Autism has never been so widely discussed as it has in 2025. Diagnoses are on the rise, thanks in large part to an increased awareness, and numerous celebrities have shared their experience with the condition.
But, even now, half of the world’s population is still being overlooked when it comes to the understanding of symptoms and the rate of diagnosis. Gender bias in medicine means that much of the general understanding of autism is skewed towards its presentation in men, leading many women with autism to fly under the radar.
“For too long, autism has been predominantly understood through a male-centric lens, with stereotypes and diagnostic criteria shaped by how it typically presents in boys,” says Leanne Cooper-Brown, Neurodevelopment Lead at Clinical Partners. “As a result, many women, girls, and non-binary individuals on the autism spectrum remain undiagnosed or are diagnosed much later, often missing out on vital support. This underdiagnosis leaves many without the necessary support, impacting their mental health, education and employment opportunities.”
See also: Has the internet diagnosed you with ADHD or autism?
Recent studies have shed light on this disparity, with 2023 research showing that while 1.22 per cent of males in England have been diagnosed with autism, only 0.35 per cent of females have received a diagnosis.
Autism presents differently in women and girls, which is part of the reason it’s underdiagnosed. But in order to understand how it presents differently, you need to first understand how autism presents more generally.
How autism presents in both sexes
“The first key [autistic trait] is differences in the way someone communicates and behaves in social relationships,” explains Dr Rachel Moseley, Principal Academic in Psychology at Bournemouth University, who is autistic herself. “Both in terms of their verbal behavior — maybe they use language in a slightly different way, maybe their language is little old fashioned, maybe they struggle with pragmatic aspects of language, like understanding jokes — but then you'll also have some people who really don't use watch spoken language. Maybe they only communicate using other people's words, [which is called] echolalia.”
Then there are the differences in nonverbal behavior. “Use of eye contact, use of gesture. Do they show emotions in their voices? Do they express emotions in their faces? Maybe their emotions and their gestures are kind of more vivid. Then there can be differences in what we call social imagination, which is your ability to understand and recognise the mental states of other people, so what they might be feeling, thinking, believing, based on their behavioural signs or facial expressions.”
Dr Moseley also notes that autistic people may have a “preference for sameness” and very intense interests: “Rather than having little hobbies that we dabble in, we would develop an encyclopedic knowledge on certain topics,” she says.
How autism presents in girls
Dr Moseley says it can be harder to spot autistic girls than it is to spot autistic boys, as girls of all levels of neurodiversity tend to have better outward socialisation habits than boys. “You tend to see non-autistic girls being the most socially proficient,” she explains. “Then you see autistic girls and non-autistic boys come in around the same level, so they're sort of comparable in terms of their outward social behavior. And then you see that autistic boys are considerably worse. So it's kind of like a sliding scale where autistic girls tend to be at a midpoint between non autistic girls, non autistic boys, and autistic boys, who are at the very bottom, if you were to be scoring them in terms of their outward social behavior.”
This often means that autistic girls are seen on the fringes of social groups, or “weaving in and out of the edges of friendship groups,” but less likely to be ostracised in the way that autistic boys are.
Autistic girls’ special interests also tend to be more socially acceptable than autistic boys’ ones. “You are more likely to see interests that are socially related. Maybe their interests are in other people, or TV programs or celebrities, or maybe in activism, all things that have a social, relational nature.
“With boys, you are more likely to see interests that are age-and-gender-unusual, like a little boy who's interested in baked bean cans. Whereas with a little girl, you're more likely to see an interest that is age and gender appropriate, but it's unusual in its intensity.”
So, while an autistic boy might be interested in trains and baked bean cans, a girl might be entirely devoted to Taylor Swift, or fighting the climate crisis.
This is all part of masking, an autistic trait that is much more common in autistic women and girls than autistic men and boys. “Many [women and girls with autism] develop coping strategies, such as masking, where they mimic social behaviours to fit in, which can make their struggles less visible,” explains Cooper-Brown. “Additionally, traits like sensory sensitivities or difficulties with eye contact, commonly recognised in males, are sometimes suppressed or overlooked in females [...] Masking can lead to exhaustion, anxiety and burnout, contributing to the mental health challenges that many autistic women face.”
How autism presents in women
“Adult women have learnt a lot of strategies to compensate for their differences and difficulties in order to fly under the radar,” says Dr Moseley. “For autistic women, you'll still see these core difficulties in social understanding — like struggling with banter in the office, struggling to read the coded information in emails, implicit suggestions, struggling to connect with people at work.
“You might be painfully shy, and you might be working very, very hard to hide all of this. You might have sensory differences, so you might find it really hard to tune things out, you might be overwhelmed by all the sound and the light and so forth. You might have very fixed ways of doing things, and you're quite inflexible, so you find it hard to do things a different way. You find it hard to adapt in the workplace. You might find your emotions hard to deal with. You might struggle to identify your emotions or to recognize them until they're really overwhelming. You might struggle with meltdowns.”
Masking also continues into older life, Dr Moseley confirms. “We often hear a lot of autistic women are, as a form of masking, quite passive. They're people pleasers. They are desperately trying to be liked in order to be accepted and not be victimised. These are all common profiles of autistic women, but, importantly, not all autistic women like this. Some people don't mask a lot. Some people are more blunt, whereas others are more that kind of masking, people pleasing profile.
Signs of autism in adult women
According to the NHS:
Autistic women may be more likely to:
- have learned to hide signs of autism to 'fit in' - by copying people who do not have autism
- be quieter and hide their feelings
- appear to cope better with social situations
- show fewer signs of repetitive behaviours
“This was the predominant view of autism that it was, you know, the more classic stereotyped presentation, the kind of Rain Man image, and that is often not what we see in girls and women.”
As a result, the only women and girls to be recognised as autistic by researchers and psychologists were women and girls who presented with classically male traits of autism, reinforcing the stereotype. It wasn’t until 2013 that masking, a key feature in autism amongst women and girls, was added to the DSM-5 (Diagnostic and Statistical Manual of Mental Illnesses).
“There has been a historic failing in serving people assigned female at birth, people with more subtle presentations of autism,” Dr Moseley says. “They have been underserved for so long, and we know they're out there. Now we’re finally getting to a place where we’re better at recognising them.”
