Misdiagnosed, misunderstood, missed.

The gender difference in diagnosis rates can be attributed to:

  • Autistic girls and gender-diverse youth often display an internalised autistic presentation.
  • Gender bias in existing screening tools and diagnostic criteria.
  • Stereotypes and social expectations about how girls ‘should’ behave.
  • Lack of clinician training and experience in recognising the internal autistic experience.

About Autism

Autism and Gender

While we are getting better at recognising autism, and the growth rate in autism prevalence in recent years is bigger for females than males1, the formal diagnostic process continues to favour males2. Boys are still three to four times more likely to receive an autism diagnosis than girls3, and autistic girls are on average diagnosed several years later than boys4. One recent study found that 80% of autistic females remain undiagnosed or misdiagnosed at the age of 185. The challenge of receiving a timely diagnosis for girls (and for gender diverse youth who are still largely absent in research) remains a significant issue, and many of our ladybugs continue to be missed, or diagnosed only in their teens or as adults. More nuanced and informed research is starting to confirm what many in the autistic community have long suspected - when clinical tools are adjusted for sex biases, roughly the same percentage of boys and girls are identified as autistic.6

Girls Under the Radar

Although there are some shared autistic traits, girls and autistic gender-diverse young people may experience and express their autism in ways that are less visible from the outside, which can be harder to recognise, and can result in needs not being met.

Click here to learn more about the internalised autistic experience

Less visible expressions of autism can include

  • Being consistently compliant to avoid conflict or distress
  • Anxiety around change
  • Subtle but increased stimming when stressed
  • Shutdowns or situational mutism
  • Masking or using compensation strategies to hide challenges
  • Experiencing sensory overwhelm but hiding this
  • Appearing fine throughout the school day, and unravelling at home

Common Traits in Girls

While this list is not exhaustive or exclusive to any gender, autistic girls and gender-diverse young people may:

  • Display a deep focus in their special interests (often animals, nature, music, books, art)
  • Be selective in communicating (seen as ‘extremely shy’)
  • Be less prone to following traditional social conventions (seen as ‘bossy’ or not aware of social boundaries)
  • Be a ‘high masker’ – hiding distress in public but melting down or shutting down once home
  • Be dependent or reliant on one friend or drift between different groups, or prefer to be alone
  • Be interested in friendship, but unsure how to approach making neurotypical connections
  • Have strong sensory sensitivities (noise, food, clothing, temperature)
  • Struggle with transitions and change
  • Feel emotions intensely
  • Prefer deep interest-based discussions to small talk
  • Take a leadership role in play (seen as “controlling”) and prefer less reciprocal play
  • Interpret language literally
  • Be more fluid in their gender identity
  • Be extremely empathetic, nurturing, and sensitive
  • Have great attention to detail
  • Be highly creative and imaginative
  • Be a perfectionist in some areas but find basic tasks overwhelming
  • Have a strong sense of social and/or personal justice
  • Be very rules-focused and compliant

1. Australian Bureau of Statistics. (2022). Disability, Ageing and Carers, Australia: Summary of Findings. ABS. https://www.abs.gov. au/statistics/health/disability/disability-ageing-and-carers-australia- summary-findings/latest-release. 2. Cruz, S., Zubizarreta, S.CP., Costa, A.D. et al. (2024). Is There a Bias Towards Males in the Diagnosis of Autism? A Systematic Review and Meta-Analysis. Neuropsychol Rev. https://doi.org/10.1007/s11065-023- 09630-2 3. Loomes, R., Hull, L., & Mandy, W. (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. DOI: 10.1016/j.jaac.2017.03.013 Cruz, S. et al. (2024) 4. Russell G, Stapley S, Newlove-Delgado T, Salmon A, White R, Warren F, Pearson A, Ford T. (2022) Time trends in autism diagnosis over 20 years: a UK population-based cohort study. J Child Psychol Psychiatry 63(6):674-682. DOI: 10.1111/jcpp.13505 5. McCrossin, R. (2022). Finding the True Numbers of Females with Autistic Spectrum Disorder by Estimating the Biases in Initial Recognition and Clinical Diagnosis. Children, 9(2), 272. https://pubmed. ncbi.nlm.nih.gov/35204992/ 6. Hess, P. (2022). Autism’s Sex Bias Disappears After Tracking Trajectories. Spectrum News https://www.spectrumnews.org/news/ autisms-sex-bias-disappears-after-tracking-trajectories/ 7. Cruz, S. et al. (2024). Cook J, Hull L, and Mandy W. (2024) ‘Improving Diagnostic Procedures in Autism for Girls and Women: A Narrative Review’. Neuropsychiatr Dis Treat. 20:505-514. https://doi.org/10.2147/NDT.S372723 8. Nerelie C. Freeman, Ashley Grigoriadis. (2023). A survey of assessment practices among health professionals diagnosing females with autism, Research in Developmental Disabilities, Volume 135, 104445, ISSN 0891-4222, https://doi.org/10.1016/j.ridd.2023.104445