Relatively recent research suggests that the ratio of autistic boys to girls is likely to be nearer three to one (Loomes et al, 2017), or even equal (Grey et al, 2021), however only one fifth of autistic girls are diagnosed before the age of 11 compared with over half of autistic boys (Belcher et al, 2022).

There are often challenges with girls being recognised as autistic which then means their needs are not recognised nor met and can lead to significant mental health issues in adolescence and into adulthood. 

While there will always be exceptions, it can be suggested that the diagnostic criteria for autism are based on a ‘male presentation’ of autism (caveats, naturally) and certainly a presentation that does not involve ‘camouflaging’ or ‘masking’. Loomes et al (2017) have identified that there is a diagnostic gender bias which means girls are less likely to receive clinical diagnosis.

Girls are more likely than boys to display camouflaging or masking behaviours although some boys will also mask.  They may demonstrate more desire to interact with others, may maintain some friendships and demonstrate more social, emotional and empathetic behaviours than boys, or may display behaviours perceived as shy or passive (Zakai-Mashiach, 2023).  Stereotypical views of autism may be of children who cannot make eye contact, who are isolated, who have unusual and fixed interests and communication skills that demonstrate a difference in use of tone and body language.  However, many girls observe and practice their social skills so they are appearing to interact like their peers, and their special interests may be age appropriate, so the intensity of these is not identified.  They may well be perfectionists and high achievers who appear to be doing well academically and socially.

The resources needed to camouflage in autistic people can result in a loss of identity, internal conflict, anxiety, depression and increased risk of suicidality (Belcher et al, 2022; Howe et al, 2023). Risk of suicide is seven times higher in autistic people than non-autistic people (Howe et al, 2023) and autistic females are more likely to die by suicide than autistic males, with camouflaging being an additional risk factor in suicidality (Cassidy et al, 2018).  They are also at higher risk of experiencing sexual violence (Hopkins et al, 2023).  Autistic girls are more likely to underachieve academically compared with their non-autistic peers, but are less likely to get support because they internalise their difficulties (Zakai-Mashiach, 2023). 

The complexities of adolescence can lead to mental health issues in non-diagnosed autistic girls, where if they are lucky, someone will consider the possibility of autism. Teachers need to be alert to the knowledge that camouflaging may mean that they have far more autistic pupils in their classes that they realise and the behaviours may look quite different in girls. Organisations such as the Autistic Girls Network (https://autisticgirlsnetwork.org/) are working hard to raise awareness of the needs of autistic girls and women and have lots of useful information on reasonable adjustments in school. Parents of autistic girls are more likely to report elevated levels of stress than parents of autistic boys (Hopkins et al, 2023), due to the mental health issues of their children, late diagnosis, needs not being met and the increased vulnerability of girls. This also has implications for how schools work in partnership with parents and enable them to feel supported.

Michelle Sogga is a Senior Tutor in Education (Early Years) and can be found on X at @msogga

  • Anderson, P. (2023) ‘Autism tied to higher rates of self-harm, suicide’ Available at:  https://www.medscape.com/viewarticle/995275?form=fpf  [Accessed 1/2/24]
  • Belcher, H., Morein-Zamir, S., Mandy, W., and Ford, R. (2022) ‘Camoflaging Intent, First Impressions, and Age of ASC Diagnosis in Autistic Men and Women’, Journal of Autism and Developmental Disorders, 52, pp. 3413-3426. https://doi.org/10.1007/s10803-021-05221-3
  • Cassidy, S., Bradley, L., Shaw, R. and Baron-Cohen, S. (2018) ‘Risk markers for suicidality in autistic adults’, Molecular Autism, 9 (42) https://doi.org/10.1186/s13229-018-0226-4
  • Craddock, E. (2024): Raising the voices of AuDHD women and girls: exploring the co-occurring conditions of autism and ADHD, Disability & Society, https://doi.org/10.1080/09687599.2023.2299342  
  • Gray, L., Bownas, E., Hicks, L., Hutcheson-Galbraith, E., and Harrison, S. (2021) ‘Towards a better understanding of girls on the Autism spectrum: educational support and parental perspectives’, Educational Psychology in Practice, 37 (1) pp. 74-93. https://doi.org/10.1080/02667363.2020.1863188
  • Hopkins, N., Iles, J. and Satherley, R. (2023) ‘The Experience of Raising Girls with Autism Spectrum Disorder: A Systematic Review of Qualitiative Research Studies’, Review Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s40489-023-00419-w
  • Howe, S., Hull, L., Sedgewick, F., Hannon, B. and McMorris, C. (2023) ‘Understanding camouflaging and identity in autistic children and adolescents using photo-elicitation’, Research in Autism Spectrum Disorders 108
  • Loomes, R., Hull, L., Palmear, W. and Locke, M. (2017) ‘What is the Male-to-Female ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis’, Journal of the American Academy of Child and Adolescent Pyschiatry, 56 (6) pp. 466-474.  Available at: https://www.sciencedirect.com/science/article/abs/pii/S0890856717301521?via%3Dihub [Accessed 26/1/24]
  • Maenner, M. et al (2021) Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years.  Available at: https://www.cdc.gov/mmwr/volumes/70/ss/ss7011a1.htm?s_cid=ss7011a1_w  [Accessed 26/1/24]
  • Milton, D. (2012) ‘On the ontological status of autism: the ‘double empathy problem’, Disability and Society, 27 (6), pp. 883-887.
  • Mitchell, P., Sheppard, S. and Cassidy, S. (2021) ‘Autism and the double empathy problem: Implications for development and mental health’, British Journal of Developmental Psychology, 39 pp. 1-18
  • Zakai-Mashiach, M. (2023) “I Was Like a Bird Without Wings”: Autistic Women’s Retrospective Experiences in General Schools’, Journal of Autism and Developmental Disorders, 53 pp. 4258-4270. https://doi.org/10.1007/s10803-022-05717-6

Useful online resources

Autistic Girls Network (also on Facebook and Twitter) https://www.youtube.com/@AutisticGirlsNetwork

Leave a comment