Clinical InsightsWhy Autism Is Still Missed in Girls and Women

For many years, autism was largely understood through research based on boys. As a result, many girls and women whose experiences did not fit the "typical" presentation were overlooked, misunderstood or diagnosed much later in life.

Thankfully, our understanding has evolved. Today, we recognise that autism can present differently from person to person, and that many autistic girls and women develop ways of adapting to their environment that can make their differences less obvious to others.

As clinicians who assess children, young people and adults, we regularly meet individuals who have spent years wondering why they have always felt "different". For many, receiving an assessment provides not only answers, but also a greater understanding of themselves.

Why can autism look different in girls?

Every autistic person is unique, but research and clinical experience suggest that girls are often more likely to develop strategies to blend in socially.

This is sometimes referred to as masking or camouflaging.

A girl may carefully observe her peers and imitate their behaviour, rehearse conversations before social situations, or work incredibly hard to hide feelings of anxiety or confusion. From the outside, she may appear to be coping well, while internally finding everyday interactions exhausting.

Because of this, autistic girls are sometimes described as quiet, shy or anxious rather than being recognised as autistic.

Signs can be subtle

Autism is not defined by a single behaviour or characteristic. However, some girls and women may experience:

• Feeling different from their peers without understanding why.

• Becoming exhausted after social situations.

• Strong interests that may appear typical but are experienced with unusual intensity.

• Difficulties maintaining friendships despite wanting social connections.

• Sensory sensitivities, such as finding certain sounds, fabrics or environments overwhelming.

• Feeling they have to "perform" socially rather than interacting naturally.

Not everyone will experience these characteristics, and experiencing one or more does not necessarily mean someone is autistic. However, when these experiences have been present over many years and significantly affect daily life, it may be appropriate to seek specialist advice.

Why are some women diagnosed later in life?

Many adults who seek an autism assessment tell us they have developed ways of coping throughout childhood and adulthood.

They may have achieved academically or professionally while quietly struggling with organisation, relationships, sensory overload or exhaustion. Some only begin to question whether autism might explain their experiences after their own child receives a diagnosis, or after reading about autism in women and recognising themselves.

Receiving a diagnosis later in life can bring mixed emotions. There is often relief in finally understanding lifelong experiences, alongside sadness that support was not available sooner.

Both reactions are entirely understandable.

A careful assessment matters

Autism is a complex neurodevelopmental condition, and no two individuals present in exactly the same way.

A comprehensive assessment considers developmental history, current experiences and how an individual functions across different aspects of life. It also explores whether there may be other explanations for the difficulties someone is experiencing, ensuring that any diagnosis is thoughtful, evidence-based and centred on the individual.

The aim is not simply to answer the question, "Is this autism?" but to understand the person as a whole.

Looking beyond stereotypes

There is no single way to be autistic.

As our understanding continues to grow, it is becoming increasingly clear that autism presents differently across individuals, genders and stages of life. Moving beyond outdated stereotypes allows more people to access the understanding and support they need.

For many, an assessment is not about receiving a label. It is about gaining clarity, recognising strengths as well as challenges, and finding strategies that support everyday life.

Thinking about an assessment?

If you recognise these experiences in yourself, your child or someone you care about, seeking specialist advice may be the first step towards understanding what lies beneath those difficulties.

At Hearfield Mashru, we provide comprehensive neurodevelopmental assessments for children, young people and adults. Every assessment is tailored to the individual, taking the time to understand their unique experiences and providing clear, evidence-based recommendations to help them move forward with confidence.

This article is intended as general information. If you have concerns about yourself or your child, we recommend speaking with us.