AUTISM IN GIRLS AND WOMEN: PHENOTYPIC SPECIFICITY, CAMOUFLAGING, AND DIAGNOSTIC CHALLENGES
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.5964Keywords:
Autism Spectrum Disorder (ASD), Female Autism Phenotype, Camouflaging, Masking, Neurodevelopmental Disorders, Late DiagnosisAbstract
Autism spectrum disorder (ASD) has traditionally been studies mainly involving male populations, which has influenced both diagnostic criteria and clinical expectations. Because early diagnostic criteria were built almost entirely around how boys present, we now face a reality where autistic girls and women are routinely missed. They end up spending years—often well into adulthood—navigating this heavy, unexplained social friction and emotional burnout before anyone actually connects the dots. This review is an attempt to unpack that female autism phenotype, looking closely at camouflaging, why the system fails them, and what exactly keeps these diagnoses delayed for so long.
To get a clearer picture, we went through literature from 2000 to 2025 across PubMed, Scopus, and similar databases, focusing on sex-based differences, coping mechanisms, and co-occurring mental health issues.
What the data actually shows is that autistic women rarely fit the old textbook mold. Their social differences are much quieter, and their verbal skills often hide the struggles. To survive, they rely heavily on "camouflaging"—essentially a polite term for masking their traits and mimicking neurotypical peers just to blend in. Sure, it works to get them through the day, but the internal cost is massive. We are talking severe anxiety, clinical depression, and sheer exhaustion. Since standard diagnostic tools still hunt for overt male behaviors, this whole internal struggle remains largely invisible to clinicians.
References
Aguiar, E. S. (2025). The different aspects of autism spectrum disorder in girls and adolescents: An integrative review. Research & Scientific Development Journal.
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: Female autism phenotype and under-recognition. Journal of Autism and Developmental Disorders, 46(10), 3281–3294.
Chellew, T. (2024). The early childhood signs of autism in females: A systematic review. Review Journal of Autism and Developmental Disorders.
Cook, J., Hull, L., Crane, L., & Mandy, W. (2021). Camouflaging in autism: A systematic review. Clinical Psychology Review, 89, Article 102080.
Dolfi, A., & Tudose, C. (2025). Diagnostic challenges of autism spectrum disorder in women without intellectual or language impairments: A narrative review. Journal of Medicine and Life, 18(8), 710–720.
Edwards, H., Mitchell, A. E., Unwin, G., & Taylor, E. C. (2024). A systematic review and meta-analysis of late-diagnosed women with autism spectrum conditions: Investigation of the female autism phenotype. Journal of Child Psychology and Psychiatry.
Examining androgen and estrogen profiles during pubertal development in autistic girls. (2025). Hormones and Behavior, 176, Article 105837.
Gellert, B. (2025). Underdiagnosed and misunderstood: Clinical challenges in recognizing the female autism phenotype. Behavioral Sciences, 15(8), Article 1073.
Halladay, A. K., Bishop, S., Constantino, J. N., Daniels, A. M., Koenig, K., Palmer, K., Messinger, D., Pelphrey, K., Sanders, S. J., Singer, A. T., Taylor, J. L., & Szatmari, P. (2015). Sex and gender differences in autism spectrum disorder: Summarizing evidence gaps and emerging priority areas. Molecular Autism, 6, Article 36.
Hull, L., & Mandy, W. (2023). Perspectives of autistic adolescent girls and women on wellbeing and social challenges. Journal of Autism and Developmental Disorders.
Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders.
Lockwood-Estrin, G., Milner, V., Spain, D., & Colvert, E. (2021). Barriers to autism spectrum disorder diagnosis for young women and girls: A mixed-methods systematic review. Review Journal of Autism and Developmental Disorders, 8(4), 454–470.
Loomes, R., Hull, L., & Mandy, W. P. L. (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 Psychiatry, 56(6), 466–474.
McQuaid, G. A., Ratto, A. B., Jack, A., Harrison, A. J., & Pelphrey, K. A. (2024). Gender, assigned sex at birth, and gender diversity: Windows into diagnostic timing disparities in autism. Autism, 28(11), 2806–2820.
McVey, A., Schiltz, H., Radanovich, A., Jackson, E., & Van Hecke, A. V. (2023). Sex differences in predictors and outcomes of camouflaging: Comparing diagnosed autistic, high autistic trait and low autistic trait young adults. Autism, 27(2), 402–414.
Messinger, D. S., Young, G. S., Webb, S. J., Ozonoff, S., Bryson, S. E., Carter, A., Carver, L., Charman, T., Chawarska, K., Curtin, S., Dobkins, K., Hertz-Picciotto, I., Hutman, T., Iosif, A. M., Klin, A., Landa, R., Messinger, D. S., Nelson, C. A., Stone, W. L., ... Zwaigenbaum, L. (2015). Early sex differences are not autism-specific: A baby siblings research consortium (BSRC) study. Molecular Autism, 6, Article 32.
Milner, V., Mandy, W., Happé, F., & Colvert, E. (2019). A qualitative exploration of the female experience of autism spectrum disorder (ASD). Journal of Autism and Developmental Disorders, 49(6), 2389–2402.
Minutoli, R. (2025). Female gender and autism: Underdiagnosis and misdiagnosis in cognitively competent females with ASD. Frontiers in Psychiatry.
Ortas de Haro, E., & Ayllón-Negrillo, E. (2025). FEM-A questionnaire: Assessment tool for level 1 autism in women. Education Sciences.
Ratto, A. B., Turner-Brown, L., Kenworthy, L., Anthony, L. G., Fombonne, E., Greenlay, J. A., Grieco, J., Maddox, B. B., Myrick, Y., Nadzan, A., & Schultz, R. T. (2018). What about the girls? sex-based differences in autistic traits and adaptive skills. Journal of Autism and Developmental Disorders, 48(5), 1698–1711.
Rynkiewicz, A., & Łucka, I. (2018). Autism spectrum disorder (ASD) in girls: Co-occurring psychopathology and sex differences in clinical presentation. Psychiatria Polska.
Sandin, S., Yip, B. H., & Reichenberg, A. (2024). Examining sex differences in autism heritability. JAMA Psychiatry, 81(7), 673–680.
Tsirgiotis, J. M., Gurd, A., Simpson, K., & Pellicano, E. (2024). A comparison of the presentations of males and females with autism: Barriers to diagnosis. Autism.
Wood-Downie, H., Wong, B., Kovshoff, H., Mandy, W., Hull, L., & Hadwin, J. (2021). Sex/gender differences in camouflaging in children and adolescents with autism. Journal of Autism and Developmental Disorders, 51(4), 1353–1364.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Magdalena Bieniak, Maria Mamczak, Lesia Slobozheniuk, Martyna Michalik, Julia Ołdak, Oleksandra Korshak, Dominik Zając, Agnieszka Wiktoria Paluszek, Filip Jasiński, Maja Kubiaczyk, Aleksandra Skrobisz, Iga Maria Owczarek-Danowska, Julia Płóciennik
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
