Why So Many Girls and Women Are Diagnosed Late — Or Not At All
What Gets Missed
When most people think of autism, they picture a specific kind of child — usually a boy, usually one whose differences are visible and obvious from an early age. But research increasingly shows that autism presents differently in many girls and women, and that these differences are systematically overlooked.
The result: girls on the spectrum are diagnosed an average of 1–2 years later than boys with similar profiles, and many aren't identified until adolescence or adulthood — if they're identified at all.
This isn't because autism is rarer in girls. It's because the diagnostic criteria, the screening tools, and the cultural expectations were all built around how autism looks in boys.
The Masking Effect
Girls on the spectrum are more likely to "mask" — to study social rules, mimic peers, and perform neurotypicality in ways that are exhausting but effective enough to fly under the radar.
A girl who masks might:
Have one or two close friendships, which gets read as "fine socially" — even though she's working incredibly hard to maintain them
Seem quiet or shy rather than socially different
Have intense interests that look socially acceptable — animals, art, reading, certain fandoms, specific celebrities — rather than the stereotypical interests that trigger referrals
Follow social "scripts" she's memorized rather than navigating interactions intuitively
Hold it together at school all day, then melt down at home when the performance is over
Appear anxious or perfectionistic rather than rigid or inflexible
Masking isn't a conscious choice. It's an adaptive survival strategy — and it comes at a significant cost.
The Cost of Being Missed
Girls who aren't identified often develop secondary mental health challenges by adolescence — not because of autism itself, but because of the cumulative toll of fitting into a world that wasn't designed for their brain.
What this often looks like:
Anxiety that doesn't respond to standard interventions, because the root cause (sensory overload, social performance, rigid thinking patterns) isn't being addressed
Depression that develops as the gap between their internal experience and everyone else's expectations widens
Disordered eating — which can stem from sensory food sensitivities, a need for control, or rigid thinking patterns
Chronic burnout and fatigue from the energy it takes to mask every day
Social crises in middle school when the unwritten rules become more complex and masking strategies stop working
A growing sense that something is fundamentally wrong with them that nobody else seems to see
Many of these girls collect other diagnoses along the way — generalized anxiety, social anxiety, OCD, depression, eating disorders — without anyone connecting the dots.
What to Watch For
Consider whether autism might be part of the picture if you're seeing a girl or young woman with:
Strong academic performance but significant social exhaustion
Intense friendships that cycle between closeness and painful ruptures
Anxiety or perfectionism that feels more like rigidity than worry
Sensory sensitivities dismissed as being "dramatic," "picky," or "high-maintenance"
Deep, focused interests that she organizes her world around
Difficulty with unstructured social time (lunch, recess, parties) even when structured settings go fine
A noticeable difference between how she presents at school versus at home
A feeling — from her, or the adults who care, — that something doesn't quite fit
How We Evaluate for the Female Phenotype
A standard autism screening tool may not catch girls who mask. That's why our evaluations go beyond checklists.
We use a comprehensive approach that includes:
Detailed developmental and social history — with specific attention to how differences may have been compensated for or hidden over time
Direct assessment tools designed to capture subtler presentations, including the ADOS-2 (which assesses social communication in real time, not just on paper)
Observation of masking patterns — not just what she does, but how much effort it takes
Assessment across environments — how she presents at school, at home, with peers, and in one-on-one settings
Evaluation of co-occurring conditions that may be masking or complicating the picture — anxiety, ADHD, learning differences
The goal isn't just a yes-or-no answer. It's a full understanding of how her brain processes social information, sensory input, and cognitive demands — so that support can be targeted to what she actually needs.
What Identification Changes
For girls and women who've spent years feeling like something was off without being able to name it, an accurate identification is often described as life-changing.
It doesn't change who they are. It gives them a framework for understanding their experience — why certain things are harder, why certain things come easily, and why the strategies that work for everyone else don't always work for them.
For parents, it shifts the lens from "what's wrong with my daughter" to "how does her brain work, and how do I support that." That shift changes everything — at home, at school, and in the relationship.
Is This Your Daughter?
If you're reading this and thinking this sounds like her — trust that instinct.
A comprehensive evaluation can give you the clarity you've been looking for. And if it turns out autism isn't part of the picture, the evaluation will still tell you what is — so either way, you leave with answers.