Understanding autism in girls: why so many girls are missed

Introduction 

Many parents of autistic girls describe a similar experience. They notice that something feels different about their daughter’s development, social experiences or emotional wellbeing, yet concerns are often dismissed with comments such as: 

“She’s just shy.” 

“She’s anxious.” 

“She’s a bit socially awkward.” 

“She seems fine at school.” 

“She has friends, so it can’t be autism.” 

For years, autism research and diagnostic understanding were largely based on boys. As a result, the signs of autism in girls have often been overlooked or misunderstood. We now know that many autistic girls present differently from autistic boys and may work incredibly hard to hide their difficulties from others. 

Although girls can and do receive autism diagnoses during early childhood, many are not identified until adolescence or adulthood. Some spend years struggling to understand why social situations feel exhausting, why they find friendships difficult to maintain, or why they feel different from their peers despite trying so hard to fit in. 

In this article, Jo Condon, Clinical Lead and autism specialist, explains why autism in girls is often missed, the role of masking and camouflaging, the signs that parents and professionals should look for, and the benefits of obtaining an autism assessment.

Why is autism in girls often missed?

Historically, autism has been diagnosed more frequently in boys than girls. Current diagnostic ratios suggest that approximately three boys are diagnosed for every girl. However, researchers increasingly believe that many autistic girls remain unidentified because their presentation differs from traditional autism stereotypes. 

Research suggests that girls are often: 

• Better able to imitate social behaviour. 
• More likely to observe and copy peers. 
• More motivated to fit in socially. 
• Less likely to display behaviours that attract attention. 
• More likely to internalise distress rather than express it outwardly. 

As a result, many autistic girls appear to cope well on the surface, even when they are struggling significantly underneath. 

Parents frequently report being told by schools that there are “no concerns”, despite observing clear difficulties at home. This discrepancy can be confusing and frustrating. However, research increasingly suggests that autistic girls often use compensatory strategies that can make their difficulties less obvious within structured environments such as school. 

Masking and camouflaging: the hidden side of autism in girls 

One of the most important developments in autism research over the last decade has been our understanding of masking and camouflaging. 

Masking refers to the conscious or unconscious strategies autistic people use to hide their differences and appear more socially typical. 

Research by Hull and colleagues found that autistic girls and women often engage in significantly higher levels of social camouflaging than males. Studies suggest that this can contribute to delayed diagnosis and unmet support needs. 

Masking may include: 

• Copying other children’s behaviour. 
• Rehearsing conversations in advance. 
• Forcing eye contact despite discomfort. 
• Mimicking facial expressions and gestures. 
• Suppressing repetitive movements (stimming). 
• Following social scripts. 
• Carefully monitoring their behaviour to avoid standing out.  

For many girls, masking begins at a surprisingly young age.

The different ways girls may mask 

Masking strategies are different for everyone. Some common masking behaviours include:

Appearing “Shy” 

Some autistic girls cope by reducing social interaction altogether. 

They may: 

• Hide behind parents. 
• Allow others to speak for them. 
• Avoid unfamiliar people. 
• Stick closely to one trusted friend. 

Adults often interpret this as shyness, but underneath may be significant social anxiety or difficulty understanding social situations. 

Copying Others 

Some girls become skilled observers of social behaviour. 

They may: 

• Copy speech patterns. 
• Mimic interests. 
• Rehearse social interactions. 
• Learn social rules from television, books or siblings. 

Because they appear socially competent, difficulties are often overlooked. 

Taking Control 

Other girls attempt to make social situations predictable by controlling them. 

These girls may: 

• Set strict rules during play. 
• Direct other children’s activities.
• Dominate conversation. 
• Become distressed when others do not follow expected rules. 

Adults sometimes describe these girls as “bossy”, “controlling” or “overconfident”, when these behaviours may actually reflect anxiety and attempts to manage uncertainty. 

The cost of masking 

Although masking can help autistic girls fit in socially, research increasingly shows that it comes at a significant cost. 

Studies have linked prolonged masking to: 

• Anxiety 
• Low self-esteem 
• Depression 
• Emotional exhaustion 
• Identity difficulties 
• Burnout 
• Increased risk of self-harm 

Many autistic girls describe feeling as if they are constantly performing. 

Teachers may see a calm, compliant child at school, while parents witness meltdowns, emotional exhaustion and distress after school. 

This phenomenon is increasingly recognised within the autism research literature and highlights why relying solely on school observations can sometimes lead to girls being missed.

Common misconceptions that contribute to missed diagnoses 

There are many misconceptions about how autism presents, and these misconceptions particularly impact the recognition of autism in girls.

“Autistic children don’t make eye contact” 

This is one of the most common myths about autism. 

Whilst some autistic people avoid eye contact, many autistic girls learn that eye contact is expected and consciously force themselves to do it. 

Clinicians do not simply assess whether eye contact occurs. They consider: 

• How eye contact is used. 
• Whether it feels natural. 
• Whether it supports communication. 
• Whether the child appears comfortable. 

A girl who makes eye contact is not necessarily non-autistic. 

“Autistic people lack empathy” 

Research does not support the idea that autistic people lack empathy. 

Many autistic girls describe feeling emotions very intensely. 

Some may: 

• Become overwhelmed by other people’s distress. 
• Worry excessively about others. 
• Show deep compassion towards animals. 
• Experience strong emotional reactions to injustice. 

The difficulty may lie in recognising, interpreting or responding to emotions in expected ways, rather than a lack of caring. 

“Autistic children don’t pretend” 

Many autistic girls do engage in pretend play and imaginative activities. 

However, the nature of the play may differ. 

For example: 

• Play may be repetitive. 
• Characters may always follow the same script. 
• The child may become upset if others alter the storyline. 
• There may be a preference for controlling how the play develops. 

Many autistic girls are highly creative and go on to enjoy: 

• Art 
• Writing 
• Music 
• Drama 
• Creative storytelling 

The presence of imagination does not rule out autism.

Signs of autism in girls 

Although every child is different, some common signs include: 

Signs of autism in girls in the early years 

Girls are typically identified later on in life, but some signs of autism in girls during early childhood include:

• Differences in language development. 
• Repetitive use of language or scripts. 
• Limited or repetitive play themes. 
• Controlling play with adults. 
• Distress around unfamiliar people. 
• Reduced use of gestures such as pointing. 
• Sensory sensitivities. 
• Sensory-seeking behaviours. 
• Strong preferences around food, clothing or routines. 
• Preferring to interact with adults rather than other children.
• Watching other children rather than joining in with their play.
• Repeating phrases from books, television or favourite programmes.

Primary school-aged girls 

During primary school, the signs of autism often become more apparent as the child grows. Signs include:

• Using memorised or scripted responses. 
• Difficulty maintaining friendships. 
• Preference for one close friend. 
• Socially “following” rather than leading. 
• Intense interests. 
• Excessive reassurance-seeking. 
• Strong need for routine and predictability. 
• Anxiety when plans change. 
• Emotional exhaustion after school. 
• Preference for solitary activities. 
• Difficulty navigating playground politics.
• Strong perfectionism.

Teenage girls 

For teenage girls, as social demands increase, difficulties often become more noticeable. 

Common signs include: 

• Friendship difficulties. 
• School-related anxiety. 
• Social exhaustion. 
• Feeling different from peers. 
• Difficulty with social “small talk”. 
• Black-and-white thinking. 
• Strong need for routine. 
• Intense interests. 
• Sensory overwhelm. 
• Increased masking. 
• Low self-esteem. 

Many girls first come to professional attention during secondary school because the social demands become too complex to continue masking successfully. 

Many autistic teenage girls describe feeling as though everyone else was given a rulebook for social interaction that they never received.

The benefits of an autism assessment for an autistic girl 

For many girls, receiving an autism diagnosis can be life-changing. 

A diagnosis provides: 

Understanding 

Girls often report enormous relief when they finally understand why certain things have felt difficult. 

Rather than viewing themselves as “different” or “failing”, they can begin to understand their experiences through a neurodiversity-affirming lens. 

Improved self-esteem 

Research suggests that understanding autistic identity can support psychological wellbeing and self-acceptance. 

Access to support 

A diagnosis can help schools better understand a child’s needs and implement appropriate support and reasonable adjustments. 

Under the Equality Act 2010, schools have a duty to make reasonable adjustments for disabled pupils, including many autistic children. 

Support for families 

An assessment often provides practical recommendations for: 

• School 
• Friendships 
• Anxiety 
• Sensory differences 
• Emotional wellbeing 

This helps families understand and support their child more effectively. 

Final thoughts 

Autism in girls is often hidden beneath coping strategies, social mimicry and a strong desire to fit in. As our understanding of autism continues to evolve, we are increasingly recognising that many autistic girls have been overlooked because they do not fit outdated stereotypes of what autism “should” look like. 

Beneath the surface, many of these girls are working incredibly hard to navigate a social world that feels confusing, exhausting and unpredictable. 

Recognising autism is not about labelling a child. It is about understanding who they are, listening to their experiences and ensuring they receive the support they need to thrive. 

For many girls, diagnosis is not the start of a journey—it is the explanation for a journey they have been navigating all along. 

If you are an adult and recognise these experiences in yourself, read our guide to the signs of autism in women.

References 

American Psychiatric Association (2022) Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). 5th edn, text revision. Washington, DC: American Psychiatric Association. 

Bargiela, S., Steward, R. and 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), pp. 3281–3294. 

Cook, J., Hull, L., Crane, L. and Mandy, W. (2021) ‘Camouflaging in autism: A systematic review’, Clinical Psychology Review, 89, 102080. 

Dean, M., Harwood, R. and Kasari, C. (2017) ‘The art of camouflage: Gender differences in the social behaviours of girls and boys with autism spectrum disorder’, Autism, 21(6), pp. 678–689. 

Gould, J. and Ashton-Smith, J. (2011) ‘Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum’, Good Autism Practice, 12(1), pp. 34–41. 

Happé, F. and Frith, U. (2020) ‘Annual Research Review: Looking back to look forward – changes in the concept of autism and implications for future research’, Journal of Child Psychology and Psychiatry, 61(3), pp. 218–232. 

Hull, L., Petrides, K.V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.C. and Mandy, W. (2017) ‘Putting on my best normal: Social camouflaging in adults with autism spectrum conditions’, Journal of Autism and Developmental Disorders, 47(8), pp. 2519–2534. 

Hull, L., Mandy, W., Lai, M.C., Baron-Cohen, S., Allison, C., Smith, P. and Petrides, K.V. (2019) ‘Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q)’, Journal of Autism and Developmental Disorders, 49(3), pp. 819–833. 

Lai, M.C., Lombardo, M.V., Auyeung, B., Chakrabarti, B. and Baron-Cohen, S. (2015) ‘Sex/gender differences and autism: Setting the scene for future research’, Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), pp. 11–24. 

Lai, M.C. and Szatmari, P. (2020) ‘Sex and gender impacts on the behavioural presentation and recognition of autism’, Current Opinion in Psychiatry, 33(2), pp. 117–123. 

Lockwood Estrin, G., Milner, V., Spain, D., Happé, F. and Colvert, E. (2021) ‘Barriers to autism spectrum disorder diagnosis for young women and girls: A systematic review’, Review Journal of Autism and Developmental Disorders, 8(4), pp. 454–470. 

Mandy, W. (2019) ‘Social camouflaging in autism: Is it time to lose the mask?’, Autism, 23(8), pp. 1879–1881. 

National Institute for Health and Care Excellence (NICE) (2021) Autism Spectrum Disorder in Under 19s: Recognition, Referral and Diagnosis (CG128). London: NICE.