The Lost Girls: Why Autism in Women is So Often Misdiagnosed

For decades, the classic image of autism has been that of a young boy, perhaps obsessed with trains and struggling with social interaction. This stereotype, born from early research that focused almost exclusively on males, has had a lasting and damaging consequence: countless girls and women with autism have been left feeling broken, misunderstood, or simply "wrong," without ever knowing why.

They are the lost girls. They are women who have spent their lives learning to perform "normalcy," often at great personal cost, while their genuine neurotype goes unrecognized.

At my practice, I specialize in neurodiversity-affirming care and see firsthand the profound impact of a late diagnosis. This post explores why autism spectrum disorder (ASD) presents differently in women and why the healthcare system has been—and continues to be—so slow to catch up.

The Male-Centric Model of Autism

The foundation of our understanding of autism was built on observing boys. The diagnostic criteria in the DSM-5, while evolving, were heavily influenced by these initial observations. This created a diagnostic framework that looks for externalizing behaviors: obvious repetitive motions (stimming), clear social awkwardness, lack of eye contact, and highly focused, often "mechanical" interests.

While these traits can certainly apply to anyone on the spectrum, this model fails to capture the more subtle, internalized presentation often seen in women and girls.

How Autism Can Present Differently in Women

Due to a combination of societal pressures and potential neurological differences, many autistic women develop sophisticated coping mechanisms from a young age. This is often referred to as "masking" or "camouflaging."

Here are some common, yet often overlooked, signs of autism in women:

Sophisticated Masking: Autistic girls often learn by observing and mimicking their peers' social behaviors. They may develop a "social script" for conversations, practice facial expressions in the mirror, and force eye contact even when it's uncomfortable. This is incredibly draining and can lead to social burnout.

Internalized Symptoms: Instead of external meltdowns, an autistic woman might experience intense internal shutdowns, anxiety, or depression. The distress is just as real, but it's invisible to outsiders.

Social Differences, Not Deficits

An autistic woman might not lack social motivation, but she may find small talk exhausting and prefer deep, one-on-one conversations. She may have a few very intense, loyal friendships rather than a large social circle.

This is one of the most common reasons autistic women are overlooked. A parent or partner might say, "But she can't be autistic, she always had friends!"

However, when we look closer at the how and why of these friendships, a distinct pattern emerges that points not to neurotypical social skills, but to sophisticated coping strategies. This often involves a "social anchor"—a close friend who unknowingly provides a bridge to the social world.

While this makes her look neurotypical, the underlying dynamics are often quite different:

The Friendship's Origin: The relationship was often initiated by the friend. The autistic woman may have connected based on a shared intense interest or simple proximity, while the friend drove the social aspects of the relationship.

The Social Bridge: This friend acts as a passport to a wider social life. The autistic woman might attend parties and gatherings, but she rarely would have been invited or gone on her own. She is there with her friend, which makes navigating the event possible.

A Form of Masking: She may begin to mirror her friend's personality—adopting their style of dress, mannerisms, and even opinions. This is a powerful subconscious strategy to learn the "rules" of social engagement by studying a successful example.

"Acceptable" Special Interests

The stereotype of an autistic special interest—a boy's encyclopedic knowledge of dinosaurs or train schedules—is one of the biggest reasons autistic girls are missed. Their interests are often quieter, more internal, and fall into categories deemed "socially acceptable" for girls.

For countless women I see in my practice, that special interest was simply reading. A deep, lifelong passion for losing oneself in fictional worlds for hours on end is seen as a love of literature, not a potential autistic trait. Another incredibly common, yet overlooked, special interest is an intense drive to understand the human mind. This often manifests as a passion for psychology, self-help, and personal growth—a quest to figure out the "rules" of the world and, ultimately, to understand themselves. Because these interests are introspective and common, they are almost never flagged as a sign of a different neurotype. The key is not the subject matter, but the intensity: the way the interest brings joy, provides comfort, and becomes a lens through which to understand the world.

The Cascade of Misdiagnosis

When a clinician is not trained to recognize this presentation, they see the symptoms of a lifetime of masking, not the root cause. This leads to a string of common misdiagnoses, including:

• Borderline Personality Disorder (BPD)

• Generalized Anxiety Disorder (GAD)

• Major Depressive Disorder (MDD)

• Obsessive-Compulsive Disorder (OCD)

• Eating Disorders

Many people, including clinicians, only see the "tip of the iceberg"—the anxiety, depression, or BPD that can result from a lifetime of masking. The true underlying cause, an autistic neurotype, often remains unseen beneath the surface.

This problem becomes especially damaging when trauma is involved. I have worked with numerous clients who were denied a diagnosis by a previous assessor, who told them they needed to "treat their trauma first." This approach is not only inaccurate, but it effectively gatekeeps a diagnosis from the very people who need it. The reality is that autism and trauma are deeply intertwined. Living in a world not built for you is inherently traumatic, and the sensitive nervous system of an autistic person makes them more susceptible to being traumatized by events that a neurotypical person might not be. Refusing to see the full picture does a profound disservice to the client seeking answers.

A Diagnosis Doesn't Add a Problem—It Solves a Mystery

I often speak with people whose loved ones fear a diagnosis. They worry that receiving the label of "autism" will somehow add a layer of pathology to the person they care about, making something "wrong" with them.

This fear, while understandable, comes from a deep misunderstanding of what a diagnosis truly is.

A diagnosis does not create anything new. We are simply giving a name to the reality that already exists. Think of it this way: if a person has struggled their entire life with social exhaustion, sensory overload, and feeling like an outsider, those challenges are already present. The "pathology," if you want to call it that, is already there.

The diagnosis is the act of providing the explanation. It's the missing chapter that makes the rest of the book make sense.

Nothing changes about the person when they are diagnosed. They are the same person they were the day before. But now, they have the profound relief of validation and a roadmap for understanding themselves. They can stop blaming themselves for things that were never their fault. Reducing the stigma around getting this kind of clarity is one of the most important things we can do in mental health today.

The Path Forward: From Understanding to Action

If this article resonates with you on a deep level, please hold onto this truth: you are not alone, and you are not broken. For many women, receiving an autism diagnosis is not about finding a flaw; it is about finding a framework. It is the act of finally being given the right manual for your own brain, allowing you to stop blaming yourself for challenges that were never your fault.

This understanding is the crucial first step. The next is learning how to use that knowledge to build a life that honors your neurotype, rather than fighting against it. Seeking a formal evaluation from a professional who specializes in adult and highly-masked presentations of autism can be a profound act of self-acceptance and the beginning of finding the right kind of support.

Find Clarity with a Neurodiversity-Affirming Assessment

Navigating the path to an adult autism diagnosis can be daunting. I provide a safe, validating space to explore your experiences and find the clarity you deserve. If you are ready to take that next step, I invite you to contact me to schedule a consultation.

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