Autistic Women & Girls: Why So Many Are Missed or Misdiagnosed

by Dr Maria Daves 

For a long time, autism has been widely misunderstood—especially when it comes to how it presents in women and girls. It was once assumed that autism was primarily a male condition, with research and diagnostic tools heavily focused on boys and men. As a result, many autistic women and girls have spent years—often decades—without the diagnosis, support, or understanding they need.

But this is changing.

More women and girls than ever are now discovering they’re autistic, often later in life. This growing awareness is beginning to challenge outdated stereotypes and reveal just how inaccurate the old assumptions were. Autism is not just a male experience. It affects people of all genders—including women and girls, and non-binary individuals—in complex and diverse ways.

Why Are Autistic Women and Girls Often Missed?

One key reason autistic girls and women go undiagnosed is masking.

By: ali reza

Many autistic females learn to camouflage their difficulties by copying others, mimicking social behaviour, or “performing” in ways that make them seem neurotypical. This masking can be so effective that teachers, family members, or even clinicians miss the signs entirely.

At school, an autistic girl might appear to be part of a friendship group, achieve good academic results, and seem like she’s coping well. But underneath, she may be struggling to manage intense anxiety, sensory overload, or feelings of not fitting in. Her success in one area can completely mask her difficulties in others.

Another issue lies in the tools and criteria used for diagnosis. Many were developed with boys and men in mind, so they fail to capture the traits more common in women and girls. These tools may overlook the subtler, internalised signs of autism—such as intense interests that align with socially acceptable topics (like books, celebrities, or animals) or more passive behaviours that don’t draw attention. This research bias has a long history – the earliest studies on autism looked at far more boys than girls, a gap that’s shaped diagnostic criteria ever since.

What Does Autism Look Like in Women and Girls?

While every autistic person is unique, there are some common traits and patterns often seen in autistic women and girls:

• Masking or camouflaging their traits in social settings, which can lead to extreme exhaustion or burnout later.
• Internalised challenges, such as anxiety, low mood, and perfectionism.
• Highly focused interests, which may be socially acceptable and therefore overlooked.
• Difficulty identifying and expressing needs—especially when these have been suppressed over many years.
• Meltdowns or shutdowns, which may only happen in safe environments like home.
• Struggles with identity, often from years of trying to fit in and meet others’ expectations.

Crucially, many autistic women and girls are misdiagnosed with mental health conditions such as anxiety, depression, eating disorders, or borderline personality disorder—without their underlying autism being recognised.

The Cost of Masking

By: Mikhail Esteves

Masking might help autistic individuals “pass” in social situations, but it often comes at a huge personal cost.

Suppressing natural instincts and coping strategies—like stimming, using direct language, or seeking alone time—can lead to:

• Emotional burnout
• Mental health issues, including depression and suicidal thoughts
• Physical exhaustion
• A sense of isolation or disconnection
• Increased vulnerability to abuse
• Loss of identity or low self-esteem

Many autistic women and girls have spent their lives being told they’re “too sensitive,” “lazy,” “odd,” or “not trying hard enough.” Over time, they may begin to believe these labels—without realising that their differences stem from neurodivergence, not personal failings.

Finding Support and Reclaiming Identity

One of the most powerful steps for many autistic women and girls is finding community. Connecting with other autistic people—whether online or in person—can offer validation, understanding, and a sense of belonging. Support groups and neurodiversity-positive organisations can also help individuals rediscover their identity, strengths, and preferences.

Therapy can be another important part of the journey. At Harley Therapy, our practitioners work with autistic women and girls to help them:

• Unmask safely, at their own pace
• Reconnect with who they truly are
• Navigate burnout and anxiety
• Build self-awareness and self-advocacy
• Embrace their neurodivergence as a valid and valuable identity

Moving Forward: What Needs to Change?

By: Helgi Halldórsson

To better support autistic women and girls, we need widespread change—across education, healthcare, workplaces, and families. That change starts with three key pillars:

1. Awareness – recognising the varied and often subtle presentations of autism in girls and women.
2. Inclusivity – creating environments where neurodivergent individuals are welcomed and supported, not expected to mask.
3. Understanding – challenging assumptions and listening to autistic voices.

As understanding grows, we hope to create a world where autistic people don’t have to hide who they are—and where girls and women are diagnosed not decades too late, but when they first need support.

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If you or someone you care about might be autistic and is looking for support, visit Harley Therapy to find an experienced therapist. Dr. Maria Daves, Consultant Counselling Psychologist and ADHD Coach, offers specialist autism and ADHD assessments and support both online and in our London clinics.