Why Autistic Women Are Underdiagnosed: What the Research Shows

For decades, autism has been understood almost entirely through a male lens. Early research focused on boys, and diagnostic tools were designed around their behaviour. The result? A clinical picture of autism that has been shaped, tested, and retested on a largely male sample.

While this has helped many boys access the right support, it has left thousands of autistic women and girls invisible. Their experiences don’t always fit the “classic” profile, and so their difficulties are often missed, misinterpreted, or misdiagnosed.

This matters. Underdiagnosis has a ripple effect — shaping how women see themselves, how teachers and families respond to them, and whether they receive the understanding and support they need. For many, it results in years of confusion, self-blame, and unnecessary suffering.

As a clinician and researcher, this issue is deeply personal to me. My master’s dissertation explored autistic women’s experiences of dating, and I’ve worked with many autistic girls and women who describe feeling unseen, invalidated, or misunderstood. I believe that by recognising these patterns and listening more closely to women’s experiences, we can start to close the gap.

So, why are autistic women so often underdiagnosed? And how can we change this?

1. The Male Model of Autism

Autism was first described by Leo Kanner in the 1940s, based on a small group of children — most of them boys. Later research and diagnostic manuals continued to rely on overwhelmingly male samples. This created what’s often called the “male model of autism”.

Clinicians are trained to look for traits such as:

• Strong and unusual restricted interests (e.g., train timetables, electronics, numbers)
  
  

• Overt repetitive behaviours, such as rocking or hand-flapping
  
  

• Clear withdrawal from social situations
  
  

• Limited eye contact or facial expressions
  
  

These markers do show up in many autistic people — but they don’t capture the full picture, especially for women.

Girls may present in more subtle ways:

• Their restricted interests might look “typical” (make-up, fashion, celebrities, books, animals). Because these are common among peers, their intensity goes unnoticed.
  
  

• Their repetitive behaviours may be hidden, suppressed, or channelled into socially acceptable habits like doodling, twirling hair, or exercising.
  
  

• Instead of withdrawing, girls may stay physically present but feel disconnected, “lost” in group settings.
  
  

As a result, traits that would raise red flags in boys are often dismissed as ordinary in girls.

2. The Hidden Cost of Masking

Perhaps the biggest reason women are missed is masking — also known as camouflaging. Autistic women often become skilled at hiding their difficulties by observing, copying, and performing social behaviour.

Masking can include:

• Copying speech patterns or slang to “fit in”
  
  

• Practising jokes or phrases before saying them aloud
  
  

• Forcing eye contact despite discomfort
  
  

• Mirroring other people’s gestures or body language
  
  

• Suppressing stimming behaviours like rocking, humming, or hand-flapping
  
  

• Adopting the role of the “quiet one,” “the helper,” or “the listener” to avoid standing out
  
  

A striking example of this comes from play in childhood. Teachers may describe a girl as “joining in” imaginative play, when in reality she is taking the role of “the dog.” She’s physically present, but not contributing to the storyline or negotiating the rules. On the surface, it looks like inclusion; in practice, it’s a way of staying close to peers without having to manage the complexity of group play.

Masking is often protective — it helps girls avoid bullying, rejection, or being labelled as “weird.” But it comes at a huge cost. Many autistic women describe “crashing” after social situations, needing hours or even days to recover from the effort of performing. Over time, this leads to exhaustion, anxiety, depression, and even burnout.

Masking can also blur self-identity. If you spend years pretending to be someone else, it can feel almost impossible to know who you really are.

3. Misdiagnosis and Diagnostic Overshadowing

Because girls don’t fit the classic male model, clinicians often reach for other labels first. Common misdiagnoses include:

• Anxiety disorders
  
  

• Depression
  
  

• Personality disorders (often Borderline Personality Disorder)
  
  

• Eating disorders
  
  

While these diagnoses may explain certain struggles, they often miss the bigger picture. This phenomenon is called diagnostic overshadowing: once a label is applied, other possibilities are overlooked.

For example, a teenage girl with social difficulties and rigid food preferences may be diagnosed with an eating disorder. While that may be accurate, the underlying autistic differences — sensory sensitivities, rigidity, social exhaustion — may never be explored.

The result is years of therapy that only scratches the surface, leaving women to feel like they are broken, dramatic, or “too much.”

4. The Double Standard Around Special Interests

Special interests are one of the most defining features of autism — but in women, they are often ignored.

For boys, having encyclopaedic knowledge of train schedules signals something unusual. For girls, spending hours learning make-up techniques, researching animals, or memorising details about favourite TV shows is seen as typical teenage behaviour.

But the difference lies in intensity. For autistic girls, these interests can dominate their time, soothe anxiety, and shape identity. Just because the topic is “ordinary” doesn’t mean the interest isn’t autistic.

By overlooking these interests, clinicians miss a vital diagnostic clue.

5. The Role of Gender Expectations

Societal expectations also play a role. Girls are often expected to be more socially skilled, empathetic, and adaptable.

When a girl is quiet, shy, or compliant, she is often praised as “good” or “easy.” In reality, she may be overwhelmed, anxious, or disengaged. Behaviours that would raise concern in a boy — such as withdrawing from peers — may be brushed off in a girl as “just shy.”

This double standard delays recognition and reinforces the invisibility of autistic women.

6. The Emotional Toll of Late or Missed Diagnosis

The consequences of underdiagnosis can be profound:

• Mental health struggles: many women develop chronic anxiety, depression, or trauma responses from years of masking and misunderstanding.
  
  

• Educational challenges: without recognition, their learning needs aren’t met, leading to disengagement or underachievement.
  
  

• Relationship difficulties: women often describe feeling “different,” “too much,” or “never enough” in friendships and romantic relationships.
  
  

• Employment struggles: many experience burnout in workplaces that don’t accommodate sensory or social needs.
  
  

• Low self-esteem and identity confusion: perhaps most painfully, many women internalise the belief that something is wrong with them.
  
  

On the flip side, receiving an accurate diagnosis — even later in life — can be transformational. It provides validation, language for self-understanding, and a framework for seeking support. Many women describe the relief of realising, “It’s not that I’m broken. I’m autistic.”

7. Progress in Research and Practice

Thankfully, the landscape is changing. Researchers such as Francesca Happé, William Mandy, and Gina Rippon have highlighted the importance of recognising female presentations. There is growing acknowledgement that autism is diverse, and no two people present the same way.

New assessment approaches emphasise:

• Asking about internal experiences, not just observable behaviours
  
  

• Recognising the role of masking
  
  

• Valuing lived experience as much as clinical observation
  
  

• Considering context: how girls cope at school versus how they feel at home
  
  

Autistic women themselves have also driven this change. Through books, blogs, podcasts, and advocacy, they have challenged stereotypes and made space for more nuanced, authentic understandings of autism.

Final Thoughts

For me, this issue is not just theoretical. It’s about the women and girls I meet in my work and research — women who have spent years feeling different, invisible, or broken. Women who were told they were too sensitive, too dramatic, too shy, or too difficult. Women who were given a string of other diagnoses while the truth remained hidden.

When we expand our understanding, we don’t just improve diagnosis. We give women the chance to reclaim their identity, embrace their strengths, and live authentically.

Autism does not have one face. It does not belong to one gender. It is time our diagnostic systems, research, and culture finally caught up.

Because every woman deserves to be seen.

References

• Gould, J. and Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice (GAP), 12(1), pp.34–41.

• Happé, F. (2019). Why are autistic girls and women often missed or misdiagnosed? The British Journal of Psychiatry International, 16(2), pp.25–26.

• Hull, L., Mandy, W., Lai, M.C., Baron-Cohen, S., Allison, C., Smith, P., Petrides, K. and Happé, F. (2019). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49, pp.819–833.

• Lai, M.C., Lombardo, M.V., Auyeung, B., Chakrabarti, B. and Baron-Cohen, S. (2015). Sex/gender differences and autism: setting the scene for future research. Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), pp.11–24.

• Mandy, W., Chilvers, R., Chowdhury, U., Salter, G., Seigal, A. and Skuse, D. (2012). Sex differences in autism spectrum disorder: Evidence from a large sample of children and adolescents. Journal of Autism and Developmental Disorders, 42(7), pp.1304–1313.

• Rippon, G. (2019). The Gendered Brain. London: The Bodley Head.