Autism diagnoses have peaked this year, and a record 190,000 people are expected to be diagnosed with autism by 2024—many of them girls and women. In fact, the number of girls receiving an autism diagnosis is especially on the rise.
But do rocketing rates in autism diagnoses mean autism is becoming more common? Not necessarily. It may very well mean that in previous years, doctors and medical providers simply did not have enough knowledge and awareness to recognize it—especially in girls and women.
How do people without knowledge of autism normally picture an autistic person? Perhaps, as Dr. Devon Price said, “a white man with a monotone voice, rude demeanor and a penchant for science.” Price, a social psychologist, professor and trans author on the autism spectrum, lists in his book Unmasking Autism (2022) more stereotypical examples of autism in pop culture: Shaun Murphy from The Good Doctor, Sheldon from The Big Bang Theory and Rick from Rick and Morty. In other words, he writes, some variation of “white boys who love trains.”
But autism can take many forms, and often presents differently in girls and boys.
(To refer to autism in this article, I will use Price’s recommended language and terms. He discourages using “person-first” language—i.e. “people with autism”—because it disrespects autism’s integral nature to his life. “We don’t call Asian people ‘people with Asianness’ and we don’t call gay folks ‘people with homosexuality,” he writes, “because we recognize it is respectful to view these identities as parts of their personhood.” Instead, he prefers the terms ‘autistic person’ and ‘on the autism spectrum.’)
What Does It Mean to ‘Mask’ Autism?
Masking can appear differently for each person on the spectrum, and it generally entails mimicking the behavior and interaction styles of neurotypical (non-autistic) people. This painful process involves concealing their natural selves—and traits of their autism—to protect themselves from an ableist world.
Alex, a 22-year-old diagnosed with autism at 20, described masking as “an unconscious survival strategy”—for example, a behavior necessary to succeed in jobs. They use the example of maintaining eye contact, which they often find challenging. “I make good eye contact, and I shake the interviewer’s hand,” said Alex. “If I was unmasked in that situation, I might seem ‘unprofessional’ and therefore might not be chosen for the position.”
Women and girls on the spectrum have continuously been more under- or misdiagnosed with autism than boys, and on average receive diagnoses later in life than boys and men do. The National Library of Medicine (NLM) notes that the ratio of autistic boys and men to autistic girls and women is generally considered 4:1, yet NLM researcher Robert McCrossin suggests this statistic might be inaccurate due to sexist bias.
At age 18, shows McCrossin’s research, 80 percent of these women remained undiagnosed. After his study, McCrossin suspects the real male-to-female ratio is closer to 3:4.
Price said autism is underdiagnosed not only in girls, but also in Black, indigenous, Asian and Latinx people, as well as those in poverty.
So, why do girls and women go largely undetected?
How Do Girls Often Mask Their Autism?
Because of the way women are socialized to ‘fit in’ and pick up on social cues, underlying traits of autism … essentially get missed.
Dr. Jenara Nerenberg
Studies on autistic adults have found that women mask their autism more than men do, which could explain why they often fly under the radar. The cause may relate to sexist social expectations for women and discrimination from patriarchal medical systems.
For girls, masking can manifest through behaviors less associated with the stereotype of someone autistic. Some doctors diagnose autistic girls with eating disorders, depression, anxiety or low self-esteem, failing to recognize the root cause as autism.
Girls on the autism spectrum can be misdiagnosed with eating disorders, because many autistic people find certain textures and tastes in food difficult to tolerate. Doctors can also misdiagnose an autistic girl with low self-esteem, when her quietness may actually be an autism-related nonverbal trait.
In a social context, girls are also more likely to control their behavior in public, making it harder to recognize their autism. Nonverbal tendencies can also appear as a girl’s coping mechanism for being bullied due to her autism. Doctors often rule out autism in girls simply because girls more often mask by adhering to learned social rules, having been taught to blend in.
“Because of the way women are socialized to ‘fit in’ and pick up on social cues, underlying traits of autism … essentially get missed,” wrote autistic author Dr. Jenara Nerenberg in her book Divergent Mind (2020).
Sexist misconceptions about autism stem partly from the development of autism diagnostic tests. When creating these tests, scientists primarily based their design on studies about autistic white boys. Price described the diagnostic test as an exclusive “gatekeeping process” that bars anyone who is “too Black, too feminine, too queer and too gender nonconforming.”
The assumption that autism is a “boy’s” disorder traces back to Nazi-era psychiatrist Hans Asperger, who often omitted girls from his research, wanting only to highlight “high-functioning” autistic boys who would be useful to the Nazi party.
“Girls with disabilities were seen as more disposable,” wrote Price, “so they were left out of the conversation.”
Because of its background and discriminatory meaning, the term “high-functioning” should be avoided. Alex considered the term a label “based on how much of a nuisance to others an autistic person is”—a label deeply disrespectful of neurodivergence.
This sexism has carried into the present, especially into diagnostic tests. Doctors may screen for restricted interests, a common autistic trait. They often stereotype this as a boy who fixates on a few topics, like trains, taxis, maps or U.S. presidents. This sexist stereotype can inhibit doctors from recognizing autism in girls, who can have different fixations that might fit stereotypically “feminine” interests, like animals, dolls, unicorns or celebrities. This means for girls, the intensity of their fixation can indicate autism perhaps more than the object of interest itself.
How Does Masking Harm Women and Girls?
The pressure they feel to conform to neurotypical standards can cause distressing feelings of social anxiety.
“[High-masking] autism is hard, because you have more perception of all the differences in yourself and how people perceive you,” said Eliza, a 24-year-old woman diagnosed with autism in elementary school. “You see yourself as a different person, out of place.”
Writer Catina Burkett, a Black autistic woman, also described the pressure to conform in an interview with Price. She noted how flatness of expression is perceived as Sherlock-like genius, yet “when a Black autistic woman is even slightly flat in her emotional expressions, she has to worry people will call her ‘angry’ or ‘unprofessional.’”
To defy this stereotype of autistic people as masculine, “cold” and insensitive, girls often overcompensate by becoming easygoing people pleasers. This makes them more vulnerable to sexual exploitation and abusive relationships, simply because they want to feel accepted and avoid being ostracized.
Their stress can also manifest in other harmful coping strategies to keep the mask up, such as alcohol or substance use problems, detachment and dissociation. Girls may also stop expressing their pain or discomfort to avoid seeming “crazy” or “demanding,” which leads to their needs getting ignored.
Unmasking as a ‘Radical Act of Self-Love’: Empowering Girls on the Spectrum
The pressure to mask can severely affect the overall health of women and girls. However, some powerful tools still exist to help overcome these challenges.
Price proposed taking off the neurotypical mask, as long as it feels safe and comfortable to do so. He described unmasking as “a revolutionary act of disability justice” and “a radical act of self-love,” and potentially a strongly uplifting experience.
Joining and finding women role models in autistic communities can help autistic girls unfold in this challenging process of self-acceptance. He suggests finding activist groups run by autistic people and for autistic people, like the Autistic Self Advocacy Network and Autistics Against Curing autism groups. Following social media tags like #Neurodivergent, #AutisticSelfAdvocacy and #AutisticJoy can also help to form an online community.
Things to avoid include organizations like Autism Speaks—run by mostly neurotypical leadership—and cruel autism treatments like Applied Behavior Analysis (ABA). This trauma-inducing form of therapy punishes autistic students for harmless neurodivergent behaviors, using methods like electrocution, covering their crayons in hot sauce (to discourage chewing) and spraying them on the tongue with vinegar.
In academic settings, Price recommended creating more neurodiversity education in schools, promoting the research of neurodiverse scientists and expanding research on how autistic people can help alleviate their self-stigma. In policy, the government can enact more disability benefits to help better support their needs.
Instead of defining themselves by what they lack, autistic girls and women can also try identifying themselves more by their strengths. Price suggested looking for reasons that autism has shaped their lives positively, giving them qualities like stronger sensitivity, directness and attention to detail. They can also practice daily actions, like advocating for their needs without apology and sharing their emotions with people they trust.
We should also directly prioritize the voices of autistic people themselves when fighting in the movement. “It’s only when [people] reach out to the autistic community that they begin to build an accurate understanding of autism by learning from the lived experiences of actually autistic people,” wrote Sharon DaVanport, autistic activist and founding executive director of the Autistic Women and Non-Binary Network (AWN).
Uplifting autistic women and girls is no simple task; it will take a vast community effort. But together, we can fight to replace sexism and ableism with mutual acceptance, respect and love, creating a world where neurodiverse people not only can survive, but thrive.
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