Autism in Women - Why Is It Often Missed and How It Manifests

Autism is a neurodevelopmental condition characterised by differences in social interaction, communication, and repetitive or restrictive behaviours. While the diagnosis applies equally to men and women, autism in women is often recognised later – or sometimes not at all. Below you can read about what autism is, why women often “fly under the radar,” and how masking symptoms can lead to missed or delayed diagnosis.

What Is Autism in Women?

In the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), autism is classified as a developmental condition, meaning that symptoms typically begin in childhood. For a diagnosis, two main criteria groups must be met:

1. Difficulties with social interaction and communication

Women with autism may struggle with aspects of social communication across different settings. This can include:

  • Limited or atypical eye contact.

  • Differences in body language.

  • Challenges maintaining or initiating friendships.

  • Feeling different or misunderstood in social situations.

2. Restrictive and repetitive behaviours

These may appear as:

  • A strong need for routines and predictability.

  • Distress when routines are disrupted (e.g. changing schools, moving house, unexpected events).

  • Intense and highly focused interests, which may seem typical on the surface (e.g. horses, literature, fashion) but are pursued with unusual intensity.

How Autism in Women Differs from Men

Although the diagnostic criteria are the same, autism often presents differently in women:

  • Subtler symptoms: Behaviour may be interpreted as shyness, sensitivity, or introversion.

  • Social misunderstandings: Difficulty interpreting unspoken rules in friendships.

  • Less disruptive behaviour: While boys may display hyperactive or outward signs, girls and women may appear “well behaved” and therefore go unnoticed.

This difference in symptom expression contributes to many women not receiving a diagnosis until adolescence or adulthood.

Masking and Camouflaging

One reason autism is missed in women is that many become skilled at masking their difficulties. This means consciously or unconsciously copying social behaviours to “fit in.” Examples include:

  • Forcing eye contact despite discomfort.

  • Rehearsing conversations or behaviours in advance.

  • Suppressing stimming behaviours during school or work.

While masking can help women navigate social expectations, it is mentally exhausting. Many women “crash” at home after holding themselves together in school, work, or social situations. Over time, this can lead to burnout, anxiety, or depression.

Special Interests in Women

Special interests are a hallmark of autism, but in women they may be harder to recognise:

  • Men/boys: Often display interests considered unusual or niche (e.g. trains, dinosaurs, space).

  • Women/girls: Interests may look more “typical” (e.g. animals, books, celebrities, fashion) but are pursued with an intensity that affects daily life.

Because these interests don’t always stand out, autism in women may be overlooked.

Why Women Are Diagnosed Later

  1. Atypical presentation: Behaviours such as shyness or introversion may not raise concern.

  2. Male-based research: Diagnostic frameworks are historically based on male presentations.

  3. Masking: Women learn to camouflage early, hiding their difficulties from teachers and peers.

  4. Different perceptions between home and school/work: Families may see signs of distress that are invisible to teachers or colleagues.

As a result, many women go without diagnosis and support for years, missing opportunities for early intervention.

Autism Assessments for Women

An autism assessment typically involves interviews, developmental history, and cognitive or behavioural tests. In the UK, assessments follow NICE guidelines and are carried out by a multidisciplinary team (psychologists, psychiatrists, and other specialists).

Receiving a diagnosis can open the door to support such as:

  • Adjustments in education or work environments.

  • Social communication support and skills training.

  • Therapy (e.g. CBT) for anxiety, depression, or other co-occurring conditions.

Autism and Mental Health in Women

Undiagnosed autism often increases the risk of mental health challenges, including:

  • Anxiety and depression

  • Burnout from years of masking

  • Low self-esteem from feeling “different” without understanding why

Early diagnosis and tailored support can make a huge difference for women, helping to reduce stress, improve self-acceptance, and strengthen wellbeing.

Summary

Autism in women is often overlooked because symptoms may be subtler, better masked, or misinterpreted as personality traits. Many women are diagnosed later in life, missing out on crucial support during childhood and adolescence.

By raising awareness of how autism presents in women – from differences in social communication to the hidden cost of masking – more women can access the understanding and support they need.