What Is the Female Autism Phenotype?

Why do so many autistic girls and women fall through the diagnostic cracks?

Many autistic females are going undiagnosed until their 30s, 40s, 50s, or even later. Autistic females have some of the highest rates of suicide due to the mass failure of healthcare professionals to recognize the different ways that autism presents in girls, women, and those assigned female at birth (afab). More awareness about the female autism phenotype — or how autism presents in girls and women — is needed to protect the mental and physical health of individuals on the autism spectrum. | Photo by Bruce Christianson on Unsplash

Many autistic girls and women are not being properly diagnosed — some do not receive an autism diagnosis until their 30s, 40s, 50s, or even older.

Born with autism, a genetic neurodevelopmental condition associated with various social, neurological, and sensory difficulties, these girls and women are able to hide the signs and characteristics of autism from themselves and others, even evading the concern of the most highly-trained healthcare professionals.

More commonly and devastatingly, they are misdiagnosed with conditions like borderline personality disorder, obsessive-compulsive disorder, social anxiety, bipolar disorder, and so on.

These conditions — including eating disorders like anorexia — can be highly comorbid (often appearing alongside autism), but without that key autism diagnosis, a girl or woman’s understanding of herself will be limited — sometimes with devastating consequences. She will unlikely get the support and help that she needs.

But why are so many autistic girls and women never diagnosed or not diagnosed until late in life?

Many autistic girls and women hide their social difficulties and other autistic characteristics beginning at a very young age. In fact, the number one thing that their friends and acquaintances say upon hearing of their autism diagnosis is, “But you don’t look autistic!” According to experts, autism is not something that is obvious or can be seen. It presents in vastly different ways from person to person. | Photo by Matheus Ferrero on Unsplash

Females or afabs (assigned female at birth) that do get diagnosed as autistic at a young age often present with more male-like or “classical” autistic characteristics. Some might say that they present with more “obvious” or expected autistic traits. While those who get diagnosed early in life are NOT more autistic, their characteristics do tend to be more in line with stereotypical ideas of autism, on which the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria are based.

The earliest autism research focused on men and boys, and autism research today continues to be focused on men and boys. For this reason, several experts have concluded that the current autism diagnostic criteria and assessment tools require significant changes and revisions to ensure reliable autism diagnosis in all genders.