Autism in Women: Why It Often Goes Undiagnosed — and How Understanding It Can Be Life-Changing
Introduction
For many women, discovering they are autistic happens later in life — sometimes after years of wondering why social interactions feel draining, why certain sounds or textures are overwhelming, or why it feels so hard to fit in. Autism spectrum disorder (ASD), also known as autism, is a neurodevelopmental condition that affects communication, behavior, and social understanding.
Historically, autism has been studied and diagnosed primarily in boys, leading to widespread underdiagnosis among women and people assigned female at birth (AFAB). Recent research suggests that up to 80% of autistic women remain undiagnosed by age 18, despite showing signs since childhood.
Understanding autism in women requires challenging long-standing assumptions and recognizing that traits often look different than the “classic” presentation seen in males.
Why Autism in Women Often Goes Undiagnosed
There is no single medical test for autism. Clinicians rely on developmental history, behavioral patterns, and standardized assessments to make a diagnosis. But when these tools are based on male-centric models of autism, women’s experiences often go unnoticed.
A History of Male-Based Research
For decades, autism was viewed as a condition that primarily affected boys. Early research, diagnostic criteria, and assessment tools were shaped by male behavior patterns — such as visible social withdrawal, repetitive play, or overt behavioral challenges.
As a result, autism in females has often been misinterpreted or overlooked because it doesn’t always align with those traditional traits.
Differences in Presentation
Autism traits in girls and women tend to appear more subtly. Many autistic females are socially motivated, eager to connect, and skilled at observing and mimicking others to “fit in.” This ability to compensate, called masking, can hide autistic traits during childhood and even well into adulthood.
Autism Traits and Signs in Females
While every individual on the autism spectrum is unique, research and lived experience highlight several patterns more commonly seen in autistic females:
Fewer outward social difficulties. Many women with autism are highly observant and develop strong social scripts — learned patterns of what to say or do in certain settings — allowing them to navigate interactions effectively, even when it’s exhausting.
Internalized struggles. Instead of externalizing frustration, females often turn stress inward, resulting in anxiety, depression, or perfectionism. This can lead to misdiagnosis with mood or personality disorders.
“Socially acceptable” special interests. Whereas autistic boys might focus intensely on trains or math, girls may fixate on subjects such as celebrities, animals, or beauty — interests that don’t raise concern because they seem typical for their age group.
Sensory sensitivities. Autistic women may experience heightened sensitivity to light, sound, touch, or smell, leading to overwhelm in busy or stimulating environments.
Emotional exhaustion from masking. Constantly trying to appear “normal” takes a toll, often leading to burnout, fatigue, and a sense of disconnection from one’s authentic self.
Masking: The Hidden Challenge of Autism in Women
Masking (or “camouflaging”) refers to consciously or unconsciously hiding autistic traits to blend in. Many autistic women describe this as performing normalcy — mimicking facial expressions, rehearsing conversations, or forcing eye contact even when it feels unnatural.
While masking can help individuals function socially, it often comes at a cost. Over time, it can lead to:
Anxiety or depression
Emotional exhaustion
Loss of identity
Delayed or missed diagnosis
Recognizing masking behaviors is critical to understanding autism in adult women and offering compassionate, accurate assessment and support.
Adult Diagnosis: A Validating and Liberating Experience
For women diagnosed with autism later in life, the experience is often transformative. A diagnosis can provide clarity, self-acceptance, and a framework for understanding lifelong patterns — from social anxiety and sensory overwhelm to deep focus and empathy.
An autism diagnosis in adulthood is not about labeling; it’s about unlocking self-knowledge and access to appropriate resources, such as therapy, accommodations, and community.
Autistic adult women may experience challenges such as:
Difficulties with executive functioning (organization, time management, or task completion)
Sensory overload at work or home
Emotional dysregulation or burnout
Struggles with self-advocacy or boundary-setting
Through diagnosis and self-understanding, these experiences can be reframed as part of one’s neurodivergent wiring rather than personal shortcomings.
Co-Occurring Conditions
Autism is not degenerative — it doesn’t worsen over time — but many autistic adults live with additional conditions that overlap or stem from years of misunderstanding their needs. These may include:
Anxiety or depression
ADHD
Eating disorders
Obsessive-compulsive disorder (OCD)
Sleep disturbances
Tic disorders
Proper assessment helps differentiate between autism and co-occurring issues, leading to more effective support.
How Coast Psychology Approaches Autism Testing in Women
At Coast Psychology, we recognize that traditional autism assessments often fail to capture how autism presents in women. Our testing process is designed to honor the lived experience of women and AFAB individuals, considering how gender expectations, cultural background, race, and social conditioning shape the way autism shows up in daily life.
Our autism evaluations are:
Contextual and Identity-Informed. We explore how each individual’s environment, upbringing, and identity intersect with neurodiversity.
Evidence-Based. We use validated diagnostic tools alongside in-depth clinical interviews, developmental history, and behavioral observation.
Validating and Liberating. For many women, the process is deeply eye-opening — replacing self-doubt with understanding and self-compassion.
Unlike standardized models that compare individuals to male-centric baselines, Coast Psychology’s approach provides a comprehensive, personalized understanding of each client’s strengths, challenges, and neurodivergent traits.
“Our autism testing is highly contextual, capturing the lived experiences of women — how their autism symptoms may show up differently, and how this intersects with other important factors of their identity like race/ethnicity and social conditioning. Our assessments are cutting-edge and different in this way — evidence-based, and often eye-opening, validating, and liberating for adult women seeking to understand themselves.” - Dr. Laura Morizio
If you’re ready to explore whether autism may be part of your story, our team can help you gain clarity and connect to the support you deserve.
Taking the Next Step
If you think you may have autism, you don’t need to wait for a formal diagnosis to seek support. Speaking with a qualified psychologist can help you better understand your experiences and determine if an assessment would be helpful.
A comprehensive autism evaluation can:
Clarify why certain patterns or challenges persist
Open access to workplace or educational accommodations
Improve relationships through better self-awareness
Foster a sense of belonging in the neurodiverse community
Coast Psychology provides autism testing for adults, adolescents, and children across Long Island and surrounding communities.
Learn more about our psychological testing services →
Schedule an autism assessment today →
Key Takeaways
Autism in women often presents differently than in men — with more internalized symptoms and social masking.
Many women go undiagnosed until adulthood, leading to years of misunderstanding and self-doubt.
A diagnosis can be validating, opening the door to tailored therapy, self-acceptance, and community.
Coast Psychology offers evidence-based, identity-informed autism testing designed to reflect women’s lived experiences.
References
Autistic Women & Nonbinary Network (AWN). (2023). Resources and advocacy for autistic women. Retrieved from https://awnnetwork.org
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294.
Centers for Disease Control and Prevention (CDC). (2023). Data and Statistics on Autism Spectrum Disorder (ASD). Retrieved from https://www.cdc.gov/ncbddd/autism/data.html
Gould, J., & Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice, 12(1), 34–41.
Hull, L., Mandy, W., & Petrides, K. V. (2017). Behavioural and cognitive sex/gender differences in autism spectrum condition and typical development: A meta-analysis. Psychological Bulletin, 143(4), 324–356.
Hull, L., et al. (2019). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 49, 704–716.
Lai, M.-C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11–24.
Leedham, A., Thompson, A. R., Smith, R., & Freeth, M. (2020). “I was exhausted trying to figure it out”: The experience of adults diagnosed with autism in adulthood. Autism, 24(1), 135–146.
Lever, A. G., & Geurts, H. M. (2016). Psychiatric co-occurring symptoms and disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Psychological Medicine, 46(4), 559–576.
Loomes, R., Hull, L., & Mandy, W. P. L. (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, 56(6), 466–474. https://doi.org/10.1016/j.jaac.2017.03.013
National Institute for Health and Care Excellence (NICE). (2021). Autism spectrum disorder in adults: Diagnosis and management (CG142). Retrieved from https://www.nice.org.uk/guidance/cg142
