Guide · Autism
Autism in women and girls: why it is missed, and what to look for
Autism is the same condition in everyone, but in girls and women it is often less visible, so it gets missed or diagnosed years later. Here is what the research shows, what masking costs, and what to look for.
Updated 25 September 2026 · About 8 minutes to read · All guides
In short
- Autism is diagnosed about three times more often in males, but many girls and women who meet the criteria are missed or diagnosed years later.
- The criteria are the same for everyone; in girls the signs are often less visible, such as ordinary-looking interests, copying peers and keeping distress inside.
- Masking means hiding autistic traits to fit in. Autistic women report more of it on average, and it is linked with exhaustion and poorer mental health.
- Anxiety, depression, eating difficulties and ADHD often come with autism in women, and are sometimes diagnosed instead of it.
- Questionnaires can miss masked autism, so a good assessment draws on developmental history and more than one source.
How often autism is missed in women and girls
More males than females are diagnosed with autism: about three for every female, according to Healthdirect, which says autism is thought to be underdiagnosed in females.
A 2017 meta-analysis pooled 54 studies covering about 13.8 million people. Across all studies there were about four autistic males for every female, but in studies that screened whole populations, rather than counting existing diagnoses, the ratio was lower. The authors concluded it is closer to three to one, and that girls who meet the criteria are at disproportionate risk of not being diagnosed.
Girls also tend to be diagnosed later. In a 2026 Swedish study of 2.7 million people, diagnosis rates peaked at 10 to 14 for boys and 15 to 19 for girls. By age 20, about 1.2 males had been diagnosed for every female.
In Australia, the ABS 2022 disability survey found 1.6% of males and 0.7% of females reported as autistic, but the number of autistic females had risen 95.5% since 2018, against 24.2% for males. These are self-reported figures.
How autism can show up in girls and women
There is no separate “female autism” diagnosis. The diagnostic criteria are the same for everyone, and they allow that signs may not show fully until social demands outgrow a person's capacities, or may be masked by learned strategies later in life.
What researchers describe are tendencies, sometimes called the female autism phenotype. A 2020 review concluded the evidence supports a female-typical presentation, but said it still needs testing across all genders and ages. These are group tendencies, not rules, and not every autistic girl shows them.
- Interests that look ordinary. Intense interests in animals, fictional characters or psychology can seem typical for a girl's age, so the intensity is overlooked.
- Wanting friends, and struggling to keep them. Autistic girls tend to show more interest in friendships than autistic boys, but can find conflict within friendships especially hard.
- Copying others. Healthdirect says girls and women are more likely to hide differences by copying how others behave. Women diagnosed late describe imitating other people's speech and body language, often without meaning to.
- Keeping distress inside. Autistic boys show more outward behaviour problems, which school notices. Girls' difficulties more often turn inward, into anxiety or low mood.
- Stronger language skills on average, which can hide social communication differences.
A US study watched primary school children at recess. Autistic boys spent more time alone, which was easy to spot. Autistic girls stayed close to other girls and moved in and out of their games, so they looked included even when sustained play was hard.
Autism masking: what it is and what it costs
Masking, or camouflaging, means hiding or compensating for autistic traits in social situations. In a study of 92 autistic adults, people described copying others, preparing scripts before conversations, forcing eye contact and holding back stimming, to fit in and to connect with people. It is a way of coping, not deception, and women diagnosed late describe much of it happening without them realising.
On average, autistic women seem to mask more than men. A UK study of 30 autistic women and 30 autistic men compared how autistic each person appeared in a clinical observation with their own reported traits. The gap was larger in women, though it varied a lot in both groups. A 2021 systematic review of 29 studies also found sex and gender differences in camouflaging.
Masking has costs. People in the 2017 study described it as mentally, physically and emotionally draining, followed by anxiety and a need to be alone to recover. The 2021 review linked more camouflaging with worse mental health. For how this can build into months of exhaustion, see autistic burnout.
In a UK online survey of 164 autistic adults, camouflaging was one of the factors linked with suicidal thoughts and behaviour, alongside unmet support needs. The survey was a snapshot, so it cannot show that masking causes it.
What autism gets mistaken for, or comes with
Other conditions are common alongside autism, and in women they are often noticed first.
- Anxiety and depression. A Swedish study followed 1.3 million young people, including 20,841 autistic people, from 16 to 24. By 25, 77 in 100 autistic females and 62 in 100 autistic males had a psychiatric diagnosis, with the sex difference mainly in anxiety, depression and sleep disorders.
- ADHD. A 2019 meta-analysis estimated about 28% of autistic people also have ADHD, though estimates varied widely. See ADHD in women and girls and what AuDHD means.
- Eating difficulties. Autistic traits are over-represented in anorexia nervosa. A 2017 review found estimates from 4% to 52.5%, lower when parents' accounts of early development were used, so some traits may come from the illness itself.
Some diagnoses turn out to be wrong. In a Dutch study of 1,211 autistic adults, about a quarter said a past psychiatric diagnosis had been a misdiagnosis, women more often than men (31.7% against 16.7%). Personality disorders were the most common. These are people's own views, not clinically checked.
Autism and borderline personality disorder (BPD) share features, such as difficulties with relationships and regulating emotions. A 2021 meta-analysis found around 4% of autistic people had a BPD diagnosis, and could not say how often one is mistaken for the other. A careful assessment weighs both.
Signs of autism in girls that parents might notice
Most signs of autism in children apply to girls too. With girls, look past whether she seems to fit in, to what fitting in costs her.
Primary school
- She seems part of the group but stays on the edges, drifting in and out of games.
- She copies a particular friend's way of talking, or takes on their interests.
- Her interests are intense, even if the topic, such as animals or a book series, seems ordinary.
- School describes her as quiet or no trouble, while you see a different picture at home.
Teenagers
Raising Children Network notes signs can become clearer in secondary school, when work is more demanding and friendships more complex. Watch for:
- friendships that keep falling apart, and a lot of distress about conflict
- taking things literally, or finding back-and-forth conversation hard
- being very upset by change
- anxiety, low mood or eating difficulties that treatment has not fully explained
None of these on its own means autism. If a pattern fits, your GP is a good first step.
Autism in women: diagnosis in adulthood
Many women are not diagnosed until adulthood. In a UK study of 14 women diagnosed in late adolescence or adulthood, women described “pretending to be normal”, professionals who missed their autism because they were female, and being treated for anxiety or depression without autism being considered.
A late diagnosis can still matter. In a study of 11 women diagnosed after 40, women described becoming less self-critical and more self-compassionate, though the change in identity was painful to adjust to so late.
What a good autism assessment looks at
Australia's national guideline for autism assessment, approved by the NHMRC in December 2023, includes a Comprehensive Needs Assessment and, where appropriate, a Diagnostic Evaluation. It says practitioners should:
- take possible gender-based differences in autism into account
- use standardised assessments to support clinical decisions, not rely on them alone
- gather information from all relevant people
For someone who masks, that means asking about effort as well as behaviour: what social situations cost, what happens afterwards, and what childhood looked like. It also means considering whether anxiety, depression, ADHD, trauma or a personality disorder explain the picture better, or sit alongside autism.
Questionnaires have limits. Healthdirect notes the tests used to diagnose autism are more likely to detect features more common in males. In a UK study of 476 adults referred for assessment, 64% of those who scored below the cut-off on a widely used questionnaire, the AQ, were diagnosed autistic anyway.
Our free autism test for adults asks about masking directly, and is a starting point, not a diagnosis. See adult autism assessment or child autism assessment for what a full assessment involves. The free screener suggests which assessment fits, and tells you if one does not look like the right next step.
Questions people ask
What are the signs of autism in women?
Common signs include social situations taking conscious effort, copying others to fit in, exhaustion after socialising, intense interests, strong sensory reactions and distress when plans change. For a diagnosis, these differences need to have been present since early development and to affect daily life.
What are the signs of autism in girls?
Autistic girls may copy peers, have intense interests in topics that seem ordinary, stay on the edges of groups rather than alone, and keep distress inside. The criteria are the same as for boys; the signs are often harder to see.
Why is autism missed in girls and women?
Girls tend to show fewer outward behaviour problems and are more likely to mask. Healthdirect notes doctors and teachers may be less familiar with how autism shows in females, and diagnostic tests are better at detecting features more common in males.
What is autism masking?
Masking, or camouflaging, is hiding or compensating for autistic traits to fit in, such as copying others, rehearsing conversations or forcing eye contact. Research links it with exhaustion and poorer mental health. It is a coping strategy, often learned without realising, not a choice to deceive.
Can you be diagnosed with autism as an adult woman?
Yes. Autism can be diagnosed at any age, and many women are diagnosed in adulthood. The assessment still has to establish that the differences were present from early development, so childhood history is part of it.
Wondering whether an assessment makes sense? The free screener takes about three minutes, for your child, your adult son or daughter, or yourself. It suggests which assessment fits, and it will tell you if one does not look like the right next step. Start the free screener.
Where this information comes from
We would rather you checked us than took our word for it. Every link below is the original source, not a summary of one.
- Loomes et al. (2017). What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis. Journal of the American Academy of Child & Adolescent Psychiatry.Meta-analysis of 54 prevalence studies (13.8 million people) estimating the true male-to-female ratio at closer to 3:1 and finding evidence of diagnostic gender bias.
- Fyfe et al. (2026). Time trends in the male to female ratio for autism incidence: population based, prospectively collected, birth cohort study. BMJ.Swedish birth cohort of 2.7 million people showing girls diagnosed later than boys and the cumulative ratio narrowing to about 1.2 to 1 by age 20.
- Australian Bureau of Statistics. Autism in Australia, 2022.National survey figures on autism by sex, including the 95.5% rise in autistic females reported between 2018 and 2022.
- Healthdirect Australia (2025). Autism spectrum disorder (ASD).Government-funded health information on the three-to-one diagnosis ratio, underdiagnosis in females and how autism can present in girls and women.
- Autism Aspergers Advocacy Australia (A4). Autism Spectrum Disorder (ASD) in the DSM-5-TR.Reproduction of the DSM-5-TR autism criteria, including the note that signs may be masked by learned strategies later in life.
- Hull, Petrides & Mandy (2020). The Female Autism Phenotype and Camouflaging: a Narrative Review. Review Journal of Autism and Developmental Disorders.Review of evidence for a female-typical autism presentation, covering interests, friendships, internalising difficulties and camouflaging.
- Dean, Harwood & Kasari (2017). The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder. Autism.US playground observation study of 96 primary school children showing autistic girls' social difficulties were less visible than autistic boys'.
- Hull et al. (2017). “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. Journal of Autism and Developmental Disorders.Qualitative study of 92 autistic adults describing why and how people camouflage and its consequences, including exhaustion and anxiety.
- Lai et al. (2017). Quantifying and exploring camouflaging in men and women with autism. Autism.UK study of 30 autistic women and 30 autistic men finding women camouflaged more on average, with wide variation in both groups.
- Cook et al. (2021). Camouflaging in autism: A systematic review. Clinical Psychology Review.Systematic review of 29 studies finding sex and gender differences in camouflaging and a link between more camouflaging and worse mental health.
- Cassidy et al. (2018). Risk markers for suicidality in autistic adults. Molecular Autism.UK cross-sectional online survey of 164 autistic adults linking camouflaging and unmet support needs with suicidality.
- Martini et al. (2022). Sex Differences in Mental Health Problems and Psychiatric Hospitalization in Autistic Young Adults. JAMA Psychiatry.Swedish register study of 1.3 million young people finding autistic females more often had psychiatric diagnoses, especially anxiety, depression and sleep disorders.
- Lai et al. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. The Lancet Psychiatry.Meta-analysis of 96 studies estimating ADHD in about 28% of autistic people, with very wide variation between studies.
- Westwood & Tchanturia (2017). Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review. Current Psychiatry Reports.Review finding autistic traits over-represented in anorexia nervosa, with estimates from 4% to 52.5% depending on methods.
- Kentrou et al. (2024). Perceived misdiagnosis of psychiatric conditions in autistic adults. eClinicalMedicine.Dutch register study of 1,211 autistic adults in which women more often reported a past diagnosis they saw as a misdiagnosis, most often a personality disorder.
- May et al. (2021). Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta-analysis. Autism Research.Meta-analysis on shared features and co-occurrence of autism and borderline personality disorder.
- Bargiela, Steward & Mandy (2016). The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of Autism and Developmental Disorders.UK interview study of 14 women diagnosed in late adolescence or adulthood on camouflaging, imitation and being missed by professionals.
- Leedham et al. (2020). ‘I was exhausted trying to figure it out’: The experiences of females receiving an autism diagnosis in middle to late adulthood. Autism.UK interview study of 11 women diagnosed after 40 on what a late diagnosis meant for them.
- Raising Children Network. Autism diagnosis: pre-teens and teenagers.Australian parenting resource explaining why autism may become clearer in secondary school and the assessment pathway.
- Raising Children Network. Autism signs: pre-teens and teenagers.Lists signs of autism in teenagers, such as difficulty with conversation turns, taking things literally and being upset by change.
- Autism CRC (2023). National Guideline for the Assessment and Diagnosis of Autism in Australia (updated edition).Australia's national assessment guideline, including attention to gender-based differences and not relying solely on standardised tools.
- Ashwood et al. (2016). Predicting the diagnosis of autism in adults using the Autism-Spectrum Quotient (AQ) questionnaire. Psychological Medicine.Study of 476 adults referred to a UK national autism service showing the AQ questionnaire missed many people who were diagnosed autistic.
- Healthdirect. Mental health helplines.Current numbers for Lifeline, Kids Helpline and emergency services.
Links to external sites are provided for reference. We do not control them and they may change. Last checked 25 September 2026.
This guide is general information, not medical advice. If you are worried about yourself or your child, talk to your GP.
Not sure where to start?
For your child, your adult son or daughter, or yourself. The free screener takes about three minutes and tells you which assessment fits — or whether you need one at all.