Why Do So Many Autistic Girls and Autistic Women Go Undiagnosed?

Before we dive into the reasons why so many autistic girls and women go undiagnosed, we need to acknowledge that for many of the same reasons, autistic non-binary people, trans women and anyone who is not cis male often go undiagnosed. Gender bias in autism affects more people than just cis women. We also need acknowledge that there is no ‘male autism’ and ‘female autism’. Autism cannot be separated into two distinct presentations based on these two genders. Many autistic girls and autistic boys present in very similar ways.

So, why is it that cis autistic girls are so often undiagnosed and dismissed? To understand this we need to look at gender bias, sexism, gender stereotypes and socialisation processes.

Often, it’s simply that people still believe autism is a condition which only affects cis boys and not girls. Autistic women are overlooked, missed and misdiagnosed. This stems from when autism was first studied, largely only in boys, when it was believed to be a male condition. We can see this thought process simply in how the ratios of how many boys were thought to be autistic compared to girls have changed over time. It’s still uncertain, but it has fluctuated between 16:1 boys to girls, to 10:1, to 3:1, to 2:1. An autistic boy and an autistic girl could present in exactly the same way. They could both have a speech delay and frequent meltdowns (i.e. their autism could both be seen externally from a young age), yet whilst the boy might receive his diagnosis at aged 3, the girl often won’t.

This gender bias that autism is predominantly a cis male condition means anyone who is not cis male is often misdiagnosed with anxiety disorders or other mental health conditions. EUPD/BPD is a common one in teenagehood or early adulthood when the masked autistic person’s mental health begins to suffer drastically. An autistic girl who is so overridden by anxiety may just be seen as ‘shy’ and ‘quiet’, which people think is ‘sweet’. If an autistic boy is presenting this way though, alarm bells ring, right? Gender bias. But, if the girl does struggle, they may be seen as dramatic or hormonal. Sexism.

The media has not helped with this. Think of the films you know about autism. Rain Man probably jumps to mind. But even besides ‘Rain Man’, most media portrayals of autism have been of cis autistic white boys.

Gender stereotypes also impact the diagnostic process. Stereotypes say that autistic children are obsessed with trains and lining toy cars up. Many young autistic boys are, because this is how they are socialised. Often autistic girls get missed because their special interests seem more ‘normal’. Many line up their dolls, but this is deemed socially acceptable. I used to read non-stop. Aged 8, I’d read at least one novel a day. I’d get told off in class because I wouldn’t stop reading. I’d read at lunch. I read whilst walking to school. This was all deemed as my love for reading, which it partly was. But it was more than that. Partly because my special interest wasn’t trains or something else stereotypically autistic, no-one realised I was autistic.

Another key reason why cis autistic girls and women go undiagnosed is because we are socialised very differently to boys, so our autism can present differently. Women may feel more pressure to fit in in different ways socially, meaning we may mask our autism more. For example, I learned very quickly that it was important to be seen to have friends at school. I was therefore overly social. I made eye contact. I had lots of friends. I was very chatty and loud. I was also awkward. But the way my autism presented was not seen as autism. I was desperate to fit in. So I learned to copy how other children acted from a young age in order to fit in. I wanted to appear as normal as possible. I did everything I could to hide my autistic traits. That’s called masking, and it can be very damaging to your mental health.

Autistic boys can do this too. That’s why boy autism and girl autism isn’t a thing. Because autistic boys can also mask from a young age. But because boys and girls are socialised differently due to their perceived genders, it may be that autistic girls are still more overlooked.

Understanding why so many autistic girls and women go undiagnosed takes into factor many different complexities like gender bias, sexism, discrimination, gender stereotypes and socialisation processes. Much of society still needs to learn that GIRLS CAN BE AUTISTIC TOO.

P.S. Check out Autistic Girl’s Network, a new charity which I am proud to be a Trustee for!