Where are the Autistic Girls and Women?

The history of autism research is, in large part, a history of studying boys. When Leo Kanner first described autism in 1943, his case studies were predominantly male. Hans Asperger’s research followed the same pattern. The diagnostic criteria that emerged from their work were built on male presentations – and those criteria have shaped clinical practice ever since.

For decades, the ratio of male to female autism diagnoses was estimated at around 4:1. More recent research suggests the true ratio is likely closer to 3:2. The gap, it turns out, was never as wide as we thought. What was wide was our ability to see it. Among girls identified early, the majority tend to have co-occurring difficulties – epilepsy, intellectual disability, developmental delay – that make their autism harder to overlook. For those without such markers, the story is very different.

According to Minister of State for Disability Emer Higgins, 40% of children who are diagnosed with a disability are diagnosed as autistic (HSE, 2026). Yet girls and women continue to be significantly under-identified.

Awareness is slowly growing. Recognition of the term “neurodiversity” has risen from 53% to 69% since March 2025, with 55% now also recognising the term “neurodivergence”. Almost three in four people are now aware of either term – a meaningful shift, and a sign that broader cultural understanding is beginning to catch up. But awareness of language is only the first step. Understanding the lived reality of autistic women and girls – and the specific barriers they face in getting recognised and supported – requires much more.

So where are all the autistic women and girls?

Hiding in Plain Sight

In many cases, they are right in front of us – and we are simply not seeing them.

Autistic girls and women are, on average, significantly better at masking their difficulties and mirroring the social behaviours around them. Research suggests this reflects a combination of neurological differences, socialisation, and the intense pressure placed on girls from an early age to be agreeable, empathetic, and socially fluent. From childhood, girls are expected to read the room, smooth over conflict, and perform connection – and so many autistic girls learn to do exactly that, at enormous personal cost.

Researchers have identified three distinct components of this social camouflage. The first is compensation – using scripts, rehearsed responses, and careful observation of others to navigate social situations that don’t come naturally. The second is masking – the constant, exhausting monitoring of one’s own behaviour (eye contact, facial expression, tone, gesture) to project a convincingly non-autistic persona. The third is assimilation – actively pushing oneself to participate, to perform interest, to belong.

The cumulative effect is that autistic women often appear to be coping well on the surface. They make eye contact. They have friends. They hold down jobs. And so they are missed – by teachers, by GPs, by mental health professionals, and sometimes by themselves.

But masking is not the same as coping. Chronic camouflage is associated with serious mental health difficulties, autistic burnout, and a profound erosion of identity. Many autistic women describe not knowing who they really are beneath the performance – because the performance has been running, without interruption, for most of their lives. Studies show that autistic women experience significantly higher rates of anxiety, depression, and eating disorders than both non-autistic women and autistic men – with late or missed diagnosis a key contributing factor.

Yet despite how central masking is to the autistic experience, awareness among those who work with autistic people remains limited. Only 31% of respondents in an AsIAm Same Chance Survey (2026) reported understanding masking – and 31% said they want more staff and professionals trained in this area. For autistic women and girls in particular, where masking is often the very reason they go unrecognised, this gap in professional understanding has real consequences.

“I spent 40 years thinking I was odd or different, just always out of step. Getting my diagnosis didn’t change the person I am – it just helped me to understand how my brain worked and how to use my strengths, not hide them. Now I am working on celebrating my neuro-spicy brain.”

– Sandra, diagnosed autistic at age 40.

Strengths, and the Cost of Hiding Them

It is important to recognise that many autistic women are remarkably high-achieving – working as doctors, lawyers, artists, academics, and advocates. Autistic thinking often brings with it deep focus, exceptional attention to detail, strong systemising ability, creativity, and an intense commitment to honesty and fairness. These are genuine strengths.

Yet for many, those strengths come at a hidden price. The effort required to mask, to perform neurotypically, and to navigate environments not designed with neurodivergent people in mind can be exhausting. High achievement and high anxiety are not mutually exclusive – and for many autistic women, they go hand in hand. Research suggests that up to 80% of autistic women will experience a mental health difficulty at some point in their lives, with anxiety being the most common.

We know from the lived experience of Autistic adults that the journey to adulthood is fraught and stressful.

“The educational setting does not align with functional, sensory, and emotional regulation needs. Masking contributes to an underestimation of distress, while the sustained impact is evident through burnout, anxiety, and reduced capacity for consistent attendance.”

– Fin, AsIAm (Same Chance, 2026) Survey respondent

What Needs to Change

The landscape is shifting, but not fast enough.

Awareness of the distinct ways autism can present in women and girls is growing among clinicians. New assessment approaches are beginning to emerge. Autistic women themselves, alongside advocacy organisations and researchers, are driving meaningful change through visibility, education, and lived experience.

But awareness alone is not enough. Systemic change requires updated training for clinicians at every level of care. Awareness of masking and the unique presentations of autistic girls and women is increasing; however, more training must be provided at every level in society, but particularly in the education and health systems. It requires diagnostic tools designed to capture the full range of autistic experience, not just its most visible expressions. It requires schools that can recognise and support autistic girls before they have spent years learning to hide. And it requires a broader cultural shift – away from a single, narrow image of what autism looks like, and towards the full, diverse reality of who autistic people actually are.

Are you a clinician looking to deepen your understanding of autism assessment? Explore our ADOS-2 & ADI-R training programme, designed to equip professionals with the skills to identify and support autism across the full range of presentations.