Autism in Adult Women: Why is it Often Overlooked?
Autism Spectrum Disorder (ASD) has historically been diagnosed more frequently in males than females. However, growing research suggests that autism in girls and women may be overlooked, misidentified, or diagnosed later in life. Differences in how autistic characteristics are expressed, social expectations, and limitations in traditional diagnostic approaches may contribute to these disparities (Cook et al., 2024).
For some women, recognizing autism in adulthood can provide a greater understanding of lifelong experiences involving social communication differences, sensory sensitivities, emotional exhaustion, or feeling different from others. Why does autism sometimes go unrecognized in women, and how can a comprehensive psychological assessment help?
Does Autism Present Differently in Women?
Autism is a neurodevelopmental condition characterized by differences in social communication and interaction, along with restricted or repetitive patterns of behaviour, interests, or activities. Although diagnostic criteria are the same regardless of gender, research suggests that some autistic characteristics may be expressed differently in girls and women. These differences can influence whether autism is recognized and whether an individual is referred for assessment (Cook et al., 2024).
Some autistic women develop strong language skills, maintain friendships, achieve academic or professional success, and appear socially confident. However, these outward abilities do not necessarily reflect the effort required to navigate social situations. For example, an autistic woman may participate successfully in conversations but find interpreting unspoken social expectations exhausting. Another may maintain meaningful relationships while experiencing difficulties managing changes, sensory demands, or unfamiliar social environments. These characteristics are not exclusive to women. Autistic individuals of all genders can experience similar challenges.
What Is Social Masking or Camouflaging?
One factor that may contribute to the delayed recognition of autism is social camouflaging, sometimes called masking. Camouflaging involves consciously or unconsciously modifying behaviour to meet social expectations or conceal differences in social communication. Research suggests that camouflaging may influence how autistic characteristics are perceived by others, including clinicians (Hull et al., 2017).
Examples of camouflaging may include:
Rehearsing conversations before social interactions.
Observing and imitating the facial expressions, gestures, or communication styles of others.
Making deliberate efforts to maintain eye contact despite discomfort.
Suppressing repetitive movements or behaviours in public.
Following learned social rules rather than responding intuitively.
Appearing socially comfortable while experiencing significant internal stress or exhaustion.
Hull et al. (2017) examined the experiences of autistic adults and identified motivations for camouflaging, including the desire to fit in and develop social connections. Participants also described consequences such as exhaustion and difficulties maintaining a sense of personal identity. Camouflaging may help individuals navigate social environments, but the effort involved can be substantial. Importantly, masking is not unique to autism. Its presence alone does not establish an autism diagnosis.
Why Might Autism Be Missed During Childhood?
Historically, autism research and diagnostic descriptions have drawn heavily on male presentations. Consequently, some characteristics of autism in girls and women may not be adequately recognized through traditional referral and assessment practices (Cook et al., 2024). For example, a girl who performs well academically, follows classroom expectations, or maintains friendships may not be referred for assessment, even when she experiences difficulties with social communication, sensory processing, or emotional regulation. Autistic characteristics may also become more noticeable as social and environmental demands increase. An individual who successfully navigated familiar school routines may encounter greater challenges when transitioning to university, employment, independent living, or increasingly complex relationships. Cook et al. (2024) emphasize the importance of recognizing a broader range of autistic presentations and considering camouflaging during the diagnostic process. For some women, these experiences contribute to seeking an autism assessment for the first time in adulthood.
Can Autism Be Mistaken for Anxiety, ADHD, or Other Conditions?
Autism may coexist with other neurodevelopmental and mental health conditions, including ADHD, anxiety disorders, depression, and PTSD. Some characteristics overlap across these conditions. For example, difficulties navigating social situations may occur in autism and social anxiety disorder. Challenges involving attention, organization, and executive functioning may also be associated with autism, ADHD, or both.
In some cases, the presence of anxiety, depression, or other psychological concerns may contribute to autism being overlooked. Cook et al. (2024) identify diagnostic overshadowing by co-occurring mental health conditions as an important consideration when assessing girls and women. This does not mean that previous mental health diagnoses are necessarily incorrect. An individual may have autism alongside one or more additional conditions. The National Institute for Health and Care Excellence (NICE, 2012) recommended that comprehensive adult autism assessments consider relevant developmental history, current functioning, co-occurring conditions, and alternative diagnostic explanations. Careful differential diagnosis is therefore important to understanding the individual's overall psychological functioning.
What Does an Adult Autism Assessment Involve?
A comprehensive evaluation may include:
A detailed clinical interview exploring current concerns and developmental history.
Review of social communication patterns, relationships, interests, routines, and sensory experiences.
Standardized psychological assessment measures.
Information from family members or other relevant sources, when available and appropriate.
Consideration of masking or camouflaging behaviours.
Screening for relevant co-occurring conditions, such as ADHD, anxiety, depression, PTSD, and intellectual disability, when clinically indicated.
NICE (2012) recommended that comprehensive adult autism assessments consider developmental history, current and past functioning, sensory experiences, and possible co-occurring psychological or neurodevelopmental conditions. Similarly, Cook et al. (2024) recommend assessment approaches that recognize diverse autistic presentations and account for camouflaging. Assessment findings should be interpreted together rather than relying on any single questionnaire or test score. An autism assessment does not necessarily result in a diagnosis. Regardless of the outcome, it may help individuals better understand their strengths, challenges, and support needs.
Is It Worth Seeking an Autism Assessment in Adulthood?
For some adults, assessment provides greater clarity about longstanding experiences that were previously difficult to explain. A diagnosis, when appropriate, may help individuals better understand their developmental history, recognize support needs, and explore relevant accommodations.
Others may discover that their concerns are better explained by different or co-occurring psychological conditions. The decision to pursue an assessment is personal. It may be particularly helpful when longstanding differences in social communication, sensory processing, behavioural patterns, or everyday functioning raise questions about autism. There is no upper age limit for considering an autism assessment.
Autism Assessments at Vandana Psychological Services
At Vandana Psychological Services, we provide comprehensive autism assessments for children aged 4 and older, adolescents, and adults in Saskatchewan. Our individualized approach considers developmental history, social communication, sensory experiences, current functioning, and relevant co-occurring conditions. Dr. Vandana D'Sena's doctoral research examined differences in the identification of autism in females and males, reflecting a particular professional interest in understanding how autism may present across individuals.
A comprehensive assessment can help clarify diagnostic questions, identify individual strengths and challenges, and provide recommendations for appropriate supports and accommodations.
For more information, please visit our Autism Assessments page or contact Vandana Psychological Services to learn about assessment procedures and appointment availability.
References
Cook, J., Hull, L., & Mandy, W. (2024). Improving diagnostic procedures in autism for girls and women: A narrative review. Neuropsychiatric Disease and Treatment, 20, 505–514. https://doi.org/10.2147/NDT.S372723
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534. https://doi.org/10.1007/s10803-017-3166-5
National Institute for Health and Care Excellence. (2012). Autism spectrum disorder in adults: Diagnosis and management (Clinical guideline CG142). https://www.nice.org.uk/guidance/cg142
