Why is Autism Historically Under-Diagnosed in Girls?

For decades, autism was believed to affect more males than females—often by a ratio of four-to-one or even higher. Yet as our understanding of autism expands, it is becoming increasingly clear that many girls on the autism spectrum have gone undiagnosed or been diagnosed later in life. This disparity can lead to missed opportunities for early support and intervention, which are crucial for helping children flourish.

At Norfolk Autism Center, we are committed to providing comprehensive, unbiased assessments and interventions grounded in evidence-based Applied Behavior Analysis (ABA) therapy principles. We believe every child deserves an accurate diagnosis—no matter their gender—so families can gain meaningful support as early as possible.

Historical Context: Early Misconceptions and Biases

Historically, autism research and diagnostic criteria were based largely on male presentations. When autism was first documented in the 1940s, many of the initial studies and diagnostic guidelines focused on boys. As a result, clinicians were trained to spot the more classic, and typically male, traits—like overt communication challenges, restricted interests in traditionally “male” topics (e.g., trains, science, technology), or repetitive behaviors.

Because the diagnostic framework was built around male-centric markers, autistic girls who did not exhibit these traits in such obvious ways were more likely to be overlooked. This meant they could go through childhood—and sometimes well into adulthood—without a clear explanation for their differences, leading to confusion and a lack of tailored support.

Masking Behaviors: The Art of Camouflaging

One key factor behind the under-diagnosis of autism in girls is “masking,” also known as camouflaging. Many autistic girls develop highly sophisticated strategies to hide social and communication difficulties. Instead of standing out, they may study their peers, memorize social cues, and replicate expected behaviors, all in an effort to “blend in.”

• Observing and Mimicking: Some girls watch their classmates or siblings closely, imitating mannerisms, speech patterns, and social behaviors—even if they don’t fully grasp the underlying social rules.
• Scripted Conversations: Girls might prepare conversational topics or jokes in advance, relying on “scripts” they have memorized.
• Hiding Interests: If a girl notices her special interest is considered unusual, she may keep it hidden or pretend to like something more socially acceptable.

While these masking behaviors can temporarily reduce teasing or bullying, they can also be exhausting for the child. Constantly needing to “perform” makes it harder for families and professionals to see an underlying autism spectrum disorder. Over time, this can contribute to stress, anxiety, and burnout.

Common Presentations in Girls: Subtle Signs to Notice

Girls with autism are as unique as boys with autism—no two children present exactly the same way. However, certain patterns of behavior or areas of challenge can be more common among girls:

1. Social Interests: Many autistic girls have a strong desire for friendship but struggle with the subtleties of social communication. They may have one or two very close friends rather than a wide social circle.
2. Special Interests: While boys might develop interests in trains, mechanics, or gaming, girls with autism may focus intensely on dolls, animals, literature, or other topics that appear more “socially typical.” Because these interests often seem more expected of girls, adults may overlook how intensely focused or repetitive these interests are.
3. Imaginative Play: Some autistic girls engage in elaborate pretend play but can become rigid in their storylines or struggle to include others in their games.
4. Emotional Sensitivity: Many girls are adept at noticing others’ emotions—sometimes even more so than neurotypical peers. However, they might struggle with regulating their own feelings, leading to sudden overwhelm or “meltdowns” at home where they feel safe.

The Importance of Early Identification

Early detection of autism is key to ensuring children receive the targeted support they need during critical periods of development. When signs of autism go unnoticed, girls may miss out on interventions that could significantly improve their social skills, academic performance, and emotional well-being. Identifying autism early allows families to access supportive therapies—like ABA—that can be personalized to meet each child’s unique strengths, challenges, and interests.

How Norfolk Autism Center Assesses Autism in Girls

At Norfolk Autism Center, we take a comprehensive, gender-inclusive approach to diagnosis and intervention. Our goal is to look beyond the traditional “checklist” of autistic traits and ensure that we capture the full spectrum of how autism can present in each individual.

1. In-Depth Developmental Histories: We start by gathering detailed background information, paying special attention to any subtle signs—such as advanced masking strategies or social struggles masked by apparent sociability.
2. Observation Across Settings: Our specialists observe children in multiple environments (e.g., clinic, home, or school) to see how they behave around different people and in different contexts. This helps us pick up on any inconsistencies or signs of masking.
3. Specific Screening Tools for Girls: We stay current with evolving research and utilize assessment methods that recognize how autistic traits can be expressed differently in girls. When appropriate, we also gather input from teachers, caregivers, and the child herself to ensure a well-rounded picture.
4. Collaboration with Families: We believe parents are the best experts on their children. By partnering closely with caregivers, we uncover patterns that might be overlooked in a single clinical setting.
5. Evidence-Based ABA Therapy Principles: Our assessments and interventions are grounded in scientifically supported ABA methods. These principles help us create individualized programs focusing on skill-building, communication, and social interaction, while also emphasizing emotional well-being and independence.

Supporting Girls on the Autism Spectrum

Identifying autism in girls is just the first step. Once we have a comprehensive understanding of a child’s strengths and challenges, we work with families to develop a personalized plan that aligns with their goals and values. Our services may include:

• Social Skills Training: Helping girls navigate complex social norms and build genuine friendships.
• Emotional Regulation: Teaching strategies to recognize and cope with strong emotions, reducing the strain of masking and maintaining better mental health.
• Family Support and Education: Equipping parents and siblings with the tools to recognize and support the child’s needs at home.
• School Collaboration: Working with educators to ensure the child’s unique learning style is accommodated, supporting academic growth and social inclusion.

Moving Toward Informed Care

The under-diagnosis of autism in girls is rooted in outdated assumptions and diagnostic frameworks that focused primarily on male presentations. By recognizing the subtle signs in girls—especially those who are highly skilled at masking—parents and professionals can ensure that autistic girls receive the tailored support they need.

At Norfolk Autism Center, our commitment to thorough, gender-inclusive assessments and evidence-based ABA therapy ensures that girls who might otherwise be overlooked are given the opportunity to thrive. We look forward to partnering with families to build a future where every child, regardless of gender, is recognized, understood, and supported on their unique journey. If you have any concerns about your child, feel free to reach out to us. Together, we can ensure that no child is left without the helping hand they deserve.