Understanding the difficulties with diagnosing autism in women and girls is important for individuals who are struggling to find answers. Autism Spectrum Disorder (ASD) is a complex condition affecting lifelong neurological development and bringing challenges in social interaction, communication, behaviors, and more. (1) However, differences in the way the condition presents in women and girls can lead to misdiagnosis and delays in receiving care.
At NeuroZone, speech-language pathologist Erin Badour specializes in helping clients with neurodivergence and improving mental health. Erin also specializes in the treatment of auditory processing disorders and other learning disabilities as they relate to speech and language development.
Contact our office online or call (310) 821-3640 to learn more about autism and schedule a consultation at one of our locations in Culver City, Manhattan Beach, or Santa Monica.
About Autism in Women and Girls
Although autistic individuals often have many cognitive strengths, such as attention to detail, exceptional memory, and creativity, many struggle in a “neurotypical” world that is designed for different cognitive strengths. Autism was traditionally thought to be a predominantly male condition; however, recent studies suggest that approximately one million adult women in the United States may be autistic. (2) Receiving an accurate diagnosis about their condition can be difficult, as there are many stereotypes surrounding this topic. These expectations can lead women to feel they should mask their behaviors, making it harder to receive a proper diagnosis and the appropriate care. Women and girls with autism face many challenges, including:
- Communication challenges: Some individuals with autism struggle with verbal or nonverbal communication as they may experience difficulty picking up on social cues or maintaining conversations. (3)
- Sensory Sensitivities: Some individuals may be overly sensitive to their environments. This may cause them to feel severe anxiety and physical discomfort from everyday sounds, lights, textures, or smells.
- Health Conditions: Individuals with autism may experience recurring conditions like anxiety or depression. They may also experience chronic fatigue, gastrointestinal problems, sleep disorders, and hypermobility.
- Late Diagnosis: Some women and girls receive a late diagnosis, which can impact their quality of life and lead to long-term difficulties without receiving proper care early in their lives.
- Stigmas: Some individuals struggle with misconceptions about autism, which leads to judgment and possible exclusion from social groups. Moderating factors include the quality and quantity of contact with autistic people, cultural factors, sex and gender, individual differences, and diagnostic disclosure. (4)
The Role of Communication Style
Communication differences in autistic women and girls tend to be unique, but they may not trigger concern in traditional diagnosis. Many develop strong vocabularies and verbal skills, which can obscure challenges with conversational flow, interpreting tone, or understanding implicit social rules.
As a result, specialists may overlook autism in individuals who appear articulate and can socially engage on the surface. However, these women often feel disconnected, misunderstood, or exhausted by communication demands. Recognizing these internal experiences is critical to receive an accurate diagnosis.
Cultural and societal expectations may also complicate autism diagnosis in women and girls. Some are taught to prioritize others’ needs over their own, making it less likely to voice or acknowledge struggles. Additionally, access to diagnostic resources varies widely based on socioeconomic factors, race, and geography. Women can also face many barriers in their diagnosis due to systemic bias and limited healthcare access when they are in marginalized communities. These disparities highlight the need for culturally sensitive and inclusive diagnostic practices.
Gender Differences in Autism
Diagnosing autism in women and girls is challenging since women are more likely to “mask” their symptoms and present themselves in a more socially acceptable manner. (5) Women and girls, compared to men and boys, also show signs of autism later in their adolescence, and pre-existing and more subtle difficulties may only be apparent during high social demands. The key challenge in diagnosis is that many women and girls are overlooked during standard evaluations, as their traits may present differently, often with subtler differences in communication and behavior compared to men and boys. (5)
Many women and girls develop strong observational skills early in life by learning how to imitate peers, follow social scripts, and mirror expected behaviors. However, these observations and masking abilities can make autism far less noticeable during clinical assessments. For example, a girl who makes eye contact, engages in conversation, and appears socially aware may not raise immediate concerns, even if she experiences confusion, anxiety, and exhaustion internally during social interactions. Over time, this constant effort to appear neurotypical can contribute to chronic stress, emotional burnout, and identity confusion. (6)
Benefits of Proper Diagnosis
For individuals experiencing these challenges, supportive therapies, including neurofeedback training, may make everyday life easier. When women and girls receive a proper diagnosis, several doors open for them. With the proper support and therapies, they can experience benefits such as:
- Improved communication: Speech and language therapy can help improve an individual’s understanding and use of language. Individuals with ASD can either communicate verbally or nonverbally through the use of pictures, signs, gestures, and electronic devices.
- Enhance daily functioning: Occupational therapy teaches skills that help the individual live as independently as possible. It teaches skills like eating, bathing, dressing, and relating to other individuals on a social level.
- Improve mood and emotional regulation: Cognitive behavioral therapy can assist in managing anxiety, regulating emotional outbursts, and reducing frustration. It achieves this by teaching the connection between thoughts, feelings, and behaviors, which trains individuals how to think in the moment and respond.
- Sensory integration skills: Occupational therapy can also help individuals improve responses to sensory input that may be restrictive or overwhelming by using sensory integration. Physical therapy can also help improve fine motor skills in the hands and gross motor movements of the body.
- Long-term development: Early and/or accurate diagnosis allows the individual to receive help early on. This can contribute to a higher quality of life by fostering self-confidence and self-advocacy.
Refining Autism Assessment
Improving diagnosis rates in women and girls requires a shift in how we access autism. Specialists should look beyond the behaviors and begin to explore developmental history, internal experiences, sensory patterns, and coping strategies. At NeuroZone, Erin and her team recognize that autism assessment is not about categorizing individuals into a rigid set of criteria. Instead, it involves understanding how each person experiences and navigates their world differently. This perspective allows for nuance in the identification, particularly for those who have learned to mask.
Cost of Autism Diagnosis and Therapy in Southern California
The cost of autism care and a diagnosis will depend on your specific treatment protocol, struggles, concerns, and more. During a consultation, Erin Badour will outline all costs and help you navigate your options. Contact our office online or call (310) 821-3640 to book your personal consultation and gain better insight into your mental health!
FAQ
What are the main challenges in diagnosing autism in women and girls?
The main challenges when diagnosing autism in women and girls are sometimes the late appearance of autism after adolescence and the prevalence of masking behaviors, which obscure symptoms.
How does autism present differently in women and girls?
Women and girls may experience different behaviors or co-occurring health conditions due to differences in socialization and upbringing.
Can a late diagnosis impact mental health in women and girls?
Yes, a late diagnosis can often leave individuals struggling with anxiety, depression, and low self-esteem, creating a need for mental health support later on.
What can I do after receiving my diagnosis?
Engaging in support groups, finding a therapist who is familiar and can assist with autism, and advocating for resources in educational settings all play significant roles in managing your condition.
Is it possible to have co-occurring conditions?
Yes, many women and girls also face other mental health challenges, such as anxiety and eating disorders, but recognizing these is essential for comprehensive treatment. Autism affects everyone differently, but Erin and her team can assist in creating the best personal protocol for your needs during your consultation.
References
- National Institute of Mental Health. Autism Spectrum Disorder (ASD). National Institute of Mental Health. Published April 2023. https://www.nimh.nih.gov/health/statistics/autism-spectrum-disorder-asd
- Dietz PM, Rose CE, McArthur D, Maenner M. National and State Estimates of Adults with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders. 2020;50(12). doi:https://doi.org/10.1007/s10803-020-04494-4
- Hodges H, Fealko C, Soares N. Autism spectrum disorder: Definition, epidemiology, causes, and clinical evaluation. Translational Pediatrics. 2020;9(1):55-65. doi:https://doi.org/10.21037/tp.2019.09.09
- Turnock A, Langley K, Jones CRG. Understanding Stigma in Autism: a Narrative Review and Theoretical Model. Autism in Adulthood. 2022;4(1):76-91. doi:https://doi.org/10.1089/aut.2021.0005
- Lockwood Estrin G, Milner V, Spain D, Happé F, Colvert E. Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review. Review Journal of Autism and Developmental Disorders. 2021;8(8):454-470. doi:https://doi.org/10.1007/s40489-020-00225-8
- Hull L, Petrides KV, Allison C, et al. “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. Journal of Autism and Developmental Disorders. 2017;47(8):2519-2534. doi:https://doi.org/10.1007/s10803-017-3166-5
