Autism was viewed through a predominantly male lens and diagnostic criteria reflects how it commonly presents in boys. As a result, many autistic girls are not diagnosed until adolescence or adulthood.
Awareness is growing. We understand that autism in girls often looks different, and recognising these differences is essential for ensuring girls receive the understanding and support they deserve.
Autism in girls is often missed as these girls perform at expected levels more often than boys with autism. The diagnostic domains of autism are, socialisation, restricted and repetitive behaviours and interests, and communication.
Girls are often socialised to be polite, observant, and socially aware. Many autistic girls learn to copy behaviour to fit in, this is called masking which makes their autistic characteristics less visible. Masking helps in social situations, but it is often exhausting and may contribute to anxiety, depression, or burnout.
Autistic girls often have intense interests that may appear socially typical. They may become deeply knowledgeable about animals, books, music, celebrities, history, art, or nature. Because these interests seem age-appropriate, the intensity behind them can easily be overlooked.
The social difficulties are less obvious in autistic girls than autistic boys. Girls may want friendships but struggle with the unwritten rules of social interaction. They may have one close friend rather than a large friendship group, feel confused by changing friendship dynamics, find group conversations overwhelming, copy the behaviour of peers to fit inand/or feel socially exhausted after school.
Rather than appearing withdrawn, they may appear quiet, shy, or highly sensitive.
Girls with autism may experience emotional overwhelm and may internalise their struggles instead of expressing them outwardly. They may not display any socially unacceptable or disruptive behaviour but may experience, anxiety, perfectionism, frequent crying, emotional shutdowns and/or low self-esteem.
Parents may describe a girl who “holds it together” at school but completely falls apart at home.
Sensory differences are a feature of autism but may be mistaken for fussiness or anxiety. Autistic girls may be particularly sensitive to clothing textures, hair brushing, loud environments, bright lights, food textures and/or strong smells. These sensitivities can significantly affect daily life.
Autistic girls need a routine and may become distressed by unexpected changes. They may rely on routines to feel safe and become anxious when plans change unexpectedly. Their need for predictability may be mistaken for rigidity or perfectionism.
Girls with autism show a surge of social difficulty from late childhood and adolescence. The girls with autism without intellectual disability show lower levels of restrictive and repetitive behaviours and interests. However, there are clear gender biases in diagnostic tools, such as asking about trains but not dolls. Girls with autism outperform autistic boys on linguistic abilities.
When autism is not recognised, girls may spend years feeling different without understanding why and may instead be identified primarily through anxiety, depression, eating difficulties, or obsessive-compulsive traits.
A later diagnosis can bring relief by explaining lifelong experiences and opening the door to more appropriate support.
Early recognition can lead to understanding them.
Parents and professionals looking beyond behaviour and consider what might be happening beneath the surface. Asking questions such as does she seem exhausted after social situations, is she constantly trying to fit in, does she hide distress until she gets home, does she have sensory challenges that affect daily life or does she seem to be coping on the outside while struggling internally?
As with all medical assessments, listening carefully to girls themselves is paramount. Many are aware that they experience the world differently long before adults recognise it.
You can build a more inclusive understanding by creating a greater awareness among families, schools, healthcare professionals, and communities. This can reduce delays in diagnosis and help girls receive support earlier.
More information is available at BMJ 2026;392:e084164