Research continues to highlight a significant gender disparity in autism diagnosis during childhood. Currently, boys are around four times more likely to be diagnosed than girls. However, growing evidence suggests this difference may be rooted less in actual prevalence and more in diagnostic limitations and gender-based assumptions.
Some studies estimate that up to 80% of autistic girls remain undiagnosed by the time they turn 18 – many only being identified once they reach a point of crisis. A 2022 Swedish study further underscored these risks, showing that more than 22% of autistic women were hospitalised for a mental health condition by age 25 – five times the rate of non-autistic women and nearly double that of autistic men.1
One significant reason behind the diagnostic gap is that autism often presents differently in girls. Most diagnostic frameworks were originally developed based on how autism typically manifests in boys, which means they frequently overlook or misinterpret the female experience.
For instance, girls may develop highly focused interests that appear more socially typical – such as animals, fashion, or pop culture – which may not raise immediate concern. Additionally, behaviours like perfectionism, social anxiety or high emotional sensitivity are sometimes misdiagnosed as anxiety or personality disorders, rather than recognised as part of an autistic profile.
Educators and clinicians may also unknowingly be influenced by unconsciously held gender-based assumptions. Traits such as quietness, emotional intensity, or repetitive behaviours might be dismissed as ‘normal for girls’, rather than seen as potential indicators of neurodivergence. As a result, many autistic girls remain unidentified and unsupported, missing the early interventions that could make a significant difference to their wellbeing and development.
Another major factor is masking. Many autistic girls learn from an early age to hide their difficulties in order to fit in. They may copy peers, script conversations, or suppress behaviours that might seem unusual. This ability to blend in, makes it harder for teachers or even parents to identify concerns. While masking can help girls navigate social settings, it can often come at a cost – leading to exhaustion, anxiety, depression, and even trauma over time.
The consequences of missing or delaying a diagnosis are significant. Without the right support, many autistic girls struggle with their mental health, relationships, and education. Some may be punished for behaviours they can’t control, or feel deeply misunderstood. Others grow up with a persistent sense that they are ‘different’ but don’t know why. A diagnosis, even in adulthood, can be transformative – providing clarity, self-acceptance, and allowing access to services and accommodations.
Improving outcomes for autistic girls requires a shift in how we identify and understand autism. This means developing diagnostic tools that are more inclusive of female presentations, providing training for professionals on gender differences in autistic traits, and listening to the lived experiences of autistic girls and women. By addressing these we can move towards a more equitable and inclusive system – one that recognises and supports all autistic individuals to reach their full potential, regardless of gender.
For further information please visit www.outcomesfirstgroup.co.uk.
