result, they are frequently described as shy, quirky, anxious, or overly sensitive rather than autistic.
What does camouflaging cost autistic girls and women?
In a 2021 study of autistic adults, more camouflaging was linked to more anxiety and depression. Many autistic women are identified later than they could be, and a Dutch survey of 2,275 autistic people found some groups of females were identified later than males. Late diagnosis can carry a specific grief for the years spent trying to fix rather than understand themselves.
What should I do if I think I or my daughter might be autistic?
The article encourages you to trust that instinct, whether you are a woman who suspects you are autistic or a parent raising a daughter who does not fit the profile the school describes. Seek an evaluator who has experience with women and masked presentations, because not every clinician has caught up.