Addressing the underdiagnosis of autism in girls

By Emma Sanderson, Managing Director of Options Autism

Research suggests that girls continue to be far less likely to receive an autism diagnosis during childhood than boys. In fact, boys are around four times more likely to be diagnosed as autistic than girls. Growing evidence indicates this gap may be more to do with gender bias and diagnostic limitations than actual prevalence. Some reports suggest that as many as 80% of autistic girls remain undiagnosed by the age of 18. Many only receive a diagnosis when they have reached crisis point. In 2022 a Swedish study revealed more than 22 percent of autistic women – five times the rate of non-autistic women and nearly double that for autistic men – were hospitalised for a psychiatric condition by age 25.

One key reason for this is that autism presents differently in girls. Diagnostic tools were developed largely around male traits and behaviours, meaning they often fail to capture the female experience. For example, girls may have intense interests that appear more socially acceptable – like animals or pop culture – so they are less likely to raise concern. Similarly, traits like social anxiety, sensitivity, or perfectionism, may be mislabelled as anxiety or personality disorders rather than seen as part of the autistic profile.

Clinicians and educators may also hold unconscious gender biases. Traits like shyness, emotional sensitivity, or repetitive behaviours, might be explained away or seen as ‘normal for girls’. As a result, many girls are left without answers or access to the support they need.

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.

To improve these outcomes, there needs to be a shift in how autism is recognised in girls. This includes developing more gender-sensitive diagnostic tools, educating professionals on the unique ways autism presents in females, and listening to the voices and lived experience of autistic girls and women. Only by addressing these gaps can we create a more inclusive system – one that ensures all autistic people, regardless of gender, are recognised, understood and supported to thrive.

Read more in Education Today: https://bit.ly/4kcZnQK