Why Autism Is Often Missed in Girls: What Parents Need to Know

For many decades, Autism was thought to be a condition that nearly exclusively affected boys. Over time, the diagnosis rate has evened out slightly. The Center for Disease Control and Prevention reports that approximately 3.8 boys are diagnosed for every diagnosed girl. It is now widely assumed that many girls with Autism are missed in the diagnosis process. Some key reasons for the discrepancy will be discussed below.

How Autism Presents Differently in Girls

Research is beginning to identify that girls with Autism present differently than boys. For example, girls tend to be more socially motivated than boys. Their repetitive behavior may be less intense or more socially appropriate, as is their special interests. They seem to have fewer language difficulties, and their language is more socially focused. Instead of acting out, they may internalize more of their symptoms than boys. Daily living skills may be a greater challenge. Importantly, these differences from typical developing peers often do not become apparent until they turn six years old. Keep in mind, these generalities may change as more research is published.

Clinically Observed Behavioral and Emotional Differences

There are some other differences clinicians have noticed between boys and girls with Autism. Some tendencies include a rich fantasy life, an often-related extreme focus on special interests, and greater difficulties in regulating emotions in private versus public. Others identified are greater sensory sensitivities and difficulties with transitions, lacking social boundaries and few friends, literal interpretation of language, and gender fluidity.

Diagnostic Biases and Measurement Gaps

An additional layer of complication was explained by Burrows et. al (2025). In the general population, females perform better on social communication measures than males. However, that difference is not accounted for during diagnosis. Therefore, females must be relatively more impaired than males to be identified as Autistic. Plus, females with Autism seem to present with less impaired eye contact, joint attention, and social overtures.

Why Girls Are Underdiagnosed

These differences contribute to less girls being diagnosed than boys, including two in particular (more social motivation and more socially acceptable special interests). Another contribution is that most research on Autism has been conducted on boys, including diagnostic tools, creating a skewed picture of what Autism looks like. Lastly, girls are more encouraged to camouflage the autism traits.

Camouflaging: Coping, Cost, and Consequences

Camouflaging involves masking (hiding what you do not want others to see) and compensation (finding strategies to make up for deficits). The logic behind camouflaging is that it provides practical benefits and increases connections, confidence, and safety. Some examples of what that entails includes minimizing stim, adopting an artificial conversation style, pretending to play a character, relying heavily on observational learning to identify interaction style and interests, and use strategies or extra rules to bridge skill gaps. However, the efforts are usually extremely effortful (primarily due to the extreme self-monitoring and self-control required) and challenge one’s identity. It is unclear how often such efforts are successful or whether there are net benefits.

Implications for Future Diagnosis

As explained in Burrows et. al (2025) future diagnostic tools must be developed to account for the milder presentation of some females. Once those tools are developed, be prepared for more females to be diagnosed. This event will lead to a more even gender ratio and a further increase in prevalence in the general population.

Dr. David Fischer

Psy. D., CPBA-AP BCBA-D
Behavioral Consultant

Information provided by:

Dr. David Fischer received a doctoral degree in Clinical Psychology from Rutgers University, USA, advised by Dr. Sandra Harris. Since 1999, he was worked in the field of Applied Behavior Analysis and with individuals diagnosed with a developmental disability. He completed his pre-doctoral internship and post-doctoral fellowship at the Marcus Institute in Atlanta, Georgia working in the severe behavior unit, short-term-out-patient clinic, feeding disorders unit, and early intervention clinic. From 2007 – 2011, he trained public school teachers to instruct and manage the behavior of their students diagnosed with Autism spectrum disorder. He also was the clinical coordinator of the Asperger’s College Program, which provides support services to Rutgers students diagnosed with Asperger’s Disorder.

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