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Autism in Women and Cis-Girls: Masking, Misdiagnosis and Late Diagnosis
Updated: 4 days ago
For a long time, the picture many people were given of autism was a young boy who struggled visibly with social interaction, had obvious repetitive behaviours, or became deeply focused on particular interests. Some autistic people do fit that picture. But many don't.
Autism can look very different from person to person. Not every Autistic person experiences all of the same presentations of traits, challenges, strengths or support needs. Many women and girls are not recognized until adolescence or adulthood. The same can be true for people assigned female at birth who are trans, non-binary, or otherwise gender-diverse (more on that below).
Research increasingly recognizes that some autistic people may have presentations that are less externally obvious, including differences in social communication, sensory experiences, interests, routines, and the ways they adapt to social expectations. Recent research has also found evidence of delayed identification among cis-girls and cis-women due to social camouflaging/masking and limitations in how autism has historically been recognized and assessed.
Sometimes the question isn't whether someone has autistic traits, it's whether anyone was looking for them.
The Autistic Girl Who Seems Social
One of the reasons autism can be missed is that being able to participate socially doesn't necessarily mean social interaction comes naturally.
A girl might watch other people carefully and learn how they're supposed to behave. She may copy facial expressions, phrases, gestures, or ways of making conversation. She may rehearse what she's going to say before social situations or spend hours afterwards thinking about whether she said the wrong thing. She may be able to socialize, but she is significantly activated, stressed, or anxious before, during and after social situations.
She may have friends. She may be articulate. She may make eye contact. She may appear confident.... And she may be completely exhausted.
That doesn't mean every socially capable or socially exhausted person is autistic. But social ability and autism are not mutually exclusive.
Some people become exceptionally skilled at studying and adapting to the social world around them.
Masking and Camouflaging
You may have heard the terms "masking" or "camouflaging" used when talking about autism.
These terms are related to the ways some autistic people consciously or unconsciously adapt their behaviour in order to fit social expectations or reduce the visibility of autistic traits. This behaviour and these challenges can compound depending on the other identities of the Autistic person (i.e. culturally, socio-economically, racially, etc.).
That might mean rehearsing conversations, copying other people's mannerisms, forcing eye contact, suppressing movements or sounds that feel regulating, carefully monitoring facial expressions, or hiding how overwhelmed you are.
It can also be much more subtle.
You might constantly be asking yourself: Am I standing normally? Am I talking too much? Am I making enough eye contact? Was that joke serious? Am I supposed to respond now? Did I seem interested enough? Oh dang, I shouldn't have said that!
For someone who has spent years doing this automatically, it may not even feel like masking. It may simply feel like "how I function." For many, these behaviours can be so engrained that it takes time to even realize you're doing them.
Research suggests camouflaging may be particularly relevant to understanding why some autistic women are identified later, although the research itself has limitations and the terminology and measurement of camouflaging are not yet consistent across studies.
Not every autistic person masks, and not every person who masks is autistic.
"But You Don't Look Autistic"
There is no single way to look autistic.
Being articulate doesn't rule out autism. Having a career doesn't rule out autism. Having a partner, children, friends, or a university degree doesn't rule out autism. Someone can understand social rules intellectually while still finding them exhausting to navigate. Someone can love people deeply while finding certain social environments overwhelming. Someone can appear completely fine during an appointment and then need hours of recovery afterwards.
This is one reason a short interaction doesn't necessarily tell us very much about someone's internal experience.
Why Girls Can Be Missed
Gender expectations can also play a role in what adults notice.
Girls are often expected to be socially aware, agreeable, helpful, quiet, and emotionally attuned. A child who is working extremely hard to meet those expectations may not attract the same concern as a child whose differences are more outwardly disruptive.
Women historically have relied on social relationships for survival. There is more inherent incentive to navigate these relationships and "fit in."
Research on late-diagnosed autistic women has described common experiences of trying to appear "normal," adapting to gendered social expectations, and having autism overlooked by professionals.
Autistic girls can absolutely be more visibly autistic. They can have more visible disruptive behaviours, be highly repetitive, intensely focused, or clearly struggling. Autism doesn't become invisible simply because someone is a girl.
But when someone is able to compensate effectively - or when their differences are interpreted through another lens - they may be missed. And being missed means having to navigate greater challenges on their own, and receiving less access to supported support needs. The stress of this can also make autistic teenagers and adults more susceptible to other challenging experiences, such as abusive or toxic relationships, addiction, eating disorders, school or work issues, and more.
The Empathy Misconception in Autism
A common assumption in early autistic research, which was biased towards boys, found that a lack of empathy was a more common presentation of autism. We now know that this is not universal, and in fact many autistic people of all genders can actually be incredibly empathetic and compassionate - anecdotally possibly more-so than many "neurotypical" people.
Autism Isn't Just About Social Interaction
Another reason autism can be overlooked is that the conversation can become too focused on social skills.
Autism can also involve sensory processing differences, a strong need for predictability, intense or highly focused interests, differences in communication, repetitive movements or behaviours, and differences in how someone experiences and recovers from their environment.
You might be able to get through a busy social event and then need the entire evening alone. You might function well at work because you know exactly what is expected of you, but find unstructured social situations incredibly difficult. You might tolerate noise, lights, textures & fabrics, or crowds because you've learned that you're "supposed to," while your body is telling a very different story.
Sometimes what looks like anxiety, irritability, withdrawal, or exhaustion is connected to the amount of sensory and social processing happening underneath the surface.
When Autism Is Misunderstood as Something Else
Some autistic people receive other diagnoses before autism is considered. Others may spend years trying to understand why they feel different without finding an explanation that quite fits. This doesn't mean previous diagnoses were necessarily wrong. A person can be autistic and also experience anxiety, depression, ADHD, trauma, OCD, or other mental health difficulties.
In fact, co-occurring conditions and the way they interact with autistic traits can make assessment more complicated. Research on autism identification in women has highlighted both co-occurring conditions and contextual factors as possible contributors to delayed recognition.
Often Autistic women are first mis-diagnosed with Anxiety or Depression when underlying these reactions of the body is unsupported Autism.
Sometimes the pieces only begin to make sense when someone looks at the whole picture, or what's underneath.
The Cost of Being "Fine"
One of the most important questions isn't always, "Can you do this?" It might be, "What does it cost you to do this?"
Can you go to the party? Yes.
Can you make conversation? Yes.
Can you work full-time? Yes.
Can you tolerate the fluorescent lights, the noise, the small talk, the interruptions, the unexpected changes, and the constant social monitoring?
Maybe.
But what happens before those experiences, during them, or afterwards?
For some autistic people, continually adapting to environments that don't fit their needs can contribute to significant stress and exhaustion. Studies have found associations between camouflaging and mental health difficulties such as anxiety, stress, and depression, although the research is still developing and does not mean that camouflaging causes these difficulties in every autistic person.
Sometimes the person everyone describes as "so capable" is the person who is using every available resource simply to keep functioning.
And Again, This Isn't Only About Women
When we talk about autism in women, it's important not to create another narrow category that leaves people out.
Some of the research focuses specifically on cisgender women and girls because that is where the historical gap in recognition has been particularly visible. But gender identity and autistic presentation are not the same thing.
Trans men, trans women, non-binary people, and other gender-diverse people may also experience autism in ways that don't fit traditional stereotypes. People assigned female at birth may have spent years being assessed through expectations about femininity, while gender-diverse people may face additional layers of misunderstanding when their presentation doesn't fit either traditional gender expectations or traditional autism stereotypes.
The broader issue is that autism does not have one gendered presentation. There are many ways to be autistic.
If You Were Missed - Relief & Grief
Finding out you're autistic later in life can bring complicated emotions.
There can be relief in finally having a framework for experiences that never quite made sense. There can also be grief.
You might wonder what life would have been like if someone had recognized your needs earlier. You might feel angry about how much energy you've spent trying to fit into environments that weren't designed with you in mind.
You might also begin looking back at your childhood differently. The friendships that were confusing. The sensory experiences nobody understood. The intense interests you were told to grow out of. The exhaustion after school. The need to retreat. The feeling that everyone else had received a handbook that somehow never made it to you.
A later diagnosis, or suspected diagnosis doesn't change your history. But it can change how you understand it, and shape your understanding of yourself today.
Autism Isn't Something That Needs to Be Fixed
Being autistic isn't a "failure" to become something more "acceptable."
Therapy shouldn't be about teaching someone to look less autistic or making neurodivergence disappear (in fact, this is incredibly harmful!).
Instead, neurodivergent-affirming therapy can provide space to understand yourself more fully, identify what is actually difficult, process painful experiences, and develop ways of living that don't require you to constantly override your own needs. It can move towards a celebration of who you are, and become a source of pride.
Sometimes that means working with trauma. Sometimes it means learning to recognize sensory or emotional limits. Sometimes it means exploring identity, boundaries, relationships, burnout, or the exhaustion that can come from years of trying to fit in.
And sometimes it simply means having someone say, "That makes sense," when you've spent years wondering why something that seems easy for everyone else has always required so much effort.
If you were missed, there is nothing wrong with you for needing a different explanation.
Sometimes the problem wasn't that you weren't trying hard enough. Sometimes nobody had learned how to see you yet.
Support is Here For You
Online Therapy can be incredibly helpful for some Autistic people. Virtual Therapy is accessible to wherever you are. You do not need to make an extra trip to go to therapy, you can do it from whatever spaces makes you most comfortable, and with access to being able to meet and care for your needs before, during, and after session.
I, Charlie Gray, have many types of therapy that can be helpful for the vast challenges that many Autistic people face, such as working on emotional and stress regulation by working with the nervous system, or processing relationship challenges or low self-worth, for example.
This is a neurodivergent-friendly and affirming space where we can explore your unique needs, challenges, and strengths. We can grieve together challenges from the past that may have been missed because you didn't know why you were struggling. We can process self-acceptance towards self-love for the many ways that make you - you! We can process and heal past traumas that may have come from navigating a neurotypical world.
If you are seeking Autism affirming care,
