A Space for Autistic Women

Hosted by Julie | Learning Together Tutoring, LLC

Are you an adult woman who believes you may be autistic—or were diagnosed later in life?

You are not alone!

We are starting a **free, non-profit** weekly support group for neurodivergent women like us.

The goal is simple:

…to create a safe, affirming space where we can talk, share experiences, build connections, and finally feel *seen*.

If you’ve spent years masking, adjusting yourself to fit in, and wondering why you still feel like you don’t belong—this group is for you.

Together, we’ll explore what it means to thrive as our authentic selves.

What to expect:

- A welcoming, judgment-free space - Opportunities to meet virtually, in person, or a mix of both

- Optional social outings based on shared interests (I’m a birdwatcher and love nature walks! - Please tell us what you like to do!)

- Gentle conversation, mutual support, and a whole lot of “OMG, me too!” moments.

This is not therapy—it’s community. It’s connection. It’s a chance to be with others who truly understand. Whether you’ve struggled to make friends or lost connections without knowing why, we’re here to support each other.

**There’s NO cost to join.**

This group is part of our non-profit outreach to uplift and empower neurodivergent women.

Interested in joining or learning more?

Reach out to Julie—She wants to hear from you.

443-977-2167

(text or call).

To learn a little bit about what the research tells us, consider reading below.

Please feel free to add to the discussion or ask questions!

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 Slipping Through the Diagnostic Cracks:

The Impact of Gender Bias on Autistic Girls and Women

Julie P. Hipp

School of Social and Behavioral Sciences, Capella University

PSY 7015: Foundations of Doctoral Studies in Applied Psychology

Jay Dill

November 2, 2025

Abstract

Autism Spectrum Disorder (ASD) has historically been defined through male-centric diagnostic frameworks, resulting in widespread underdiagnosis and misdiagnosis of autistic girls and women. This mini literature review synthesizes recent peer-reviewed research to examine how gender bias in diagnostic criteria influences diagnostic timing, access to early intervention and educational services, and long-term mental health outcomes. Five thematic areas emerge: historical bias in diagnostic frameworks, masking and camouflaging behaviors, mental health consequences of delayed diagnosis, intersectionality and systemic barriers, and the role of participatory research in promoting inclusive methodologies. Studies such as those by Lockwood Estrin et al. (2021), Rippon (2024), and Song et al. (2025) reveal that autistic girls often present with internalized symptoms and socially normative behaviors—such as masking and mimicry—that obscure clinical recognition and delay support. Additionally, intersectional factors including race, culture, and neurodivergence further complicate access to diagnosis and care. Despite growing awareness, significant gaps remain in longitudinal research, culturally responsive screening tools, and gender-sensitive practices. This review underscores the urgent need for diagnostic reform and equity-driven approaches in developmental psychology to ensure autistic girls and women receive timely, affirming care—reducing the long-term mental health impacts of going undiagnosed.

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Autism Spectrum Disorder (ASD) has long been studied through a predominantly male lens, resulting in diagnostic tools, criteria, and clinical expectations that often fail to capture the lived experiences of autistic girls and women (Lockwood Estrin et al., 2021; Rippon, 2024). These androcentric frameworks emphasize overt social difficulties, restricted interests, and stereotyped behaviors—traits more commonly observed in boys—while overlooking the more internalized and socially masked presentations often seen in girls (Bourson & Prevost, 2024). As a result, autistic girls and women are consistently underdiagnosed or misdiagnosed, leading to limited access to early intervention, individualized education plans (IEPs), and appropriate accommodations throughout development (Gellert et al., 2025; Hamdani et al., 2023).

Recent studies also highlight how intersectional factors—such as race, culture, and neurodivergence—compound gender bias and further obscure diagnostic visibility (Cridland et al., 2020; Piantedosi et al., 2025). Autistic girls from culturally and linguistically diverse backgrounds, for example, may be misinterpreted through a Western lens or dismissed due to systemic inequities in healthcare access. These disparities underscore the need for diagnostic frameworks that are not only gender-informed but also culturally responsive and inclusive.

This literature review explores how gender bias in diagnostic frameworks (independent variable) influences diagnostic timing, access to early intervention and educational services, and long-term mental health outcomes (dependent variables) for autistic girls and women. It synthesizes recent research to examine how masking behaviors, systemic bias, and intersectional identities contribute to diagnostic disparities. By identifying gaps in current understanding, this review aims to support more inclusive diagnostic practices and promote equity in developmental psychology and clinical care.

Five Thematic Areas

To structure this review and facilitate thematic synthesis, this paper is organized around five core areas that emerged from the literature. These themes reflect recurring patterns and conceptual frameworks across recent peer-reviewed studies. They are presented in the following order: (1) gendered diagnostic frameworks and historical bias, (2) masking and camouflaging in autistic females, (3) mental health consequences of delayed diagnosis, (4) intersectionality and marginalized identities, and (5) participatory research and inclusive methodologies. Each theme is examined in relation to its impact on diagnostic timing, access to services, and long-term outcomes for autistic girls and women.

Theme 1: Gendered Diagnostic Frameworks and Historical Bias

Historically, autism research has centered on male participants, resulting in diagnostic criteria that reflect male-typical traits such as externalized behaviors, restricted interests, and overt social difficulties (Lockwood Estrin et al., 2021). These criteria were developed based on predominantly male samples, leading to a diagnostic prototype that fails to account for the more internalized and socially nuanced presentations often observed in girls and women. Lockwood Estrin et al. (2021) argue that this foundational bias has shaped clinical expectations and contributed to widespread underdiagnosis among females.

Girls frequently present with traits such as anxiety, social mimicry, and masking—strategies that allow them to blend into neurotypical environments but also obscure their autistic identity (Rippon, 2024; Song et al., 2025). Rippon (2024) emphasizes that these behaviors are often misinterpreted as signs of emotional sensitivity or social competence, rather than indicators of neurodivergence. Song et al. (2025) found that autistic women report high levels of masking and low levels of social inclusion, suggesting that their internalized distress is frequently overlooked in clinical settings. Bourson and Prevost (2024) further highlight how gendered expectations around behavior and communication contribute to diagnostic invisibility, reinforcing the myth that autism is predominantly male.

Real-world examples of these diagnostic delays are illustrated in case studies that examine how gender-specific norms and masking behaviors obscure clinical identification of ASD in girls. These cases often involve misdiagnosis with anxiety, depression, or borderline personality disorder, or no diagnosis at all; despite clear signs of autistic traits (Blancher & Yetman, 2025). Such findings provide compelling evidence that the exclusion of girl-specific autism traits from diagnostic frameworks has significantly contributed to the under-recognition of autistic girls and women.

Together, these sources underscore the need to revise diagnostic criteria and clinical training to reflect the full spectrum of autistic experiences across genders. Addressing historical bias is essential for improving diagnostic equity and ensuring that autistic girls and women receive timely, appropriate support.

Theme 2: Masking and Camouflaging in Autistic Females

Autistic girls and women frequently engage in masking—suppressing or hiding autistic traits to fit social norms and avoid stigma (Hull et al., 2020). Hull et al. (2020), using self-report measures and qualitative interviews, found that camouflaging behaviors are significantly more prevalent among females and are associated with increased psychological distress, including anxiety, depression, and identity confusion. Participants described masking as a daily necessity, often involving rehearsed social scripts, forced eye contact, and mimicking neurotypical behaviors to avoid rejection. While these strategies may help individuals navigate social environments, they also obscure diagnostic visibility and contribute to emotional exhaustion and burnout (Hull et al., 2020; Rippon, 2024; Song et al., 2025).

Rippon (2024) emphasizes that masking is not merely a social adaptation but a survival strategy—one often misinterpreted by clinicians as evidence of neurotypical functioning. This misinterpretation delays recognition and support, particularly for girls and women whose internalized distress is overlooked in favor of externalized traits more commonly associated with autism in boys. Song et al. (2025) corroborate this, showing that autistic women report high levels of masking in social contexts and low levels of perceived inclusion. Their ecological momentary assessment data reveal that masking intensifies in the presence of non-autistic individuals and is directly linked to increased stress and reduced well-being.

Cho et al. (2023) further support this by demonstrating that autistic girls often use more neurotypical conversational rhythms than boys, including smoother turn-taking and more socially expected intonation patterns. These subtle differences in social communication can lead clinicians to overlook core autistic traits, reinforcing the diagnostic gap. Cho et al. (2023) argue that current diagnostic tools may not be sensitive enough to detect these nuanced presentations, especially in girls who have learned to camouflage from an early age.

Together, these findings illustrate how masking and camouflaging contribute to diagnostic invisibility and long-term mental health challenges for autistic girls and women. They underscore the need for gender-informed diagnostic criteria and clinician training that recognizes the complexity of internalized autistic experiences.

Theme 3: Mental Health Consequences of Diagnostic Delay

Delayed diagnosis in autistic girls and women can have profound mental health consequences. Lai et al. (2019), in a meta-analysis of co-occurring psychiatric conditions, found that autistic individuals—particularly women—experience significantly elevated rates of anxiety, depression, and suicidality. These outcomes are often exacerbated by years of misunderstanding, misdiagnosis, and lack of appropriate support. The authors note that nearly 70% of autistic individuals have at least one co-occurring mental health condition, with gender and age contributing to diagnostic disparities and heterogeneity in symptom presentation (Lai et al., 2019).

Song et al. (2025) provide ecological momentary assessment data showing that autistic women report lower levels of social inclusion and higher levels of masking—defined as the suppression of autistic traits to conform to neurotypical expectations. Their findings reveal that masking intensifies in the presence of non-autistic individuals and is directly associated with increased stress and emotional exhaustion. Participants described feeling unable to “be themselves” in most social contexts, suggesting that chronic masking contributes to long-term psychosocial strain and diminished well-being (Song et al., 2025).

Although the core sources reviewed do not provide detailed prevalence statistics on sexual victimization, emerging peer-reviewed research highlights the severity of this issue. Dike et al. (2022) conducted a systematic review of sexual violence among autistic individuals, revealing that autistic girls and women face significantly elevated risks compared to their non-autistic peers. The review identified unique autism-related vulnerabilities—including social-communication challenges, impaired risk perception, and masking behaviors—that contribute to under-recognition of distress and limited access to trauma-informed care. These findings reinforce the need for gender-sensitive, neurodivergent-affirming support systems that address both diagnostic exclusion and long-term psychosocial harm.

Douglas and Sedgewick (2024) emphasize that autistic individuals often experience repeated interpersonal victimization, with unique autism-related vulnerabilities such as difficulty recognizing abusive dynamics and limited access to tailored relationship education. Their qualitative interviews reveal that many participants struggled to identify abuse due to prior experiences of being misunderstood or dismissed, reinforcing the need for gender-sensitive, neurodivergent-affirming support systems.

Together, these findings underscore that diagnostic exclusion is not merely a clinical oversight—it is a catalyst for lifelong mental health challenges. The cumulative effects of masking, social isolation, and trauma demand urgent reform in diagnostic practices and mental health care, particularly for autistic girls and women whose needs have long been overlooked.

Theme 4: Intersectionality and Marginalized Identities

Gender bias in autism diagnosis is further complicated by race, socioeconomic status, and neurodivergent intersections (Cridland et al., 2020; Piantedosi et al., 2025). Cridland et al. (2020) emphasize that autistic women from culturally and linguistically diverse (CALD) backgrounds face compounded barriers to diagnosis and care. These include limited access to culturally competent clinicians, misinterpretation of behaviors through a Western lens, and systemic dismissal of parental concerns (Cridland et al., 2020). The authors highlight how intersecting identities can obscure autistic traits and delay recognition, particularly when cultural norms around communication and gender roles differ from dominant diagnostic expectations (Cridland et al., 2020).

Piantedosi et al. (2025) critique existing policy frameworks for their lack of gender and intersectional sensitivity. They argue that diagnostic tools and service models are often grounded in male-centric norms, which fail to capture the nuanced presentations of autism in girls and women (Piantedosi et al., 2025). This structural oversight contributes to diagnostic invisibility, especially for individuals whose traits do not align with stereotypical, externalizing behaviors (Piantedosi et al., 2025).

Cultural expectations around gender and behavior may also mask autistic traits, making culturally responsive assessment practices essential (Rippon, 2024; Lockwood Estrin et al., 2021). Rippon (2024) discusses how girls are often socialized to suppress behaviors like stimming or to mimic neurotypical peers, leading clinicians to overlook signs of autism. Lockwood Estrin et al. (2021) call for more inclusive diagnostic criteria that account for female-specific presentations, such as masking, social exhaustion, and internalized distress. Song et al. (2025) found that autistic women report high levels of masking and low social inclusion, reinforcing the long-term psychosocial impacts of under-recognition (Song et al., 2025).

Together, these findings underscore the need for diagnostic frameworks that are not only gender-informed but also responsive to the lived experiences of autistic girls and women across racially, culturally, and neurodivergently marginalized communities (Cridland et al., 2020; Piantedosi et al., 2025; Rippon, 2024; Lockwood Estrin et al., 2021; Song et al., 2025).

Theme 5: Participatory Research and Inclusive Methodologies

Recent scholarship increasingly advocates for participatory research models that center autistic voices—particularly those of women and gender-diverse individuals who have historically been excluded from autism research (Botha et al., 2023). Botha et al. (2023) argue that traditional autism research has often been conducted on autistic people rather than with them, reinforcing systemic bias and epistemic exclusion. This exclusion has contributed to diagnostic frameworks that fail to reflect the diversity of autistic presentations, particularly among those who mask, internalize distress, or do not conform to male-centric behavioral norms (Botha et al., 2023).

Participatory methodologies challenge these limitations by involving autistic individuals as co-researchers, advisors, and decision-makers throughout the research process. For example, Botha et al. (2023) describe a co-produced study in which autistic collaborators helped formulate research questions, interpret qualitative data, and revise terminology to reflect affirming, identity-first language. These inclusive practices not only improve diagnostic accuracy by capturing under-recognized traits and lived experiences, but also promote ethical research grounded in respect, reciprocity, and neurodivergent insight (Botha et al., 2023).

Importantly, these approaches emphasize the need for diagnostic reform that enables access to appropriate services. By centering autistic voices—especially from those marginalized by gender, culture, or communication style—participatory research helps identify gaps in current systems and co-create solutions that are both responsive and just. Botha et al. (2023) argue that this shift from extractive to collaborative research is essential for dismantling ableist assumptions and advancing equity in diagnosis, care, and representation.

Synthesis of Findings

Across the reviewed literature, a consistent pattern emerges: gender bias in diagnostic criteria leads to under-recognition of autistic girls and women, delayed access to services, and increased mental health risks. Lockwood Estrin et al. (2021) and Bourson and Prevost (2024) highlight how historical reliance on male-centric diagnostic frameworks has shaped clinical expectations, privileging externalized traits while overlooking internalized distress and masking behaviors. Studies by Hull et al. (2020), Rippon (2024), and Song et al. (2025) emphasize that autistic girls often camouflage their traits to meet social norms, which delays recognition and contributes to emotional exhaustion, identity confusion, and reduced access to support.

While some research explores biological differences in brain function and sensory processing (Zhang et al., 2025), the majority of recent studies center social and systemic factors—such as clinician bias, cultural misinterpretation, and policy-level exclusion—that perpetuate diagnostic disparities (Cridland et al., 2020; Piantedosi et al., 2025). Participatory models proposed by Botha et al. (2023) offer promising alternatives by centering autistic voices and co-producing research that reflects lived experience. Together, these findings underscore the urgent need for gender-sensitive diagnostic reform and inclusive methodologies that honor the diversity of autistic presentations across gender, culture, and neurodivergence.

Conclusion

The current literature reveals that gender bias in autism diagnosis has led to widespread under-recognition of autistic girls and women, limiting their access to early intervention, educational support, and mental health care. While recent studies have begun to address these disparities—through calls for inclusive diagnostic criteria (Lockwood Estrin et al., 2021), critiques of policy frameworks (Piantedosi et al., 2025), and participatory research models (Botha et al., 2023)—significant gaps remain. These include the lack of longitudinal studies tracking developmental trajectories, culturally responsive screening tools for diverse populations, and gender-sensitive practices that account for masking and internalized distress.

What remains unknown is how diagnostic reform might tangibly improve outcomes across diverse populations of autistic girls and women, especially those from marginalized communities. Future research must explore how inclusive screening tools and affirming practices can be implemented in clinical and educational settings, and how these changes might reduce long-term mental health risks associated with diagnostic delay. Studying this topic is essential not only for improving diagnostic equity but also for advancing ethical, evidence-based care that reflects the lived experiences of autistic individuals across gender identities, cultures, and neurodivergent profiles.

References

Blancher, A., & Yetman, M. (2025). Case studies on the evolution and challenges in ASD

diagnosis. Discover Psychology, 5(1), 25. https://doi.org/10.1007/s44202-025-00350-7

Botha, M., Dibb, B., & Frost, D. M. (2023). “Autism is me”: The harms of autism masking for

identity, mental health, and relationships. Autism in Adulthood, 5(1), 52–60. https://doi.org/10.1089/aut.2022.0031

Bourson, L., & Prevost, C. (2024). Characteristics of restricted interests in girls with ASD

compared to boys: A systematic review of the literature. European Child & Adolescent Psychiatry, 33(4), 987–1004. https://doi.org/10.1007/s00787-022-01998-5

Cazalis, F., Reyes, E., Leduc, S., & Gourion, D. (2022). Evidence that nine autistic women out of

ten have been victims of sexual violence. Frontiers in Behavioral Neuroscience, 16, Article 852203. https://doi.org/10.3389/fnbeh.2022.852203

Cho, S., Cola, M., Knox, A., Maggie, R. P., Russell, A., Hauptmann, A., Covello, M., Cieri, C.,

Liberman, M., Schultz, R. T., & Parish-Morris, J. (2023). Sex differences in the temporal dynamics of autistic children’s natural conversations. Molecular Autism, 14, Article 5. https://doi.org/10.1186/s13229-023-00545-6

Cridland, E. K., Jones, S. C., Caputi, P., & Magee, C. A. (2020). Being a girl in a boys’ world:

Investigating the experiences of girls with autism spectrum disorders during adolescence. Journal of Autism and Developmental Disorders, 50(6), 2164–2176. https://doi.org/10.1007/s10803-019-03924-1

Dike, J. E., DeLucia, E. A., Semones, O., Andrzejewski, T., & McDonnell, C. G. (2022). A

systematic review of sexual violence among autistic individuals. Review Journal of Autism and Developmental Disorders, 9(3), 310–328. https://doi.org/10.1007/s40489-022-00310-0

Douglas, S., & Sedgewick, F. (2024). Experiences of interpersonal victimization and abuse

among autistic people. Autism, 28(7), 1732–1745. https://doi.org/10.1177/13623613231205630

Gellert, B., Ostrowski, J., Pinkas, J., & Religioni, U. (2025). Underdiagnosed and

misunderstood: Clinical challenges and educational needs of healthcare professionals in identifying autism spectrum disorder in women. Behavioral Sciences, 15(8), Article 1073. https://doi.org/10.3390/bs15081073

Hamdani, Y., Kassee, C., Walker, M., Lunsky, Y., Gladstone, B., Sawyer, A., Ameis, S. H.,

Desarkar, P., Szatmari, P., & Lai, M.-C. (2023). Roadblocks and detours on pathways to a clinical diagnosis of autism for girls and women: A qualitative secondary analysis. Women’s Health, 19, Article 17455057231163761. https://doi.org/10.1177/17455057231163761

Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W.

(2020). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 50(7), 2209–2222. https://doi.org/10.1007/s10803-019-03925-0

Lai, M.-C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2019).

Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 58(7), 677–679. https://doi.org/10.1016/j.jaac.2019.03.019

Lockwood Estrin, G., Milner, V., Spain, D., Happé, F., & Colvert, E. (2021). Barriers to autism

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Piantedosi, I., Wolpe, S., Pearson, A., & Seers, K. (2025). “Creating a socially acceptable version

of myself”: A qualitative thematic analysis of the female and nonbinary experience of navigating the autism diagnostic system. Neurodiversity, 3, Article 112. https://doi.org/10.1177/27546330241306380

Rippon, G. (2024). Differently different?: A commentary on the emerging social cognitive

neuroscience of female autism. Biology of Sex Differences, 15, Article 6. https://doi.org/10.1186/s13293-024-00621-3

Song, W., Salzer, M. S., Steinberg, H. R., & Shea, L. L. (2025). Gender differences in self-

reported social participation in adults with autism. American Journal on Intellectual and Developmental Disabilities, 130(2), 81–87. https://doi.org/10.1352/1944-7558-130.2.81

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patterns in social visual attention among individuals with autistic traits. BMC Psychiatry, 25, Article 440. https://doi.org/10.1186/s12888-025-06896-z

Why we do what we do!

At Learning Together Tutoring, LLC, we serve children and families who often fall into the “in-between spaces”—those who are underserved or overlooked by traditional educational systems. Our approach is rooted in naturalistic and holistic, evidence-based practices, which research shows are especially effective when multiple sensory systems are engaged during joyful learning experiences (Dufek et al., 2024; Sandbank et al., 2023).

I founded Learning Together Tutoring, LLC as an autistic mother of both an autistic and a neurotypical child, a wife, a pet owner, a bird watcher, and a lifelong lover of animals and nature. Professionally, I am an early interventionist, licensed special educator, autism specialist, and doctoral researcher in developmental psychology, with a focus on cognitive and affective processes. My lived experience and academic training converge in this work, which is both personal and purposeful.

We live in a time where quantity is often prioritized over quality, and this imbalance is impacting children more than ever. Schools are overwhelmed with students needing IEPs, 504 plans, and accommodations. Teachers are not given the time or resources to remediate foundational skills from previous grades, and many students are pulled from core instruction to receive interventions that may not align with developmental needs (Blackwell & Rossetti, 2014; Yildirim, 2024).

Even more concerning, some students fly under the radar due to masking behaviors—strategies used to hide neurodivergent traits and “pass” as neurotypical. Gina Rippon (2019) describes masking as “a range of strategies employed to disguise autistic traits… training yourself to maintain eye contact, mimicking gestures and body language, even rehearsing elaborate social scripts.” Research confirms that masking is mentally exhausting and linked to increased anxiety, depression, and identity disruption (Cage & Troxell-Whitman, 2019; Hull et al., 2019).

This is why Learning Together Tutoring exists: to create a space where children are seen, supported, and celebrated. We tailor every session to the child’s needs, using ongoing data to adjust strategies. Our sessions may include:

🎨 Kinetic sand, chalk art, dry erase boards

🎶 Singing, rhyming, rapping, and storytelling

🕺 Movement-based learning and sensory breaks

💧 Hydration reminders and emotional regulation supports

👀 Visual aids and flexible seating options

We prioritize joy, creativity, and emotional safety—because every child deserves to learn in a way that honors their whole self.

-Julie Hipp, M.Ed.,

Founder, Learning Together Tutoring, LLC

References

Blackwell, W. H., & Rossetti, Z. S. (2014). The development of individualized education programs: Where have we been and where should we go now? SAGE Open, 4(2), 1–15. https://doi.org/10.1177/2158244014530411

Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49, 1899–1911. https://doi.org/10.1007/s10803-018-03878-x

Dufek, S., Vejnoska, S., & Schreibman, L. (2024). Naturalistic intervention. In Handbook of Early Intervention for Autism Spectrum Disorders (pp. 255–271). Springer. https://doi.org/10.1007/978-3-031-64499-3_14

Hull, L., Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Camouflaging Autistic Traits Questionnaire (CAT-Q). PsycTESTS. https://doi.org/10.1037/t72246-000

Rippon, G. (2019). The gendered brain: The new neuroscience that shatters the myth of the female brain. Bodley Head.

Sandbank, M., Bottema-Beutel, K., Crowley, S., & Woynaroski, T. (2023). Naturalistic developmental behavioral interventions: A systematic review of effectiveness. Journal of Early Intervention, 46(2), 135–137. https://doi.org/10.1177/10538151241242337

Yildirim, Y. (2024). Engaging families in the education of children with special needs: Challenges and strategic recommendations. Early Childhood Education Journal. Advance online publication. https://doi.org/10.1007/s10643-024-01835-1