What About the Girls? Rethinking Autism Diagnosis
5 Minute Read
“Why does autism seem to affect boys more than girls?”
It’s a question many people ask, and on the surface, the numbers seem clear: boys are diagnosed with autism about four times more often than girls. But those numbers don’t tell the full story. Girls are no less likely to be autistic. They’re less likely to be recognized as autistic.
For decades, autism has been defined through a lens that centers boys - how they communicate, how they behave, and how they struggle. As a result, too many autistic girls are overlooked, misdiagnosed, or written off entirely.
This isn’t just a gap in awareness. It’s a failure of the system. So, let’s talk about it.
Diagnostic Criteria
I’ve mentioned it before, and I’ll say it again - how we diagnose autism is based on observations and research of young boys - not girls. What we know as “stereotypical” characteristics of autism are based on how autism presents in young boys. We then turned those characteristics into the building blocks of the diagnostic criteria for autism. That means autistic girls who don't match the "classic" profile are often overlooked, and therefore are not diagnosed, misdiagnosed, or grow up with many of their needs unmet.
Masking
Autistic girls have become experts at masking: hiding or compensating for their autistic traits in order to blend in socially. They might copy their peers’ behavior, rehearse conversations, or mimic facial expressions. This can help them “pass” in social settings, but it also makes it harder for adults and professionals to spot the signs of autism.
Masking can be extremely harmful and come at a high emotional cost, often leading to anxiety, burnout, or depression later in life. *More on this in Thursday’s post*
Interests
One common trait that is used to identify autism is intense or “focused interests”, or as Barry Prizant and Clara Claiborne Park call them, “enthusiasms”. Many autistic girls who show a special interest in animals or pop stars are often seen as simply being enthusiastic or passionate. Because these enthusiasms are more “socially acceptable”, they are dismissed. This can lead to many women not receiving a diagnosis until later in life, or not receiving one at all.
Misdiagnoses
Instead of being recognized as autistic, many girls are misdiagnosed with conditions like anxiety, ADHD, or borderline personality disorder. These diagnoses are often co-occurring with autism, and because of this, they can act as “red herrings” that delay an accurate autism diagnosis for girls. This misdiagnosis can result in years without the right kind of support.
System Bias
Even with the ongoing fight for more awareness and acceptance, many professionals with the ability to diagnose still hold traditional and outdated beliefs about what autism “looks like”. When autistic girls don’t portray these characteristics, they are deemed “just shy”, “dramatic”, or “socially awkward”. In some cases, caregivers are even told that a girl is “too verbal”, “too friendly”, or “making too much eye contact” - even though none of these things rule out autism. Autistic people - just like nonautistic people - are diverse. No single trait defines the whole picture.
It’s time to broaden our understanding of what autism looks like, especially in girls, women, and nonbinary people. When we rely on outdated and narrow definitions, we leave too many people behind. We need to listen to autistic voices and recognize the wide range of experiences that come with being an autistic person. This can open the door to earlier identification, better support, and more opportunities for autistic people to live their lives genuinely and authentically.
If you or someone you know is wondering whether autism might be part of the story, trust your instincts. Seek out professionals who understand how autism can present across genders, and don’t be afraid to ask questions.
~Chloe