“It’s really in the last decade or so that we have been trying to get better at looking at some of the differences between girls and boys in terms of their presentation,” Yanan Guo said.

She is a licensed clinical psychologist at the Developmental Evaluation Clinic with Rady Children’s Hospital and board-certified behavior analyst who specialized in autism spectrum disorder before starting her doctorate.

One way autism can differ between genders is that autistic girls can sometimes present as being more social. They also might be quiet and less disruptive, meaning they might not be perceived as needing additional services, said Doris Trauner, Department of Neurosciences professor emerita at UC San Diego School of Medicine.

There are also cultural biases at play.

“If a 3- or 4-year-old girl doesn’t want to talk to anybody else, kind of hides behind her mother or wants to look at books instead of talking to people, they are described as shy,” Trauner said. “If a boy wants to do that, that’s sometimes deemed to be more concerning because boys are supposed to be running around and playing with other kids.”

Girls and women with autism are more likely to employ camouflaging strategies, masking their symptoms by imitating neurotypical social behaviors. This adaptive technique allows them to blend in with their peers, often leading to difficulties in receiving an accurate or early diagnosis.

“Even though they do these things, they’re not necessarily understanding the nuance of the more subtle things that are included in these social relationships,” Guo said.

This coping mechanism, aimed at fitting in, can also lead to increased mental health challenges for autistic girls and women.

“It’s very stressful for somebody to do that because they’re not being themselves, and so that may actually end up resulting in more behavior problems because of the stress and anxiety,” Trauner said.

Camouflaging can also lead to someone being misdiagnosed. Some common diagnoses girls and women with autism receive include borderline personality disorder, eating disorders, Tourette syndrome, bipolar disorder, social anxiety disorder or generalized anxiety disorder, the Autistic Women & Nonbinary Network reports.

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