For a few sessions, my therapist had been referring to me as “neurodivergent.”
I have OCD, which is often considered to be under that umbrella, so I didn’t flinch. But one day, I asked her what she meant by it exactly, and she suggested that I have some traits consistent with an autism diagnosis. While I haven’t undergone the very costly formal process to find out whether I am in fact autistic, her assessment made sense to me: I find social interactions taxing and confusing; I have a deep emotional attachment to stuffed animals; I sometimes feel like covering my ears when there are too many things happening at once.
“There is more and more evidence out there these days that women are chronically underdiagnosed with autism.”
I’ve often wondered whether I might be autistic as a byproduct of self-diagnosis TikToks, but this was the first time anyone else had suggested it. The thing is, there is more and more evidence out there these days that women are chronically underdiagnosed with autism.
There are a number of reasons for this, particularly that autism in those who are raised or identify as girls and women often presents very differently than it does in boys and men. This is a problem because, while a diagnosis isn’t the be-all and end-all, it can help people understand themselves better, learn coping strategies, and find community with like-minded others. I spoke to three autism experts to find out more about how autism presents in girls and women, and why it’s still so misunderstood.
What is autism?
We’ve all heard about autism, but not many of us could define it, so let’s start there.
“Autism is a neurodevelopmental condition that shows up as differences in social interaction, communication, sensory processing, and behavior patterns,” says Gayle Clark, LCSW, a trauma therapist who works with neurodivergent women. “Simply put, it means that the brain processes the world differently — it is not a mental illness or a disorder, just different wiring.” Autism often affects the way people process sensory input and experience social interactions, and can lead to feelings of overwhelm.
“Autism often affects the way people process sensory input and experience social interactions, and can lead to feelings of overwhelm.”
Autism is mostly understood to be genetic, but our experiences of life — including a history of trauma — also shape how it shows up in individuals. “For many autistic women, trauma and masking can layer over each other, making it harder to recognize,” says Vanessa Palomera, LMFT, a therapist and founder of Serene Butterfly Counseling, who is neurodivergent and a Certified Autism Spectrum Disorder Clinical Specialist. “It’s not that trauma causes autism, but it can complicate how symptoms present and make it harder to identify.”
How does autism present differently in women than in men?
Autism looks different in every individual, but there are some commonalities in how it presents in men and boys vs. women and girls, which often means the latter get missed.
One particular difference is that women and girls are more prone to “masking,” i.e., emulating social norms to a greater degree and hiding some of their autistic traits, which could potentially lead to social isolation. This means that autistic women and girls may find it more difficult to advocate for their needs.
“Women and girls are more prone to “masking,” i.e., emulating social norms to a greater degree and hiding some of their autistic traits.”
Additionally, autistic people often have special interests that take up a lot of their attention, but “women and girls are much more likely to choose socially acceptable special interests (animals, books, music, art), so are less likely to be noticed,” says Clark.
These are some signs of autism in women, according to Clark and Becky Grace Irwing, a psychotherapist in the UK who is autistic herself:
- Feeling out of step with others despite appearing competent
- Mimicking others to fit in
- Exhaustion after socializing or performing “normal”
- Struggles with small talk, social rules, or interpreting tone
- Intense internal worlds and rich imaginative lives
- Deep emotional sensitivity or sensory sensitivity
- Sensory discomforts to lights, sounds, textures, foods, being masked as “pickiness” or “sensitivity”
- Shutdowns or meltdowns when overwhelmed
- Literal thinking and difficulty with abstractions
- Need for routine and predictability
- Chronic anxiety, burnout, perfectionism, or identity confusion
Why does it take so long for women to be diagnosed with autism?
Research from Swansea University in 2022 found that it took girls six years longer than boys on average to receive an autism diagnosis, with further research corroborating the delay (though it’s difficult to pinpoint exactly how much longer it might take women to get diagnosed than men).
“A young girl who is using social camouflage may not act out in ways that make their parents concerned, and so a diagnosis is never sought out,” says Clark. “As she grows up, continuing to mask and to just push through her discomfort, she does not seek out diagnosis in adulthood. If she does decide to investigate further, she is much more likely to be misdiagnosed with mental health conditions such as borderline personality disorder, anxiety, or PTSD.”
“A young girl who is using social camouflage may not act out in ways that make their parents concerned, and so a diagnosis is never sought out.”
– Gayle Clark, LCSW
Many women aren’t diagnosed until adulthood, if they’re diagnosed at all. “It is often some major event, such as the diagnosis of a child leading to some self-reflection, or a mental health crisis, or a health provider that asks the right questions that ultimately leads to the diagnosis,” says Clark.
There are unfortunately several reasons for this delay in diagnosis. “Most diagnostic criteria were developed by studying boys who were white and had highly externalized traits or symptoms,” says Palomera. “Unfortunately, most of the tools and checklists used often miss the way autism shows up in women and people of color.” Because of this huge and bias-based oversight, there has also been a historical assumption that boys and men are more likely to be autistic than girls and women.
One of the most salient reasons that girls and women are diagnosed with autism so late is their socialization, which is very different from that of boys and men. “Girls and women are often socialized to care for others, hold the mental load, and please people, so masking is extremely common,” says Irwing. “In my practice, I see a lot of fawning behaviours: Saying ‘yes’ when they mean ‘no,’ overfunctioning in relationships, people-pleasing to the point of burnout.” Autism can look very different from person to person, “but many autistic women are deep thinkers, empaths, and often mislabeled with anxiety or borderline traits,” Irwing adds.
“Autism can look very different from person to person.”
By contrast, boys and men by and large don’t feel so compelled to mask or people-please, so the traits and behaviors consistent with their autism are often more obvious — and more likely to correspond to the existing diagnostic criteria. “Autistic boys and men tend not to care as much about what people think, possibly because their autistic behaviors are generally more accepted by society than autistic women,” says Palomera. “Instead of externalizing behaviors, which are often seen in boys and men, women and girls internalize and struggle behind closed doors. Autistic women are often the ‘quiet good girl’ or the ‘sensitive one.’”
Why does getting diagnosed matter?
An autistic person can absolutely lead a full life without ever receiving a diagnosis, but for many women, getting diagnosed can make things a lot easier. “For many autistic women, a diagnosis feels like permission to stop pretending to be something they’re not,” says Palomera. “It gives clarity on why they’ve struggled and felt different. It can help an autistic woman implement much-needed accommodations as well as self-compassion.” From there, it becomes much easier to set boundaries, tend to your needs, and practice self-love, all of which make relationships flow more easily, too — not to mention a diagnosis opens up opportunities to find community in autistic circles as well.
“For many autistic women, a diagnosis feels like permission to stop pretending to be something they’re not.”
– Vanessa Palomera, LMFT
On the flipside, being undiagnosed long into your adult life can come with a lot of difficulties. “Without understanding your neurotype, you might live on autopilot, trying to meet expectations that were never made for you,” says Irwing. “Undiagnosed autism can result in repeated burnout, chronic stress and inflammation, misdiagnoses (borderline personality disorder, OCD, anxiety, eating disorders), identity confusion and low self-trust and difficulty advocating for yourself or setting boundaries.” Irwing also notes that all of this struggle can lead to physical health issues as well, like “fatigue, digestive issues, and hormonal dysregulation, partly because of the toll of long-term masking and hypervigilance.”
In order to get diagnosed, search for a psychologist, psychiatrist, or social worker in your area who specializes in autism spectrum disorders. They should be able to carry out an evaluation to determine whether you qualify for an autism diagnosis. Just keep in mind that, depending on your insurance plan, getting diagnosed could be pretty costly.
If you’re diagnosed as autistic, do you need therapy?
Though there’s some debate, these days many experts on autism consider it to be a difference rather than a disorder. “From a medical lens, autism is classified as a disorder,” says Irwing. “From a social or neurodiversity-affirming lens, it’s a difference, a valid and natural way of being.”
“These days many experts on autism consider it to be a difference rather than a disorder.”
Meanwhile, Clark and Palomera see autism as a difference or simply a neurotype, not a mental illness, which means that in and of itself, autism doesn’t require that the individual be followed by a therapist.
But that’s not to say that therapy can’t be a great tool for autistic women — and particularly for those who are late-diagnosed. “Many autistic women carry trauma from years of masking, being misunderstood, and pushing themselves past their limits,” says Palomera. “Therapy can be helpful, but it has to be neurodiversity-affirming. That means not trying to ‘fix’ the autism, teaching social skills, or forcing exposure to things without considering their unique needs and nervous system.” Some modalities that can be supportive include integrative therapy, autistic-affirming CBT, somatic work, or attachment-focused EMDR.
Another reason that autistic women might greatly benefit from therapy is that they are “statistically more vulnerable to relational trauma, including emotional abuse, coercion, and neglect,” says Clark, citing a 2014 survey. For anyone with a history of relational trauma, therapy is highly recommended.
How can autistic women and girls lead easier lives?
For those who have been diagnosed (at last!) or who suspect they fall somewhere on the autism spectrum, there are many steps they can take to make their experience of life a lot smoother and happier. “For many, self-help looks like learning to unmask, developing self-compassionate techniques to decrease discomfort — whether that is developing better routines, seeking out sensory-friendly environments, and learning to say no — and working on a stronger and self-compassionate identity,” says Clark. “Testing out and implementing seemingly small things, such as using noise-canceling headphones or fidgets, avoiding busy places, or scripting conversations, can really reduce a lot of the everyday stress.”
Finding a community of neurodivergent women, whether online or in person, can also help a lot with fostering feelings of belonging. Irwing also recommends following autism advocates on social media, such as Ellie Middleton or Kaelynn Partlow. Resources such as the Autistic Women & Nonbinary Network can also be a huge help.
“Finding a community of neurodivergent women, whether online or in person, can also help a lot with fostering feelings of belonging.”
While the knowledge that women are overlooked in autism research and diagnosis can be disheartening, Clark emphasizes that things are slowly shifting and shares reasons to have hope.
“Our understanding of autism — especially how it shows up in women — is finally beginning to improve,” she says. “More and more people with lived experience are speaking out, raising awareness, and pushing back against years of misunderstanding and missed diagnoses. Research is growing. Stories are being shared. Supportive communities are strengthening. Slowly, the world is learning to make space for different neurotypes and ways of thinking, sensing, and being.”
Iris Goldsztajn (she/her) is a freelance writer and editor based in London, UK. Her work has been featured in British Vogue, Marie Claire, Refinery29, SELF, Bustle and many more. Iris can typically be found on her way to a fitness class or with her nose in a good book.
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