If you’ve been on social media lately, you may have come across more and more people talking about autism and how it affects them.
Autism spectrum disorder is a neurodevelopmental condition (meaning it starts in childhood) that affects how people communicate and socialize with each other and how they perceive and interact with the world around them.
Traditionally, autism has been defined by:
- Difficulties in social interaction and sharing emotions (such as missing social cues or trouble relating to peers)
- Challenges with nonverbal communication (including facial expressions and eye contact)
- Restricted or repetitive behaviors or interests (the so-called special interests)
This is what we often think of when we hear the word autism. And if I asked you to imagine an autistic person, how many of you would imagine them to be male?
Autism exists on a spectrum, meaning it can look very different from one person to another. More severe cases are usually diagnosed early, while those on the milder end of the spectrum might be missed by the healthcare system. What’s more, it can look very different in women than in men, and it is diagnosed about 4 times as often in males then in females.
However, many researchers believe the disorder is not actually more common in men, it’s just that the its female presentation is different, and therefore under-diagnosed.
This post aims to explore the reasons behind this, and ends with what you can do if you suspect you might have autism.
Genuine gender differences
First, let’s take a look at reasons why autism may actually be less common in women. These reasons are still being studied, but several hypotheses exist:
- Biology and genetics – The ‘Female Protective Effect’ theory posits that women may require a higher level of genetic risk for autistic traits to be expressed.
- Hormonal differences – Some research links prenatal testosterone levels to autistic traits. This has led to the theory that autism may represent an “extreme” version of certain cognitive patterns more commonly associated with males.
- Brain connectivity differences – There is also evidence that differences in brain connectivity patterns may play a role.
How autism can look different in women
1. Social motivation: wanting connection
One key difference is that autistic women often show higher social motivation than autistic men. This is partially due to socialization, as female children are often encouraged to play more with others, and their activities in general tend to be more community-based.
This means that:
- They may want friendships and connection
- They may put significant effort into fitting in
- They may appear more socially engaged on the surface
Because of this, their social difficulties can be less obvious to others, even though they are very much present.
2. Different types of interests
Autistic traits are often identified through “special interests.” But what counts as noticeable can be biased. Autistic men may have interests in topics like technology, systems, or mechanics, while autistic women often have interests that appear more socially typical, such as:
- Animals
- Books or fictional characters
- Psychology or relationships
The difference is not in intensity, but in how socially acceptable the interest appears. This can lead to girls being overlooked.
3. Internalizing vs. externalizing
Autistic women are more likely to experience internalizing difficulties, such as:
- Anxiety
- Depression
- Eating disorders
- Self-harm
These struggles are often less visible than external behaviours (like aggression or hyperactivity), which are more commonly seen in boys and more likely to trigger assessment.
As a result, many women are first diagnosed with anxiety or depression, while autism remains unrecognized.
The role of masking
One of the most important concepts in understanding gender differences in autism is masking. Masking refers to consciously or unconsciously:
- Copying social behaviors (by observing others, watching movies, etc.)
- Rehearsing conversations
- Forcing eye contact
- Suppressing natural responses (such as stimming or talking about a special interest)
How to know of you are masking:
- You feel very tired and drained after social interactions
- You often find yourself practicing or rehearsing what you’re going to say in advance
- You frequently copy others’ behaviors, speech patterns, or facial expressions
- You deliberately stop yourself from stimming or other behaviors that feel natural to you in public settings
- You feel like you can’t be your true self around others and constantly adjust your behavior to meet social expectations
Research shows that autistic women are significantly more likely to engage in masking. While this can help them “blend in,” it comes at a cost:
- Exhaustion and burnout
- Loss of identity and feeling confused about who you truly are
- Increased mental health difficulties, such as anxiety, stress, depression or low self-esteem
Many women report feeling like they are “performing” rather than being themselves.
Why are women underdiagnosed?
1. Diagnostic criteria are based on male presentations
Most autism research has historically focused on boys. As a result:
- Diagnostic tools, such as the adult autism quotient (AQ) may miss female presentations
- Clinicians may look for “male-typical” traits
This creates a systemic bias in assessment, making it more difficult for women to access the understanding, treatment or accommodations they may need.
2. Social expectations play a role
From a young age, girls are often socialized to be polite, emotionally aware and focus on social relationships. Because of this, autistic girls may learn to compensate earlier and more effectively.
They may also be:
- Seen as shy , quiet or withdrawn (or a pleasure to have in class by teachers)
- Overlooked as ‘functioning well’ when they withdraw or struggle with internalizing disorders, such as anxiety
3. Different social experiences
Research suggests that while autistic boys are more often overtly rejected, autistic girls are more often overlooked or socially excluded in subtle ways that they may not even recognize themselves as rejection.
Girls tend to have more social contacts, but these relationships can be:
- Less stable (switching friends or friend groups often)
- More superficial (casual friendships instead of deep emotional connections)
- Take more effort to maintain (they may find socializing very exhausting)
Why this matters
When autism in women goes unrecognized, it can lead to:
- Late diagnosis (often in adulthood)
- Misdiagnosis (e.g., anxiety, borderline personality disorder)
- Lack of appropriate support or accommodations
- Long-term mental health struggles
- A constant feeling that something is off, but being unable to place it
For many women, receiving an autism diagnosis later in life can be both validating and overwhelming, finally making sense of years of feeling different. This can also be a pathway to increased understanding and coping for both herself and her loved ones, and becoming able to access supports and accommodations at university or work.
Towards a more inclusive understanding of autism
Autism is not one single presentation, and understanding gender differences helps us:
- Recognize more diverse presentations
- Reduce diagnostic bias
- Provide better and more tailored support
- And perhaps most importantly: help people feel seen and understood.
There is a lot of nuance in this topic, especially since I have not covered intersex, agender, non-binary or transgender people.
However, if you are a woman, AFAB person, or someone who was raised as a woman, and you feel you have:
- Difficulties with social interactions – difficulties making friends, superficial relationships, etc.
- Difficulties with communication – trouble understanding language, jokes or sarcasm, taking things literally, etc.
- Sensory issues – overstimulation, increased sensitivity to certain sensory inputs, or conversely, sensory seeking (such as spinning around), etc.
- Emotional overwhelm – emotional meltdowns or shutdowns, overreactions to minor changes, etc.
- Intense interests and repetitive behaviors or rituals
- Coping mechanisms that include masking or performing
It might be useful to investigate this further, and seek help from a professional, such as a psychologist or psychiatrist.
References
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed autistic women
Baron-Cohen, S. et al. (2015). Prenatal testosterone and autistic traits
Hull, L. et al. (2017, 2020). Camouflaging in autism
Lai, M. C. et al. (2015, 2017). Sex/gender differences in autism
Loomes, R. et al. (2017). Male-to-female ratio in autism
Robinson, E. B. et al. (2013). Female protective effect
Sedgewick, F. et al. (2016). Social relationships in autistic girls