Autism in Women: Key Signs of Undiagnosed Autism in Females

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Why can autism be diagnosed late in women?

It’s concerning that a striking 80% of women remain undiagnosed with autism at the age of 18, based on currently diagnosed percentages. This late diagnosis has serious implications for the mental health of girls and young women. 32% of autistic women get hospitalised for a psychiatric condition by age 25 and women with autism are 13 times more likely to die by suicide than women living without autism; this is twice as much as men with autism.

In England, the official statistics for Autism or Autism Spectrum Disorder (ASD) reveal a concerning gender disparity, with a ratio of women to men with an official diagnosis of 1:9. This discrepancy is startling when we consider that researchers suggest the actual gender ratio of autism is closer to 1:3. Furthermore, when women are diagnosed with autism, it tends to happen at a significantly later stage compared to men.

What are the main issues when diagnosing autism in women?

Late diagnosis predominantly occurs because girls and women present with different symptoms. There can be some overlap in the key signs of autism between both men and women, but symptoms that manifest differently in girls and women can often be dismissed or misdiagnosed.

The fact that girls and women often learn to mimic the behaviours of their peers also makes it easier to mask the initial criteria for autism spectrum disorder (ASD). This mimicry contributes to the dismissal and misdiagnosis of autism symptoms, particularly when assessment criteria predominantly cater to male indicators of ASD due to Autism studies predominantly using male test subjects.

What are the main signs of autism in women?

Social Difficulty & Camouflaging

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Like boys and men with autism, a key indicator of autism in girls and women is experiencing social difficulties. But girls and women tend to excel at camouflaging their social difficulties, often referred to as ‘autism masking’, so their social challenges tend to go unnoticed, unlike in boys and men with autism where it is picked up more frequently.

Girls with autism are more likely to both establish and maintain friendships at school compared to their male peers. This leads schools to miss crucial early social difficulty indicators that would otherwise be spotted.

Emotional regulation issues or Meltdowns

While emotional regulation issues and meltdowns are prevalent signs of autism in both genders, they tend to be more pronounced in girls and women. Sadly, these issues often get overlooked and can be mistakenly attributed to ‘hormonal factors’ or misdiagnosed as Borderline Personality Disorder (BPD). Both autism and BPD share some common characteristics, such as rejection-sensitive dysphoria and high rates of eating disorders, underscoring the challenge of differentiating between the two. This is highlighted by the staggering statistic that 23% of people diagnosed with anorexia nervosa are autistic; it is assumed to be even greater due to the lack of diagnosis.

Obsessive interests

Another area where the symptoms of autism in girls and women are often disregarded is their obsessive interests. Girls and women with autism may have interests that appear more ‘mainstream,’ such as having an obsessive interest in bands or celebrities, leading to these obsessions being dismissed as mere ‘fangirl’ behaviour.

Sensory sensitivity

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Many girls and women with autism are capable of recognising their sensory sensitivities, which can manifest as heightened responses to light, sound, certain clothing fabrics, tags, and even makeup. Young women may display a particular aversion to specific bright colours or colour combinations. Women are more sensitive to sensory issues than men but unfortunately suffer silently more often.

Executive function

Executive function skills, seemingly straightforward for neurotypical individuals, can pose significant challenges for those with autism. Tasks such as planning, organising, tidying, and cooking may feel overwhelming and unmanageable. Unfortunately, these challenges are often overlooked in women. This is due to female development for most executive functions already being more advanced than males at almost all age levels.

What is being done to help address earlier diagnoses for girls and young women?

The stigma of neurodiversity and greater awareness via mainstream and social media are raising issues of the autism experience for girls and women such as how symptoms present differently.

Early diagnosis and appropriate support can help girls and women develop strategies and the people around them develop a greater understanding. With greater awareness, proper care, and support, there can be harm reduction for girls with autism.

Useful links

Take our Autism test
5 types of autism
Difference between social anxiety and autism