Autism in Women and AFAB (Assigned female at birth) individuals
- Kaitlyn Boudreault
- Aug 19
- 9 min read
Updated: Oct 18
For decades, autism research, media depictions, and diagnostic criteria have focused mainly on cisgender boys.
As a result, many autistic women and girls, especially those at the intersection of BIPOC and/or LGBTQ+ identities, have gone unseen, unheard, and misunderstood.
This lack of awareness of autism in certain populations has led to consequences, including the fact that many individuals in these population groups go undiagnosed or misdiagnosed until adulthood.
Not only this, but they also endure masking or hiding their autistic traits for years, which increases the risk of mental health challenges. This masking can also lead to challenges accessing the right support, navigating identity, and being truly understood.
Thankfully, in recent years, insights into autism in women and AFAB individuals are slowly growing, and there is more understanding of how it manifests in these population groups because of advocacy organizations that have been working hard to highlight the unique ways autism can present in these population groups.
Professionals are also starting to acknowledge that the stereotypes of the typical autistic person, such as the “quiet boy,” don’t capture the full spectrum of the autistic experience.
The more we begin to understand these experiences, the better we can support them.
If you or someone you love is exploring an autistic diagnosis, a psychologist at our partner organization can support you. An autism coach or therapist can offer you support for acceptance, clarity, and strategies that honour your strengths.
This blog will delve into the signs of autism in women and AFAB individuals, why it is often missed, the consequences of late diagnosis or misdiagnosis, and how society can better support autistic individuals.
Autism is a neurodevelopmental difference and form of neurodivergence that impacts the way a person navigates the world.
It is marked by challenges in the areas of communication, sensory processing, and social interaction. Autistic individuals may also display repetitive behaviours and focused interests.
Recognizing Autism in Women and AFAB Individuals
While autistic traits will differ from person to person, certain patterns often emerge in these groups specifically, including:
Intense, focused interests: girls and AFAB individuals tend to have intense focus on many topics that tend to be more socially typical hobbies, like dolls, psychology, books, animals, and aesthetics, rather than one specific interest, which is common in boys and AMAB individuals.
Social Situations: Women and AFAB individuals may appear to cope better with social situations, but this is usually due to masking. This is not a sign that they don't still struggle in different ways socially. This includes challenges with subtle social cues, such as sarcasm, jokes, or unspoken rules.
Sensory sensitivity: a sensitivity to lights, textures, sounds, or smells that makes it difficult to regulate emotions.
Strong need for routine: Need predictability, which can sometimes be misinterpreted as rigidity or controlling behaviour.
Intense empathy or emotional sensitivity: Some autistic women describe feeling overwhelmed by the emotions of others.
Frequent social masking: These population groups are more likely to be quieter and hide their feelings (mask). These groups are more likely to force eye contact and engage in social interactions, despite the pain. This is followed by exhaustion or emotional burnout.
Internalized distress: The challenges of autism tend to be internalized for these groups, leading women and AFAB individuals to experience internalized mental health challenges, such as anxiety, depression, perfectionism, and self-criticism.
Frequent misdiagnosis with anxiety, depression, eating disorders, borderline personality disorder, or ADHD.
Why Do Women and AFAB Individuals Often Go Undiagnosed or Misdiagnosed?
The way that autism presents in women and AFAB individuals often goes unrecognized. Diagnostic systems were historically based on male presentations, which has contributed to what’s often called the “female autism phenotype.”
But in recent years, many more autistic women and AFAB individuals are discovering that they are autistic late in life, due to the increased understanding of outdated stereotypes and diagnostic tools that are founded on male presentations.
Here are some of the reasons why these population groups go undiagnosed or misdiagnosed:
1. Masking or Camouflaging to Fit In
Autistic women and AFAB individuals have traditionally been taught by society to be quiet. These groups are more likely to consciously or unconsciously “mask” their autistic traits, which leads to forcing eye contact, scripting conversations, mirroring social behaviours, or pushing through sensory discomfort to fit in.
Psychological research also shows that women mask negative emotions more due to societal expectations for conformity.
This masking or camouflaging of autistic traits is used to help fit in or blend into society and be less likely to be excluded. But this can often come at the cost of exhaustion, anxiety, emotional overwhelm, misdiagnosis, undiagnosis, or burnout.
2. Subtle or Socially “Acceptable” Interests
Outdated research on autism tends to focus on the way autism presents in cisgender boys. For instance, when it comes to intense interests, they are stereotypically associated with niche or technical interests, such as ordering toy trains.
But many women and AFAB individuals have deep, intense interests in subjects that are considered socially acceptable, such as animals, books, and Barbie dolls. There may also be repetitive behaviours like hair twirling that are overlooked.
Because these interests don’t stand out as “unusual,” they may not trigger the same diagnostic curiosity.
3. Misdiagnosis and Co-Occurring Conditions
Women and AFAB individuals are more likely to be seen as emotional and are more likely to internalize their autistic traits, experiencing anxiety, depression, personality disorders, or eating difficulties, rather than the outwardly visible behaviors seen in cisgender boys. These neurotypes tend to overshadow autistic traits.
As a result, there is a higher rate of misdiagnosis with anxiety, OCD, depression, and personality disorders, especially borderline personality disorder (BPD) in women and AFAB individuals, without autism being considered.
4. Diagnostic Bias
Based on previous research, autism was estimated to be more common in boys and AMAB individuals than in women and AFAB individuals. Autism was seen to be 4 times more common in cisgender men.
But recent research is beginning to shift this ratio and notice that women and AFAB individuals are likely just as likely to be autistic, but it is the research gap that is explaining the gap in the diagnostic rate.
5. Gender Stereotypes
Cultural expectations that women and AFAB individuals should be polite, quiet, and socially adaptable mean that autistic girls who comply may not be seen as struggling.
Conversely, if their differences are noticeable, they may be labeled “shy” or “sensitive” instead of autistic.
The Role of Masking and Camouflaging
Masking is one of the most important concepts for understanding autism in these population groups. It involves hiding autistic traits and imitating neurotypical behaviors.
Examples of masking include:
Forcing eye contact despite discomfort
Rehearsing phrases before entering conversations
Copying peers’ body language or clothing styles
Suppressing stimming behaviors (like rocking or hand-flapping) in public
Laughing at jokes they don’t understand to blend in.
Impact of Masking and Being Undiagnosed
Many women and AFAB individuals live as autistic individuals until adulthood before getting diagnosed, due to several reasons, including masking. While masking can provide short-term social acceptance, it often comes with long-term costs:
Exhaustion and burnout: Constantly performing can drain mental and physical energy, leading to burnout or a state of extreme fatigue, reduced functioning, and loss of skills.
Anxiety and depression, linked to feeling misunderstood or “different.”
Identity confusion, often feeling guilty or broken, until a diagnosis provides clarity.
Higher rates of eating disorders and trauma due to emotional isolation
Suicidality and self-harm often correlate with invisibility and emotional pain.
Loss of identity: Over time, many autistic women describe feeling unsure of who they truly are.
Self-blame and low self-esteem: Without an explanation, many blame themselves for difficulties in school, work, or relationships.
Isolation: Feeling “different” but not knowing why can create loneliness and shame.
Myth 1: Autism is mostly a male condition.
Fact: Anyone can be autistic. But there are biases in diagnostic tools and cultural stereotypes that have often led women and AFAB individuals to be misdiagnosed or undiagnosed. Some recent research has begun to suggest that many are autistic than previously thought.
Myth 2: Autistic girls and afab individuals don’t have special interests.
Fact: They do, but their special interests tend to be closer to what would be considered socially acceptable. For example, an autistic girl may have a passion for books, which is less likely to raise concern.
Myth 3: If a girl or an afab individual is social, they can’t be autistic.
Fact: Autism exists on a spectrum. While some autistic girls and AFAB individuals may not be social, others are. Despite the fact that these individuals are social, they still may struggle with social interactions and need scripts. They may thrive in structured friendships (like one-on-one bonds) while struggling in group dynamics.
Myth 4: Autism looks the same in everyone.
Reality: Autism is highly individual. The traits in autistic women and AFAB individuals may not resemble the “classic” profile used in early research.
Myth 5: Late diagnosis means it’s “mild autism.”
Reality: A late diagnosis doesn’t reflect severity but rather how well someone has masked or how poorly their needs were recognized. Many late-diagnosed autistic women report significant struggles that were hidden for years.
The Unique Strengths of Autistic Women and AFAB individuals
Autism is often framed as a deficit or something to be fixed. But some strengths may occur in autistic women and AFAB individuals, including:
Deep empathy and caring
Creativity and out-of-the-box thinking.
Relentless dedication to interests
Attention to detail and pattern recognition.
Recognizing these strengths helps shift narratives from deficit to difference.
Supporting Autistic Women and AFAB individuals
Supporting autistic women and AFAB individuals involves affirming and accepting differences, rather than aiming to fix them. Support should be affirming, individualized, and strengths-based.
Here are some neurodiversity-affirming strategies to support autistic women and AFAB individuals:
1. Build Affirming Environments
Affirming environments can be created by challenging language that pathologizes autism.
This includes language that sees autism as something to fix or autistic individuals as less than others. Instead, societal language needs to shift to viewing autism as a difference in neurology.
2. Reduce Masking Stress
Masking or hiding autistic traits can create burnout and stress. One way to reduce this is to create safe spaces that allow autistic women and AFAB individuals to unmask. You may also want to allow them downtime and validate their emotional and sensory needs.
3. Provide Sensory & Emotional Supports
When overwhelmed by the information coming over the senses, you can accommodate autistic individuals by using accommodations. These include noise-canceling headphones, weighted items, or gentle lighting. You may also want to consider educating communities (schools, families) about sensory overwhelm.
5. Validate Interests & Strengths
Neurodiversity is the concept that everyone has differences in the way their brain functions and is structured.
Celebrate neurodiversity by celebrating the deep interests that autistic women and AFAB individuals have. Create communities of shared interest for connection and growth.
Whether at home, school, or work, the goal should not be to “fix” autistic women and AFAB individuals but to create environments where they can thrive. This means shifting away from deficit-based thinking and toward a neurodiversity-affirming perspective.
At Home
Validate sensory needs (e.g., quiet spaces, weighted blankets, noise-canceling headphones).
Encourage and celebrate special interests rather than discouraging them.
Respect routines and transitions by providing advance notice of changes.
Openly discuss masking and create safe spaces where masking isn’t needed.
At School
Provide sensory-friendly classrooms (soft lighting, quiet corners).
Train teachers on how autism presents in girls and AFAB individuals, moving beyond cisgender male stereotypes.
Offer alternative assessments or flexible participation in group work.
Implement peer awareness programs to reduce bullying.
In Healthcare
Screen for autism with tools adapted for female presentations.
Avoid dismissing symptoms as “just anxiety” or “shyness.”
Provide mental health support that acknowledges the role of masking and identity struggles.
Related: Neurodiversity-Affirming Therapy and Coaching: A Guide to Inclusive, Strengths-Based Support
In the Workplace
Encourage neurodiversity-affirming practices (flexible hours, remote options, quiet spaces).
Provide clear expectations and written instructions.
Value focus, creativity, and detail-oriented strengths are often seen in autistic employees.
Autism Across Identities: Intersectionality Matters
Intersectionality refers to how identities interact with systems of oppression to create unique experiences of discrimination and privilege. Some ways that intersectionality shows up include:
Autistic women of colour often face both ableism and racism.
Autistic LGBTQ+ individuals (neuroqueer individuals), especially those identifying as trans or nonbinary, often face higher rates of marginalization.
Those with additional vulnerabilities (e.g., low income, rural location) may lack access to assessment and support.
Understanding intersectionality when providing support is key to ensuring that support is truly diverse, equitable, inclusive, and accessible.
Diagnosis: When and How to Seek Help
Considering whether to consider an autism diagnosis or not is a deeply personal decision. Access to clinicians who understand female presentations varies. Many women and AFAB individuals seek validation later in life, often after a child’s diagnosis prompts their evaluation.
It may involve a host of feelings, from grief to excitement. You may also run a cost-benefit analysis to determine if a formal assessment is required.
But here are some signs it may be time for a formal assessment:
You consistently feel exhausted from masking.
You mistake anxiety or perfectionism for personal failure.
What to expect:
Diagnosis often involves clinical observation, developmental history, and validated tools.
Book a Free Consultation With Blue Sky Learning
If you or someone you love can relate to these experiences and would like an autism diagnosis, consider connecting with our partner organization, Fusion Psychological Services, for an autism assessment.
Blue Sky Learning can also support you with a neurodiversity-affirming therapist or coach who can help you navigate this journey to receiving an autism diagnosis with empathy, expertise, and empowerment.
Book a free 20-minute consultation by emailing hello@blueskylearning.ca or booking through the website link below.
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