Understanding Autism in Late Diagnosed Females

World Autism Awareness Day Is April 2

April 2 is World Autism Awareness Day | Photo: Peter Burdon

Emily always felt different for most of her life but couldn’t explain why. She was quiet, well-behaved, and deeply immersed in books and drawing as a child. She mimicked social behaviors by watching others and carefully scripting conversations in her head. However, she struggled beneath the surface — loud noises felt overwhelming, friendships were often exhausting, clothing tags or certain fabrics felt unbearable against her skin, and unspoken social rules were confusing. It wasn’t until she was 34, after many years of battling anxiety and misdiagnosed depression, that she finally received an autism diagnosis. Like Emily, many women with autism go undiagnosed for decades, often misinterpreting their struggles as personality quirks or mental health conditions.

Why Are Women Often Diagnosed Late?

Autism Spectrum Disorder (ASD) is diagnosed in males at a rate of about 4-1 compared to females, but recent research suggests a diagnostic gender bias (Loomes, Hull, & Mandy, 2017). When it comes to receiving a formal diagnosis, many women are overlooked due to an outdated diagnostic criteria that is based on male presentations of autism. This underdiagnosis can be attributed to a few key factors:

Quiet Symptoms: Autism in women can present differently than in men; rather than displaying overt social withdrawal, women often experience difficulties that are misinterpreted as shyness or introversion.
Masking: Many autistic women develop advanced coping mechanisms, such as mimicking neurotypical social behaviors, scripting discussions, or forcing eye contact. This ability to “mask” their autistic traits can lead to them flying under the radar for much of their lives.
Misdiagnoses: Women with autism are often initially diagnosed with other disorders, such as anxiety, depression, ADHD, or eating disorders, which can overshadow their autistic traits and further delay appropriate identification.

What Exactly is Autism Anyway?

According to the Centers for Disease Control and Prevention (CDC), ASD is a developmental condition that affects how the brain processes information (CDC, 2024). While the exact cause is unknown, research suggests that both genetic and environmental factors can play a role. Individuals with ASD may experience challenges in areas such as:

Communication: Problems with speech, understanding social cues, or holding conversations. Thus, the tendency to often mask symptoms via mimicking social behaviors.
Social Interactions: Trouble initiating relationships, engaging in small talk, making eye contact, or reading emotions.
Repetitive Behaviors: Engaging in repetitive movements (e.g., rocking, hand flapping, skin picking, etc.), following strict routines (e.g., eating the same breakfast on repeat), or intense, highly focused special interests (e.g., memorizing facts about a favorite animal or historical event).
Sensory Sensitivities: Overwhelmed by loud noises (e.g., wearing noise-canceling headphones), sensitive to bright lights, (e.g., fluorescent lighting), and certain textures or strong smells.

Sensory sensitivity is sometimes a symptom of Autism. | Photo: Courtesy

Comorbid Conditions in Autistic Women

Many autistic women also experience co-occurring conditions, which can complicate their diagnosis:

Anxiety Disorders: Women with autism tend to experience high levels of anxiety, which can be triggered in social situations and other areas deemed as unpredictable.
Depression: Difficulties of navigating a neurotypical world can lead to feelings of sadness, a sense of “otherness,” and isolation.
ADHD: Many women with autism also have ADHD (otherwise referred to as AuDHD), making it difficult to differentiate between the two conditions.
Eating Disorders: Autistic women are at a much higher risk for restrictive eating patterns, which are often tied to sensory sensitivities and/or a need for control.
Auditory Processing Disorder (APD): Processing issues and filtering auditory information (particularly in noisy environments).

Is There a Female-Specific Autism Test?

At the moment, there is no autism test specifically designed for women. However, the diagnostic process typically involves the following:

A thorough review of one’s medical, familial, and behavioral history.
Targeted questionnaires assessing social and sensory challenges.
Evaluations to assess for any overlapping conditions, such as anxiety or ADHD.
In some cases, the diagnostic process also involves neurological assessments just to rule out other causes.

Raising Awareness for More Suitable Diagnosis and Added Support

Ultimately, understanding how autism presents in women is essential to improving diagnosis rates and creating added support. An increased awareness can also help females recognize their traits, seek out an accurate diagnosis, and access resources that will enhance their holistic well-being.

Rebecca Capps, LMFT, is the CEO of Mind-Body Thrive®. *Note: The information provided is not a substitute for professional therapy or medical advice.

Resources

Books

Women and Girls with Autism Spectrum Disorder – by Sarah Hendrick

The Spectrum Girl’s Survival Guide – by Siena Castellon

Organizations & Online Resources

Autism Women & Nonbinary Network (AWN) – Resources and community support.

The Art of Autism – Features stories and artwork by autistic women

AANE (Association for Autism and Neurodiversity) – Resources specific to autistic women.

Spectrum Women Magazine – Articles and insights from women on the spectrum.

Podcasts & Blogs

Autistic Women Podcast

The Autistic Advocate Blog – by Kieran Rose