Autism in Women and Girls: Understanding Underidentification and Its Impacts

For decades, autism has been perceived as a predominantly male condition, with childhood diagnosis rates historically showing about four boys identified for every girl. However, emerging research indicates this gap may narrow by adulthood, suggesting many autistic women and girls are overlooked early in life due to differences in presentation and systemic biases in diagnosis.

The Role of Camouflaging

Autistic girls often exhibit behaviors that can mask their traits, a phenomenon known as camouflaging or masking. This involves consciously or unconsciously suppressing autistic behaviors to fit social norms, such as mimicking peers or channeling intense interests into socially accepted areas like animals or literature. While camouflaging has been observed more frequently in females in some studies, its prevalence and mechanisms remain under investigation, and it is not exclusive to one gender. This masking can make autism less visible to those relying on traditional diagnostic criteria, as noted in a 2023 systematic review in Autism Research.

'I spent years thinking I was broken,' shared one woman in a 2025 Frontiers in Psychiatry study.

Compounding the issue, much of autism research has historically focused on males. A 2023 meta-analysis in JAMA Psychiatry found that nearly 80% of autism studies predominantly included male participants, skewing diagnostic tools toward male-typical presentations. 'We’ve been using a male lens to define autism, then wondering why we miss so many females,' one researcher noted.

The Impact of Late or Missed Diagnosis

When autism goes unrecognized, the consequences can be significant. Undiagnosed autistic girls often face mislabeling (e.g., as 'shy,' 'anxious,' or 'quirky') and lack access to supports that could help them navigate school, friendships, and sensory challenges. By adolescence, many experience mental health challenges: a 2022 study in The Lancet Psychiatry00234-5) reported markedly elevated suicide risk in undiagnosed autistic women, up to eight-fold in some samples, though these findings are based on specific cohorts and require further validation.

Diagnosis in adulthood—while often a relief—can also bring grief for unmet needs. 'I spent years thinking I was broken,' shared one woman in a 2025 Frontiers in Psychiatry study. 'Knowing I’m autistic reframed my entire life.' Many late-diagnosed individuals also report greater self-understanding and access to community and accommodations.

Progress and Ongoing Gaps

Awareness is growing. The UK’s National Autistic Society now highlights female presentation in its guidelines, and some clinicians are adopting more inclusive assessments. Yet barriers persist, especially for marginalized groups: emerging evidence suggests Black and Latina girls face even lower diagnosis rates, often dismissed as 'behavioral' rather than neurodevelopmental, as highlighted in a 2023 Pediatrics study.

The key takeaway? Autism isn’t less common in females—it’s less recognized. Closing this gap requires dismantling stereotypes, expanding research, and listening to autistic women themselves.