Understanding Girls and Women on the Autism Spectrum

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Dec 15, 2025
5 min read

By Dr. Lila Kimel (Owner and Clinical Director at Kimel Psychological Services and Leader of the Adolescent Social Skills Group at KPS- an adolescent group that runs 10 weeks and is run one or two times a year at KPS.

Autism Spectrum Disorder (ASD) has long been considered a “male-dominant” condition, with classic research suggesting a 4:1 ratio of males to females. However, recent studies indicate the true ratio may be closer to 3:1, and the gap narrows even further among individuals with higher support needs. Despite these numbers, autistic girls and women have historically been overlooked, misdiagnosed, or diagnosed much later than their male peers. This blog explores why autistic females are often “hiding in plain sight,” the unique ways autism manifests in girls and women, and what clinicians and families need to know.

Why Are Autistic Girls and Women Overlooked?

Girls are, on average, diagnosed with autism two years later than boys. The average age of diagnosis is 4 for boys and 6 for girls. This delay is partly due to differences in how autism presents in females, and partly due to biases in diagnostic tools and clinician expectations, which are largely based on male samples. Girls are also more likely to be misdiagnosed with other conditions, such as anxiety, ADHD, OCD, or eating disorders, before autism is considered.

The story of Frances, daughter of Yale autism researcher Kevin Pelphrey, illustrates this challenge. Despite developmental delays, Frances was described as “very social and a very happy, easy baby.” Her diagnosis came at age five, after years of “random little diagnoses” and reassurances that “it’s not autism—it’s a girl.” In contrast, her younger brother Lowell was diagnosed at 16 months. Frances’s experience is echoed by many families: girls are often missed or misdiagnosed because their symptoms don’t fit the “classic” male-based criteria.

Key Differences in the Female Autism Phenotype

As research has begun to include more females, important differences have emerged:

Social Motivation and Camouflaging: Autistic girls often show greater social motivation and are more likely to “camouflage” their difficulties. This means they consciously or unconsciously mimic neurotypical social behaviors, masking their challenges in public but often feeling exhausted or overwhelmed in private. Jennifer O’Toole, founder of Asperkids, was a cheerleader and sorority member at Brown University, but inside, she was constantly mimicking others and felt exhausted by the effort.
Restricted and Repetitive Behaviors (RRBs): Girls tend to have fewer or less obvious RRBs, and their interests may be more typical for their age and gender (e.g., Disney characters, American Girl dolls) rather than the “classic” autism interests (e.g., trains, numbers). The difference may lie not in the nature of their interests, but in their intensity—often described as “too much, too intense, too sensitive.”
Friendships and Social Exclusion: Girls may have more typical friendships in childhood, but as social demands increase in adolescence, they often experience social exclusion and greater mental health challenges. The subtleties of junior high, flirting, and dating can be especially difficult, and direct communication styles may make autistic girls vulnerable to exploitation.
Developmental Milestones: Parent reports suggest that early developmental milestones (like first words or walking) are not dramatically different between autistic boys and girls, but parents of boys are more likely to notice social concerns earlier.

The Art and Cost of Camouflage

Many autistic girls become experts at “masking” their differences. They learn to imitate gestures, language, and friendship behaviors, often at great personal cost. This camouflaging can delay diagnosis and lead to increased anxiety, depression, and even suicidal ideation in adolescence and adulthood. The effort required to maintain this mask is exhausting, and many girls report “crashing” at home after a day of social performance.

Misdiagnosis and Overlapping Conditions

Girls with autism are often misdiagnosed with ADHD, OCD, or eating disorders. Research shows that women with anorexia have higher levels of autism traits than typical women, and up to 23% of women with anorexia may also have ASD. Sensory sensitivities and rigid thinking can manifest as severe dietary restrictions, further complicating diagnosis.

Adolescence and Adulthood: New Challenges

As autistic girls grow older, the challenges often intensify:

Mental Health: Rates of anxiety, depression, eating disorders, and suicidal ideation are higher among autistic women, especially during adolescence. A study found that 71% of women with Asperger’s reported suicidal thoughts: nearly 10 times higher than the general population.
Gender Identity: Between 15-24% of autistic individuals do not identify with their biological sex, and gender incongruence is associated with poorer mental health outcomes.
Poorer Outcomes: Autistic women often experience lower quality of life, poorer adaptive functioning, and more difficulties with employment and independent living. Social expectations for women are stricter, and “unusual” behavior is less tolerated in girls and women than in boys and men.

Why Gender Matters in Autism Diagnosis and Support

Diagnostic tools and interventions are often designed with boys in mind. Play-based assessments, clinician expectations, and even parent concerns are shaped by traditional gender norms. This means girls whose interests and behaviors align with gender expectations may be missed by current screening methods.

Moreover, research shows that gender identity and expression can influence how autism is experienced and expressed. For example, autistic girls may be more likely to have interests that are considered “typical” for girls, making their autism less visible to clinicians and educators.

The Science Behind the Gender Gap:

Simon Baron-Cohen’s “extreme male brain” theory suggests that higher fetal testosterone may predispose children to autism, with autistic brains showing strengths in systemizing over empathizing. The “female protective” hypothesis posits that girls may need more genetic or environmental “hits” to show autistic traits, which may explain why girls with autism often have more severe genetic mutations. Even with improved recognition, a male bias in prevalence is likely to remain, though less pronounced.

Moving Forward: What Needs to Change?

Personalized Approaches: We need interventions and supports tailored to the unique needs of autistic girls and women, including mental health, social motivation, and interests. Programs like “Girls Night Out” in Kansas City and Felicity House in New York City are pioneering gender-specific support.
Earlier Identification: Clinicians and educators should be trained to recognize the female autism phenotype and use sex-specific norms when possible.
Research Priorities: More research is needed on the experiences and priorities of autistic females, including puberty, sexual vulnerability, and gender identity.
Family and Clinician Education: Families and professionals should be aware of the signs of camouflaging and the mental health risks associated with delayed diagnosis.

Conclusion

Autistic girls and women have been “hiding in plain sight” for too long. As our understanding of autism expands to include the full spectrum of experiences, it’s crucial to recognize and support the unique needs of females on the spectrum. By adapting our diagnostic tools, interventions, and research priorities, we can ensure that autistic girls and women are seen, heard, and supported throughout their lives.