Autism in Teenage Girls: What the Latest Evidence Really Shows

Autism spectrum disorder (ASD) has long been researched and diagnosed through a male-centered lens.

For decades, research studies have consistently enrolled small samples of women, or excluded women altogether, and thus - the stereotype of autism has been a young boy with social challenges, repetitive interests, and clear developmental delays. In fact, so much so that men are four times more likely to be diagnosed with autism than women.

As such, growing evidence shows that this framework has left a large population overlooked: teenage girls.

Why Teenage Girls Are Often Missed

Gendered Diagnostic Criteria

Most diagnostic tools were developed and validated on boys. As a result, the behavioural “checklist” for autism often fails to capture how symptoms present in girls. A lot of this comes down to the fact women are 2.5 times more likely than men to be excluded from research participation, even with a diagnosis confirmed.

Masking and Camouflaging

Research from the past decade highlights how autistic girls often “mask” their traits to blend in. This can include rehearsing social scripts, mimicking peers, or suppressing stimming behaviours (repetitive movements like hand-flapping).

A 2024 study led by psychologist Laura McKinney at the University of Birmingham found that autistic girls aged 11 to 14 were already masking far more than their neurotypical peers. While these strategies can help them navigate adolescence, they come at a cost: exhaustion, anxiety, and identity confusion.

Studies have found this camouflaging is one reason why girls are frequently diagnosed later than boys - sometimes not until adolescence or adulthood. Research has also found that camouflaging can carry grave mental health implications.

Autistic people face elevated risk of suicidal thoughts and behaviours; evidence about whether females are at higher risk than males is mixed, but camouflaging itself shows consistent associations with suicidality in autistic samples.

Misdiagnosis and Comorbidity

Misdiagnosis is another barrier. A 2022 population study by Martini and colleagues showed that girls were more likely than boys to receive psychiatric labels - anxiety, depression, borderline personality disorder, eating disorders - before anyone considered autism. In some cases, those labels stuck for years.

Research in 2025 found that in total, 54.2% of autistic females and 40.9% of autistic males received at least one preceding psychiatric diagnosis (most common being ADHD, anxiety, and depression) before being diagnosed with autism. Autistic females also showed higher odds than males for most preceding psychiatric diagnoses.

Durham University found this number can be as high as 80% of autistic women being misdiagnosed.

A study based on self-report found that autistic women were significantly more likely than autistic men to report having received one or more misdiagnoses prior to being correctly diagnosed with autism - 31.7% for women vs. 16.7% for men.

Even when professionals look, they may be thrown off by differences in presentation. As Vanderbilt researcher Jessica Rea has shown, autistic girls on gold-standard diagnostic tests often appear “more typical” than boys - smiling more, using facial expressions, or maintaining eye contact.

And while boys may focus obsessively on trains or maps, girls’ intense interests - celebrities, animals, fashion - are often dismissed as “normal teenage obsessions,” even if they dominate hours of thought and conversation.

What signs should we be looking out for?

Social Communication & Interaction

• Masking (camouflaging): Girls often hide their difficulties by copying peers’ gestures, speech, or fashion. They may come across as “social” in structured settings but feel exhausted afterward.

• Rehearsed social scripts: Conversations may sound memorised or overly formal.

• Struggles with peer dynamics: Difficulty navigating cliques, sarcasm, gossip, or “unspoken rules” of teenage friendships.

• One close friend but trouble in groups: Many autistic girls manage dyadic friendships but feel overwhelmed in larger groups.

• Loneliness despite effort: They may join in activities but still feel disconnected or excluded.
  

Restricted or Intense Interests

• Focussed but “socially acceptable” obsessions: Instead of trains or numbers, interests might centre on animals, celebrities, literature, social causes, or fashion - pursued with unusual intensity.

• Deep dives into topics: Hours researching, collecting, or writing about their passion, sometimes at the expense of schoolwork or sleep.

• Rigidity around interests: Distress when routines or interests are interrupted.
  

Repetitive Behaviours & Sensory Differences

• Subtler stimming: Instead of hand-flapping or spinning, girls may doodle, tap pens, twirl hair, or pick at skin - often dismissed as “quirks.”

• Sensory sensitivities: Strong reactions to sounds, textures, lights, or smells (e.g., clothing tags, cafeteria noise, perfume).

• Food selectivity: Limited diet due to textures, smells, or appearance, sometimes overlapping with ARFID (Avoidant/Restrictive Food Intake Disorder).
  

Emotional & Mental Health

• Internalising symptoms: High rates of anxiety and depression; these can overshadow autism.

• Perfectionism: Striving to “get it right” socially or academically, often linked to burnout.

• Emotional meltdowns in private: Appearing calm at school but releasing pent-up stress at home.

• High risk for eating disorders: Particularly anorexia or restrictive eating linked to rigidity and sensory issues.
  

Puberty & Identity

• Exacerbation of symptoms: Hormonal changes can heighten sensory sensitivities and mood swings.

• Struggles with menstruation: Dysmenorrhea (painful periods) and sensory discomfort from pads/tampons can be especially challenging.

• Higher rates of gender questioning/diverse identities: Multiple studies show autistic teens (especially girls) are more likely to identify as LGBTQ+ or gender-diverse.

Menstruation

There is some evidence to suggest Autistic people experience menstruation differently to non-Autistic people. A 2025 systematic review by Rachel Ellis and colleagues synthesised qualitative studies and found consistent reports of heightened sensory sensitivities, burnout, and anxiety during menstruation.

Participants in the studies described increased sensory overwhelm from smells, sounds, and touch, as well as difficulty coping with period products like pads or tampons, which could feel intolerably uncomfortable. These sensory experiences often compounded with emotional dysregulation, leading to spikes in anxiety and feelings of exhaustion that could disrupt school attendance and social participation.

One striking theme from the review was the disconnect between what autistic individuals felt they needed and what adults around them focused on.

Autistic girls emphasised the importance of knowledge, preparation, and understanding - wanting clear information about what to expect, reassurance that their experiences were valid, and strategies to cope with discomfort. Parents and professionals, however, tended to focus narrowly on external markers of competence: managing hygiene independently, using products correctly, and maintaining privacy.

This mismatch often left autistic girls and young people unsupported in the areas that mattered most to them, while reinforcing feelings of isolation. As Ellis and colleagues argue, effective support must go beyond teaching hygiene - it must acknowledge the sensory and emotional impact of menstruation and provide autistic-friendly strategies for coping.

Toward recognition and support

The message from researchers is clear: autism in girls looks different, and our systems need to catch up.

That means updating diagnostic tools to reflect female presentations, training educators to recognise subtler signs, and considering autism as a possible explanation when teenage girls present with anxiety, depression, or eating disorders.

It also means reframing strengths. Many autistic girls demonstrate deep creativity, empathy, and focus. When recognised and supported early, these traits can become the foundation for thriving in adolescence and beyond.