Autism has historically been treated as a childhood disorder, however in recent years the condition has become better understood in adults, and more specifically in women. Research from 2022 suggests around 80% of autistic women remain undiagnosed by age 18, meaning there could be many adult women struggling with autism symptoms and lacking the support they need. 

Here, we are exploring why it can be difficult to identify autism in adult women, why so many women go undiagnosed, the subtle signs of autism to look for in adult women, how the condition manifests differently in women than in men, how to get a diagnosis as an adult, and where to get more help and support. At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about autism, we can help. 

What is autism? 

Autism is a neurodevelopmental condition that affects how a person interacts with other people, and how they understand and respond to sensory information. Autistic people may experience sensory issues that lead to a negative reaction to specific triggers that are personal to them. This can result in difficulties with social communication and interaction, repetitive or restricted behaviours or interests, different ways of learning or paying attention, and more. 

Some common symptoms of autism in adults include: 

• Difficulty reading social cues
• Difficulty participating in conversations with others 
• Difficulty relating to others’ thoughts and feelings 
• Difficulty regulating emotions 
• Difficulty building and maintaining relationships 
• Difficulty reading body language and facial expressions of others 
• Using a monotone speaking pattern, which makes it difficult to convey emotions
• Difficulty maintaining eye contact in conversations
• Restrictive or repetitive behaviours  
• Difficulty with last-minute changes to plans or routines
• Fixation on a favourite subject they care a lot about or are particularly skilled in 
• Sensitivity to sensory input like pain, touch or sound

Every autistic person experiences unique traits and symptoms that are individual to them, so it is important to remember that one person’s autism diagnosis can look very different on the outside – and feel very different on the inside – to another. For this reason, we believe that support for each person should be bespoke. 

You can read more about autism in our guide: What is autism?

Why can autism be difficult to identify in adult women? 

Just as autism tends to manifest differently among individuals, it can also show up differently in women than it does in men, making it more difficult to recognise and diagnose.

Research shows autistic women tend to be diagnosed later than men, with one study finding 75.4% of autistic women received a diagnosis on average 8 years after their initial evaluation from mental health services. This could be the case for several possible reasons, including: 

Autistic women are often high functioning

Studies have suggested that autistic women with intelligence levels that match neurotypical individuals could be labelled as high functioning, which could lead to missed diagnoses or the belief that they do not need as much support as others.

Women are more likely to engage in masking behaviours

Masking is sometimes known as ‘camouflaging’, and is common for autistic women. Masking – whether done consciously or unconsciously – is a way for autistic people to hide their symptoms in an effort to blend in with their neurotypical peers and those around them. 

Studies suggest autistic women more commonly engage in masking behaviour than autistic men, and this might look like preparing phrases in advance of a conversation, consciously holding uncomfortable eye contact during interactions, or imitating the social behaviours of neurotypical people. Masking can give the illusion that autistic women are coping with social situations better than autistic men by hiding how they are really feeling. 

Women could experience less obvious autism symptoms than men 

One of the most significant reasons for autistic women often being misdiagnosed or their autism being missed altogether is their differing symptoms, which tend to mirror neurotypical individuals more closely than autism symptoms in men. 

Women may experience fewer social impairments, fewer communication issues, more social motivation to seek friendships, and more motivation to ‘fit in’ with their peers. Women are also more inclined to experience internal symptoms (such as anxiety, depression or shyness) as opposed to the external symptoms experienced by men (such as difficulties being still or aggression). 

“I had been suspicious of it for a while. I always kind of had trouble socially, not recognising social cues, not picking up on things the same way other people did. But I just made excuses for it.”
– Holly Madison (TV Personality) via The Independent 

What more subtle signs of autism might women show? 

As mentioned, women may present with less noticeable symptoms of autism than men, and these might include signs such as: 

• Repetitive behaviours, or personalised rituals and routines 
• Restricted interests 
• Talking excessively about their interests 
• Masking behaviours and displaying more coping mechanisms than autistic men 
• Trouble with social cues, and unintentionally coming across as rude or uninterested
• Difficulty with self-regulation, executive function, and organisation 
• Meticulously planning things in advance, and becoming agitated when plans change 
• Difficulties in the workplace, such as having less ability to adapt to change (studies suggest that while autistic women and autistic men may obtain employment at a similar rate, women may be less likely to retain their position)

How might autism manifest differently in women than in men? 

Many studies have suggested different ratios of autism diagnoses in women and men, with one study finding this could be as high as 4-5 autistic men for every autistic woman. Throughout history, a lot of the studies on autism excluded women, focusing instead on typical male autistic traits, which means there is now an imbalance in the data on how the condition affects women. This could mean relevant treatment options for women are not as extensive as they could be with more research in this area. 

That said, there are a few known ways that autism can lead to different outcomes for women, and understanding what these are and what they might look like can help you to identify whether or not you (or a loved one) could be autistic. 

One notable difference is that studies have found autistic women tend to experience more mental health challenges than men due to the aforementioned efforts to mask their symptoms and fit in with those around them. Research shows that masking behaviours are associated with feelings of distress such as depression and anxiety, and autistic women who report above-average levels of masking have also been associated with more thoughts of suicide and further struggles to function in daily life. These additional mental health challenges could negatively impact their diagnosis. 

Autistic women are more likely to have a co-occurring condition than autistic men, and this is even more likely when they are diagnosed later in life due to a lack of support and treatment in their younger years. Autistic women may be more likely to have conditions such as:

• Anxiety or depression – There appear to be higher rates of anxiety in autistic women, and studies have found those with more autistic traits tend to experience increased suicidal tendencies. 
• Attention deficit hyperactivity disorder (ADHD) – Autism and ADHD are thought to commonly co-occur, with an estimated 50-70% of autistic individuals also presenting with ADHD. You can find more information on a dual ADHD and autism diagnosis in our guide AuDHD: Dual Diagnosis of Autism & ADHD, and if you think this sounds like you then consider a specialist AuDHD assessment to help with diagnosis.
• Eating disorders – Research suggests 4-23% of people with an eating disorder are also autistic. This comorbidity can occur for a number of reasons – such as becoming obsessed with counting calories, or developing strict eating routines – but autistic individuals may also experience something called Avoidant/Restrictive Food Intake Disorder (ARFID) due to sensory issues with food. You can read more about this in our guide to the telationship between ARFID & autism.
• Obsessive compulsive disorder (OCD) – Studies have suggested a high comorbidity between OCD and autism, possibly due to a shared familial risk. You may find more useful information on this topic in our guide to the differences and similarities between OCD vs autism.
• Sleep disorders – Sleep disorders are common in autistic individuals and can lead to negative impacts on daily life, social interactions and academic achievements. 
• Borderline personality disorder (BPD) – According to studies, autistic women may also be more likely to have co-occurring borderline personality disorder (BPD), with studies suggesting BPD may be the most common misdiagnosis for autistic women, occurring in 36.4% of cases. You can find further information on this comorbidity in our guide to the essentials of BPD and autism.

In addition, studies have found autistic women have higher rates of physical health challenges than non-autistic women and autistic men. One study on autistic women aged 25 to 34 years old found they were more likely to have “poor general health”, and also cited things like allergy or immunologic conditions, infections, musculoskeletal conditions and neurologic conditions. 

It is important for both medical professionals and individuals to recognise how autism might manifest differently in women than in men in order to reach a correct diagnosis and offer appropriate support. 

How can an adult woman get an autism diagnosis? 

Obtaining an adult autism diagnosis could be significantly more difficult through the NHS due to an increase in those with suspected autism seeking a diagnosis in recent years. However, this is certainly not impossible, and is worth speaking to your healthcare professional about. The benefits of women learning more about their autism and getting a professional diagnosis cannot be overstated, with research finding that autistic women mentioned struggles with misdiagnosis, reaching an autism diagnosis, challenges with employment, social connections, and more. 

Studies have found that many autistic women do not get an accurate or timely diagnosis, but when they finally do, they report feeling a stronger sense of identity, and more confidence in speaking up about what they need. Further studies suggested that post-diagnosis, autistic women mentioned feeling more able to be themselves, and provided key insight into their behaviours, allowing them to better navigate criticism from wider society, as well as enabling a transition from feeling self-critical to self-compassionate.

Where can women get more support for suspected autism? 

If you think you may have autism, it can be difficult to know where to turn for help and support in better understanding your condition and seeking a diagnosis. It may help to start by opening up to someone you trust about the symptoms you believe may be related to autism, any internal symptoms you are experiencing that may not show to others, and the emotions you are feeling – this may help them understand why you are seeking support for this as an adult. 

You may also wish to speak to your GP to see what help and advice they can offer you. Many people find that wait times are particularly long for autism diagnoses and support through the NHS, and may choose to seek help elsewhere to speed up the process. 

Different types of adult autism assessments (such as the RAADS-R test) are available through private autism specialists and organisations like Augmentive. We believe advice and support for those with autism should be tailored to the individual and their symptoms, as well as taking into account the nuanced nature of diagnosing autism in women and offering bespoke support applicable to their specific symptoms. 

Augmentive can help to match you with a relevant therapist who specialises in diagnosing and supporting autistic women, so reach out to discuss your current challenges, the symptoms you have noticed, and the support that can be offered to you. You may also find our guide on what to expect from an adult autism assessment to be helpful reading.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from a private adult autism assessment or AuDHD assessment, to help finding an autism specialist near you to support you on your journey.

If you have a question about mental health, like how to handle the challenge of autism and heat intolerance, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.