Early Identification of Autistic Girls and Women: What’s Missing? Challenges & Solutions 

Originally posted on 3/30/23 and updated on 10/30/25

Data from the Centers for Disease Control and Prevention (CDC) show that autism is 3.4 times more common in boys than it is in girls—but many researchers think that diagnostic gap between the sexes is wider than it should be (Shaw et al., 2025). The gap suggests that many girls and women won’t get the support they need to navigate the world.  

A growing number of studies explore the reasons why autism is identified less often and later in girls and women than in it is boys and men. Research tells us the common barriers to timely, accurate intervention include gender bias, gender norms, masking, and overlapping conditions.  

Bias in Representation and Research

Media representations of autism typically feature the male experience, which may affect how the public perceives autism characteristics. Those perceptions can influence referrals, evaluations, and diagnoses. And misperceptions can be reinforced by research that involves more male than female participants. 

Some studies have described autistic individuals as having an “extreme male brain,” because of a tendency to systemize and a reluctance to express emotion openly (Brickhill et al., 2023). Some researchers have also proposed a female protective effect—the idea that simply being female lessens the risk of developing autism. While some studies do suggest that it may take a greater number of risk factors for a girl to develop autism, the evidence is mixed and doesn’t fully explain the diagnostic gap (Doughtery et al., 2022). 

Bias in representation and in research “may have a detrimental effect on the diagnosis rate of females,” experts say. It may also decrease their well-being, lessen the support they receive, and increase the likelihood of masking (Brickhill et al., 2023).   

Social Gender Norms and Autism Traits

The core characteristics of autism are not defined according to someone’s sex or gender. Yet researchers point out that, for autism to be identified, girls must often experience more pronounced autistic traits or greater difficulties with language.  In addition, societal and cultural norms may put pressure on girls and women to behave in ways that make autism harder to recognize. 

Social Communication

Social communication has many facets. Generally, this skill set includes a person’s ability to   

• explain what an emotion feels like physically and mentally;  
• talk about times when they feel a certain emotion;  
• identify when someone is feeling a particular emotion, even if it doesn’t show in facial expressions; and  
• predict the impact someone’s emotions might have on other people or on their actions.  

Every autistic girl has a unique array of abilities. Some autistic girls may seem to have ample emotional and social skills. When researchers observed playground social settings, for example, they noted that autistic girls socialized in groups—while autistic boys played alone or were engaged in “structured activities.” On closer study, however, researchers noticed that autistic girls were often “fringe members of female social groups.” The social situations may have given girls a chance to study interactions for the purpose of camouflaging (Mattern et al., 2023).   

When Mattern et al. compared autistic boys to autistic girls, they noted that girls scored significantly higher on two specific social skills: social cognition and understanding social causality. Social cognition refers to a set of abilities that allow us to detect, interpret, mirror, and respond to emotional signals from people around us. In this study, social causality referred to the ability to describe emotional reactions to past events and explain how behaviors affected other people.   

It's important to note that imaging studies of social brain processes overwhelmingly involve male study participants. One research review found that, of 120 brain imaging studies, roughly 70% included only males or a handful of female participants (Rippon, 2024). 

Special Interests and Repetitive Behaviors

• These traits are important for meeting the threshold for an autism diagnosis. Yet the patterns of interests and repetitive behaviors sometimes differ across sexes. Several studies have concluded that autistic girls have fewer special interests than autistic boys typically do. Researchers have suggested that the difference may be owing to different phenotypes in boys and girls.  

Others say that girls’ interests may not be as apparent because they may look more like the interests of typically developing girls, such as animals, celebrities, or popular bands. The difference may not be the topic of interest for an autistic girl, but the intensity of that interest. 

In at least one small study, researchers observed that autistic girls were more likely to show these repetitive behaviors:  

• Stereotyped rocking and spinning 
• Major reactions to change 
• Repetitive language such as listing or counting 
• Tactile sensory behaviors (Cary et al., 2023) 

Parents may be more concerned about repetitive behaviors in boys than they are in girls (Lockwood Estrin et al., 2021). When that is the case, early autism diagnoses may be missed.  

 Learn more about the special interests of autistic girls and women. 

Camouflaging and Compensatory Behaviors

People of all backgrounds adapt their behavior to different social situations. For autistic people, the practice of hiding autistic traits and mirroring neurotypical behaviors takes enormous energy. And when compensatory strategies are skillful, they may interfere with an accurate diagnosis. They can also make it appear that girls are less impaired or need less support.   

There’s some evidence that autistic girls may be more inclined than autistic boys to use compensatory behaviors. Studies show that girls whose autistic traits are more pronounced tend to use camouflaging behaviors more frequently (Milner et al., 2023). Some researchers suggest that social pressure for girls to socialize, empathize, and express emotion openly may “compel autistic females to adopt camouflaging behaviors in order to align with expected gender roles” (Cancino-Barros et al., 2025). 

For example, girls in one study used gestures energetically during an autism assessment. Using fewer gestures, especially gestures to signal joint attention, is considered an autistic trait, and some autism assessments measure gesture use. For that reason, the study’s authors worried that the girls’ emphatic use of gestures might lead to a lower score and less chance of a diagnosis (Lockwood Estrin et al., 2021).  

The age at which autism is identified can also influence camouflaging. Researchers in one meta-analysis noted that later diagnosis was linked to “greater camouflaging and distinct behavioral adaptations over time,” a trend that could indicate growing social or cultural pressure, or “improved social awareness and a heightened need to adapt to diverse social environments—particularly among autistic females in adolescence and adulthood” (Cancino-Barros et al., 2025). 

Language Differences

Overall, studies show that autistic girls without intellectual disability often have better-developed vocabulary and core language skills than autistic boys of similar age. In studies, early communication delays have been linked to an earlier identification of autism. It may be that delayed language development prompts parents to seek an autism evaluation. Stronger language skills, then, may actually lead to a later autism identification. (Zhang, et al., 2024). 

Girls diagnosed with autism at an early age tend to have lower scores on measures of cognitive language ability, studies show. When autistic girls have higher language skills, they are often diagnosed with autism at a later age (Lockwood Estrin et al., 2021).  

Competing Diagnoses

Autistic girls and women often have other health conditions that can complicate the identification process. Studies show that the chances of having a co-occurring condition are higher for girls—and that co-occurring conditions affect the age at which autism will be identified. Researchers think having a co-occurring condition improves the odds that a girl will receive an autism diagnosis (Rødgaard et al., 2021).   

Conditions such as these often occur alongside autism:   

• attention-deficit/hyperactivity disorder (ADHD) 
• mood disorders such as depression  
• anxiety disorders  
• conduct disorder  
• eating disorders  
• sleep disorders  
• intellectual disability (ID) 
• obsessive-compulsive disorder (OCD) 

It’s often the case that the co-occurring condition is diagnosed first, followed by a later autism identification.  

Learn more: Lived Experiences: Autistic Girls & Women 

Consequences and Missed Opportunities

When the experiences and needs of autistic girls and women are overlooked or misinterpreted, they may not receive the support they need, and their outcomes may be worse. Studies show that delayed or missed diagnoses can lead to: 

• Mental health difficulties such as anxiety and depression
• Less educational achievement
• Unemployment or under-employment
• Social withdrawal or isolation (Cook et al., 2024)

When identification and intervention happen earlier, when a child’s brain is more adaptable, new skills can lead to better outcomes. Early intervention also creates opportunities to educate those in a child’s world who are most able to understand and support a child and to adapt their environment to meet their needs. 

What Practitioners Can Do to Improve Autism Identification

A 2024 narrative review suggests these steps for improving early autism identification in girls and women: 

1. Within the broad diagnostic categories of autism characteristics (i.e. social communication differences, special interests, and repetitive behaviors), look for some variation in how the characteristics are expressed behaviorally. For example, since studies show that autistic girls sometimes have more friendships than autistic boys typically do, it might be useful to look at the amount and nature of conflict in friend relationships between girls. 
2. Carefully consider the possibility that camouflaging could be masking autistic traits. People of all genders sometimes hide or camouflage their autistic traits, but later development of autistic traits may combine with effective camouflaging to make early identification harder in girls and women. Taking the time to build a supportive and empathetic relationships may help people open up about their camouflaging behaviors.
3. Conduct a comprehensive evaluation to identify other conditions with similar or overlapping characteristics. A holistic view of the patient should include an in-depth interview that allows girls and women to share their experiences. In their review, Cook et al. note, “Many autistic girls and women can provide detailed and insightful accounts of their neurodivergence, and during an assessment these can provide invaluable information about core autism characteristics underlying more nuanced or subtle behavioral presentations” (Cook et al., 2024).  

Key Messages

Autism in girls and women is often overlooked or misdiagnosed. That may be because another condition is easier to recognize, or because autistic traits can look different in girls and women. Compensatory behaviors, bias, and misinformation can also shape the diagnostic process.   

It’s important to be aware of these barriers because early identification and support are critical for the long-term health and well-being of autistic girls and women. Everything we know about intervention indicates that outcomes are better for everyone the earlier they begin.   

Learn more about tools that can help you identify autism early. For a deeper dive into autism in girls and women, check out our on-demand ProLearn® webinar “Unmasking the Lives of Autistic Females: Developmental, Clinical, and Diagnostic Considerations.” 

Resource Guides and Tool Kits

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Unmasking the Lives of Autistic Females: Developmental, Clinical, and Diagnostic Considerations

Gain the insight and tools needed to accurately identify and support autistic females across the lifespan—bridging research, lived experience, and clinical best practices.

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