Autism is a lifelong neurodevelopmental condition that affects how a person communicates, relates to others, and perceives the world. Often described through the lens of neurodiversity, autism represents a spectrum of experiences and traits—no two autistic individuals are exactly the same.
When we think of autism, the first images that often come to mind are shaped by longstanding stereotypes — young boys with a fascination for trains or dinosaurs, a love of maths, or an aversion to loud noises. But autism is far more complex and varied than these stereotypes suggest, and, this can make it harder to recognise autism in women and girls.
While public awareness of autism has grown, much of our understanding has been shaped around how the condition presents in boys. This has contributed to a significant gap in diagnosis and support for women and girls. In this blog, we explore why so many autistic females go undiagnosed and the unique ways autism may present across different genders.
Understanding Autism: Beyond the Stereotypes
According to the NHS, approximately 700,000 people in the UK are autistic — with the gender ratio of diagnosed individuals historically estimated at 10:1 (male to female). However, newer research suggests the true ratio could be closer to 4:1. If that’s the case, it implies that as many as 200,000 women and girls in the UK may be undiagnosed.
So, why are so many autistic girls and women being missed?
The Diagnostic System: Built for Boys?
One major reason lies in the way autism is perceived and diagnosed. Historically, the diagnostic criteria for autism have been based on research primarily conducted with boys. The original studies by Kanner and Asperger, which shaped the foundation of modern diagnostic tools, focused almost exclusively on male subjects. As a result, the way autism presents in girls and women has been under-researched and under-recognised.
Hans Asperger even claimed in 1944 that no girls were affected by the syndrome. The legacy of these assumptions still shapes how autism is diagnosed today.
Common societal stereotypes further reinforce the idea that autism is a “male” condition. Interests typically associated with autism — such as engineering, mechanics, or trains — are also traditionally considered masculine. So, when an autistic girl develops an intense interest in something like animals, celebrities, or literature (interests often considered “normal” for girls), her behaviours may go unnoticed or be dismissed. A girls quieter demeanour may be mistaken for shyness. When teenage girls show signs of emotional distress or social withdrawal, their behaviour is often attributed to puberty or hormonal changes, rather than autism.
How Autism Can Look Different in Girls
Autistic traits can present differently in females compared to males. Here are some common distinctions:
In Boys:
- More visible repetitive behaviours (e.g. lining up toys, spinning wheels)
- Disruptive behaviour and difficulties with impulse control
- Tend to act out under stress (e.g. anger or meltdowns)
- May struggle more noticeably in group settings
In Girls:
- Often better at mimicking social behaviour and “masking” their difficulties
- More likely to internalise stress, leading to anxiety, depression, or self-harm
- Interests may align with societal expectations (e.g. books, dolls) but are pursued with unusual intensity
- Tend to be quieter and less disruptive in school, leading to their struggles being overlooked
- May make socially inappropriate comments, speak too loudly, or show difficulty forming friendships
This ability to mask or camouflage autistic traits is a double-edged sword. While it may help girls appear to “fit in” socially, it can also delay diagnosis and access to support — often until adulthood, or after years of misdiagnosis.
The Mental Health Cost of Misdiagnosis
Many autistic girls are first diagnosed with mental health conditions such as anxiety, depression, or borderline personality disorder. While these may be real co-occurring conditions, autism may go undetected for years and therefore cause further difficulties with their mental health.
Misdiagnosis or late diagnosis can have significant consequences. Without an accurate understanding of their needs, many autistic women struggle through school, work, and relationships without the right support. It can be deeply isolating and damaging to mental health. Misdiagnosis could also lead to inappropriate treatment, including mis prescribing medication, lead to poor self esteem from not fully understanding their own identity and missed opportunities due to not receiving the correct support.
Changing the Narrative
There is a growing awareness of how autism presents in women and girls, and efforts are being made to improve diagnosis and support. But there’s still a long way to go.
Healthcare providers, teachers, and parents must begin to recognise that autism doesn’t have one “look.” Sometimes it looks like a bright, articulate teenage girl who seems anxious and withdrawn. Sometimes it looks like a woman who’s been misdiagnosed for years.
Early recognition, accurate diagnosis, and tailored support can make a life-changing difference for autistic girls and women.
Autism in girls is not rare — it’s just been overlooked.
At Portland Assessments our team has extensive knowledge of how autism can present in women and girls and our assessors have experience of assessing high masking females. We use a range of screening tools which can identify masking and camouflaging traits, if you feel like this is something you relate to please get in touch and our team can support you through this process.