Autism in Women: Why Is Diagnosis So Often Delayed?

For many women, an autism diagnosis comes late—sometimes in their 30s, 40s, or even 50s. Yet the "symptoms" were present from early childhood. This delay doesn’t necessarily reflect a fundamentally different “female autism”, but rather a society that interprets female behaviour differently.

This gendered, normative and often unconscious gaze plays a powerful role in the erasure of autistic profiles in women.

We explore three key factors that explain this phenomenon: social camouflaging, gendered pressure from early childhood, and medical misogyny.

1. Social Camouflaging: An Invisible Yet Exhausting Mechanism

Many autistic women develop camouflaging strategies early on—observing, mimicking, copying expected behaviours. This is not spontaneous socialising; it is constant performance.

They literally learn to "act" sociability. They rehearse what to say, force eye contact, smile at the right moment. It may look like effortless interaction—but the emotional and cognitive cost is immense.

A study by Lai et al. (2017) showed that autistic women score significantly higher on camouflaging than autistic men, directly contributing to delayed diagnosis (Nature Communications).

The more effective the camouflage, the more disorienting it becomes for others when autism is suggested: “But she talks fine,”, “She has friends.” Behind the façade, however, lies exhaustion, chronic anxiety, and sometimes a total collapse when the strategy no longer holds.

2. Gendered Conformity from Childhood: A Socially Enforced Filter

In the 1990s and 2000s, young girls were still strongly encouraged to conform, please, and not make trouble. Behaviour considered “appropriate” (sitting still, smiling, listening) often masked signs of atypical development.

As early as primary school, girls receive 2–3 times more positive behavioural feedback for being calm, quiet, and invisible, while boys are more often excused for impulsive or disruptive behaviour (Baillargeon et al., 2011; Developmental Psychology).

An autistic girl who avoids group games, remains in her own world, or fixates on a specific interest isn’t seen as “different”—she’s seen as well-behaved. Her maturity and independence are praised, though in reality they often reflect isolation and social withdrawal.

3. Medical Misogyny: A Structural Delay in Recognition

The medical world still struggles to recognise female suffering. And this sexist bias deeply affects mental health—and not only that.

In cardiology, women wait 15 to 30 minutes longer than men on average for emergency treatment when presenting with chest pain (Canto et al., 2000; Safdar et al., 2014).

If even a life-threatening emergency is taken less seriously in women, how can we expect a neurodevelopmental condition—subtle and complex—to be recognised?

Medical models are based on male-centric diagnostic criteria. Early clinical studies on autism were conducted almost exclusively on boys (Kanner, 1943; Asperger, 1944). The standard profile is biased from its foundation.

The result? A woman may spend years misdiagnosed—with depression, anxiety, or borderline personality disorder—without anyone considering autism.

It’s Not “Female Autism” That’s Different—It’s How Women Are Viewed

Autistic women are not outliers among autistic people. They are simply perceived through the social filter of gendered expectations.

They are expected to be polite, empathetic, quiet, adaptable. So when they retreat, observe, or isolate—it goes unnoticed. When they mask, it’s praised. When they burn out, it’s pathologised… but rarely seen as autistic.

It is urgent that we revise our framework—and stop searching for a mythical "female autism phenotype". It’s not hidden. It is made invisible through social conditioning, through systemic misogyny—not by neurological difference.

📚 Selected Bibliography

• Lai, M.-C., Lombardo, M. V., Ruigrok, A. N. V. et al. (2017). Quantifying and exploring camouflaging in men and women with autism. Nature Communications.

• Hull, L. et al. (2020). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders.

• Baillargeon, R. et al. (2011). Differential expectations based on gender in early childhood classrooms. Developmental Psychology.

• Canto, J. G. et al. (2000). The Paradoxical Gender Differences in Mortality in Patients With Acute Myocardial Infarction. New England Journal of Medicine.

• Safdar, B. et al. (2014). Gender Disparities in Pain Management of Emergency Department Patients With Acute Abdominal Pain. Academic Emergency Medicine.

• Bargiela, S., Steward, R., Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders.