- Autism was long seen as male, and girls who meet the criteria are at higher risk of being missed.
- Masking lets many autistic girls hide traits that would flag in boys.
- Missed girls are often first labeled with anxiety or depression instead.
- Seek an evaluator experienced with female and masked autism presentations.
Autism has historically been understood as a predominantly male condition, and the cultural image of autism was built largely around autistic boys and men.
One consequence is that autistic girls and women have been underdiagnosed, misdiagnosed, and left without support. The scale of this problem is only beginning to be understood.
The numbers
The ratio of male to female autism diagnoses has often been assumed to be 4:1. A 2017 meta-analysis of 54 prevalence studies found the ratio is closer to 3:1, and concluded that girls who meet the criteria for autism are at disproportionate risk of not receiving a clinical diagnosis. The CDC's most recent monitoring data show autism identified in 8-year-old boys about 3.4 times as often as in girls.
Recognition is catching up. A UK study of 20 years of health records found that recorded autism diagnoses rose faster for females than for males, with the greatest rises among adults. Behind numbers like these are women who spent their entire childhoods without a diagnosis, without support, wondering why they were different in ways no one seemed to see.
Why girls are missed
One major reason autistic girls are missed is masking: in a 2020 study, autistic women reported more camouflaging than autistic men. Girls are often socialized, from early childhood, toward social performance, watching and imitating others, attending carefully to social cues, smoothing over social difficulties rather than confronting them. This socialization gives autistic girls tools for masking their autistic traits that autistic boys often do not develop to the same degree.
An autistic girl who has spent years carefully observing and imitating neurotypical social behavior may appear socially fluent in a way that prevents clinicians from recognizing her autistic profile. The same social difficulties that would flag immediately in an autistic boy, an autistic girl has learned to hide them.
The masking is exhausting. The anxiety underneath it is often significant. And without a framework that explains why social interaction costs so much more for her than it appears to for everyone else, autistic girls often attribute the difficulty to personal failure.
What late diagnosis looks like
Many women who receive late autism diagnoses describe a profound experience of suddenly understanding themselves, of having a framework that explains a lifetime of feeling fundamentally different and never knowing why.
They describe years of anxiety and depression that were treated without anyone asking why, without the autistic sensory and social experience that was generating the anxiety being addressed. They describe relationships that were difficult in ways they could not articulate. Work environments that depleted them completely. The constant performance of a version of themselves that felt hollow.
Late diagnosis is not nothing. It provides a framework. It opens access to support and accommodation. It connects people to a community. But it cannot undo the years of going without.
What to do
If you have a daughter who has been diagnosed with anxiety or depression, or who has simply always seemed to find social interaction exhausting in ways she cannot explain, it is worth asking whether autism evaluation has been considered.
Finding an evaluator with specific experience with autism in girls and women makes a significant difference.
Every autistic girl deserves to understand who she is before she spends decades wondering why she feels like an alien in her own life.
Frequently Asked Questions
Why have autistic girls historically been diagnosed later than boys?
Autism has long been seen as a mostly male condition, and a 2017 meta-analysis found girls who meet the criteria are at disproportionate risk of not receiving a diagnosis. One major reason is masking: a 2020 study found autistic women report more camouflaging than autistic men, and girls are often socialized from early childhood to be socially smooth.
What is the real ratio of autistic boys to girls?
The male to female ratio has often been assumed to be 4 to 1, but a 2017 meta-analysis of 54 prevalence studies found it is closer to 3 to 1, and that girls who meet the criteria are at disproportionate risk of not being diagnosed. The CDC's latest data show autism identified in boys about 3.4 times as often as in girls.
What should I do if I think my daughter might be autistic?
If your daughter has been diagnosed with anxiety or depression, or has always found social interaction exhausting in ways she cannot explain, it is worth asking whether autism evaluation has been considered. Finding an evaluator with specific experience in autism in girls and women makes a significant difference. Late diagnosis cannot undo the years of going without, but it provides a framework, access to support, and community.