The Short Answer: Autism presents very differently in girls and women compared to boys, largely because diagnostic criteria were developed based on male neurology. Girls are often better at “masking” their autistic traits by mimicking neurotypical behavior, which leads to widespread underdiagnosis. Many girls with autism are misdiagnosed as having depression, anxiety, ADHD, or other conditions instead.

Why autism diagnosis misses most girls and women

When we think of autism symptoms, what we’re typically thinking of is *male* autism symptoms. Most autism research and diagnostic criteria are based on studies of males. However, girls and women with autism spectrum disorder (ASD) often present with very different symptoms than males, leading to widespread underdiagnosis and years of confusion, frustration, and low self-esteem.

In fact, people diagnosed with autism in their 50s often reported growing up thinking they were fundamentally flawed or “bad people” — not realizing they were neurodivergent and simply experiencing the world differently.

The masking problem: why girls hide their autism

One of the primary reasons girls with ASD go undiagnosed is their greater ability to “mask” — hiding their natural autistic traits and studying neurotypical behavior to blend in. Scientists believe girls excel at masking because they’re more wired for social connection and relational behavior.

However, masking comes at a high cost. The constant effort to suppress natural behaviors and conform to social expectations creates enormous stress and exhaustion, often triggering depression, anxiety, sensory overloads, and the “meltdowns” associated with autism. Over time, this hidden struggle can lead to burnout and mental health crises that go unrecognized as autism-related.

How girls with autism are often misdiagnosed

Female autism is frequently misdiagnosed as depression, anxiety, borderline personality disorder, bipolar disorder, or ADHD. Girls with autism also show higher rates of obsessive-compulsive disorder (OCD) and eating disorders. The intense, narrow focus required for conditions like anorexia is believed to stem from autistic traits in many girls — autism appears in approximately 20% of girls with anorexia.

The diagnostic gap exists partly because male bias in science has shaped how we understand and identify autism. Diagnostic criteria are derived from studies on male neurology and behavior. Boys with ASD tend to show obvious difficulties with socializing, communicating, and repetitive, inflexible behavior patterns. While girls with ASD may exhibit these same traits, they often do so to a milder degree or mask them entirely, meaning only girls with extreme or male-like autism presentations get diagnosed, while many girls with milder autism go unrecognized and unsupported.

Girls with autism process the world like neurotypical boys

One possible explanation for diagnostic confusion: girls with ASD often behave more like neurotypical boys than like boys with autism or neurotypical girls. Brain imaging shows that girls with autism process social information similarly to how neurotypical boys do, markedly different from how neurotypical girls process it. On assessments measuring friendship quality and empathy, girls with autism score closer to boys than to girls.

This pattern is reflected in accounts from many girls and women with autism who describe feeling “half boy” or more male-identified than female, suggesting their neurology may genuinely align more closely with male brain function in certain domains.

Being labeled “too intense” as a female autism symptom

A common response to girls and women with ASD is that they are “too intense,” “too emotional,” “too sensitive,” or “too much” in some way. This feedback contributes to shame, isolation, and a deep sense of being fundamentally wrong.

This “too intense” presentation stems partly from the sensory hypersensitivity and sensory overload associated with autism. What neurotypical people experience as normal social or environmental input can feel overwhelming or distressing to autistic people, leading to emotional intensity that appears disproportionate to outside observers.

The mental health and safety consequences of undiagnosed autism

Undiagnosed autism in girls and women carries serious mental health risks. Girls with autism often become social misfits, making them vulnerable to bullying, predatory behavior, isolation, anxiety, low self-esteem, and depression. Remarkably, two-thirds of women with milder forms of ASD report suicidal thoughts at some point, underscoring how profoundly underdiagnosis impacts wellbeing.

Proper diagnosis can be transformative, breaking years or decades of shame and providing a framework for understanding why they feel and act differently. Knowing there’s a neurological basis, rather than a character flaw, for their experience offers enormous relief and opens the door to supportive strategies.

Brain inflammation and autoimmunity in autism

Emerging research links autism in both males and females to brain inflammation and autoimmunity that can begin in utero. Maternal autoimmunity, such as Hashimoto’s low thyroid, along with maternal high blood sugar or infections increase the risk of autism in offspring.

Beyond diagnosis and support, strategies to reduce brain inflammation and address underlying autoimmune factors can help mitigate autism symptoms that cause suffering. At RedRiver, we work with families to identify and address inflammatory contributors to neurodevelopmental symptoms.