“The outsider.” “Faking normalcy.” “Observing from afar.”
These phrases encapsulate the experiences of autistic women, as shared in potent personal accounts detailing their lives prior to diagnosis. Their profound social discomfort highlighted their intense efforts to conceal any outward signs of their condition.
The Overlooked Reality of Autism in Females
From a young age, these women recount struggling to forge an identity that fostered acceptance and inclusion, instead of facing isolation and exclusion. They consciously camouflage, or adopt “masks,” to conceal their autistic traits. This strategy of masking or camouflaging is increasingly recognized as a defining characteristic of many autistic women who have historically been absent from the broader understanding of autism.
This tactic is not only draining and taxing but can also significantly undermine their sense of self and identity.
Historical Bias in Autism Diagnosis
As previously explored in this series, conventional clinical perspectives have long propagated the notion that autism predominantly affects males. This viewpoint was often reinforced by statistics indicating a fourfold higher diagnosis rate in boys compared to girls, relying on assessment methods largely shaped by a male-centric understanding of autism.
This ingrained bias has negatively impacted autistic females. Girls on the spectrum often experience a “double bind,” facing dismissal of their autistic identity due to their gender, compounded by rigid societal norms dictating expected female behavior.
Grace, a young autistic girl, articulated this struggle: “All girls face immense pressure to conform and embody a prescribed idea of womanhood. This pressure intensifies for autistic girls who are additionally navigating societal expectations of simply being human.”
Insights from Brain Imaging Research
As a professor specializing in cognitive neuroimaging, I utilize advanced brain-imaging techniques to study autistic brains.
Professor Gina Rippon’s forthcoming book, “The Lost Girls of Autism,” is scheduled for release on April 3rd.
My research interests extended to understanding the experiences of autistic girls and women. These individuals, often overlooked due to the male-oriented perspective in autism research, were frequently diagnosed much later than their male counterparts, or misdiagnosed with conditions ranging from bipolar disorder to anorexia.
Listening to Autistic Women’s Voices
To gain deeper insight, I shifted my focus from the laboratory to direct engagement, asking autistic women: “What is your lived experience?” Their responses, spanning diverse age groups, consistently highlighted the challenges of navigating social expectations, enduring persistent blows to their self-esteem, experiencing bullying or being labeled as “weird,” and feeling perpetually like outsiders.
These narratives underscored the profound importance of belonging, the fundamental need for identity, and the arduous quest to find their place in a society where they often felt fundamentally misaligned, despite their best efforts.
Crucially, discovering their autism diagnosis brought a transformative positive shift. It engendered immense relief, finally providing a genuine sense of identity where their lives and experiences gained coherence and they found a sense of community, “their tribe.”
Autism, Identity, and Gender Diversity
This raises a pertinent question: If identity uncertainty is central to the autistic experience – grappling with who you are and recognizing a disconnect from societal expectations – could this extend to broader aspects of self-identity, including gender?
Could this be a contributing factor to the elevated rates of gender diversity observed within autistic populations compared to neurotypical populations?
Research indicates that autism rates are three to six times higher among transgender and gender-diverse individuals than in the general population.
Notably, up to 15% of autistic adults identify as transgender or non-binary, with even higher rates, potentially exceeding 30%, among individuals assigned female at birth.
Neuroscientists are beginning to analyze brain activity patterns in individuals with both autism and gender identity diversity to identify potential commonalities (image depicts a model for illustrative purposes).
Mental Health Implications and Sensory Sensitivities
Understanding the intersection of autism and gender identity transcends academic inquiry; it is a pressing health concern. Emerging evidence suggests that being both transgender and autistic is linked to increased vulnerability to mental health challenges. These individuals require our understanding, support, and compassion.
Researchers at the Centre for Applied Autism Research at the University of Bath interviewed autistic adults and found participants described significant distress navigating a world often intolerant of both gender diversity and neurodiversity.
Some participants assigned female at birth reported negative experiences associated with stereotypical feminine expectations. Sensory dysphoria – discomfort stemming from autism-related sensitivities – was triggered by traditionally feminine clothing like woolen tights or frilly garments. Sensory challenges related to puberty, such as managing menstruation and body hair growth, were also frequently cited.
The Drive to Belong and Societal Expectations
One interviewee insightfully remarked, “Being autistic is like everyone else received the rulebook, and you didn’t. Gender becomes relevant because that was another rulebook you missed.” Autistic girls consistently report experiencing bullying and feelings of not belonging throughout their lives.
Compounding this, the prevailing perception of autism as a primarily male condition might lead autistic girls to seek alignment with a different gender, or reject gender altogether. The innate human drive to belong is as powerful, if not more so, in autistic girls. Seeking community outside of groups where they feel rejected becomes a natural response.
The hyper-feminine ideals often promoted on social media and in marketing may also contribute to this dynamic.
If the stereotypical characteristics associated with female identity – such as elaborate makeup routines or a preference for pink – conflict with an autistic girl’s self-perception, seeking an alternative identity, particularly male identity, for a sense of belonging becomes understandable. Elevated rates of gender non-conformity among autistic females may reflect this reaction. Biological factors may also play a role.
Brain Network Connectivity and Self-Perception
Neuroscientists are actively comparing brain activity patterns in individuals with both autism and gender diversity to pinpoint potential overlaps. A 2023 US study investigated the “default mode network,” often referred to as the “daydreaming network.” This network is active during moments of apparent inactivity, when thoughts often turn inward to self-reflection or considerations of oneself in relation to real or imagined events.
Utilizing brain scans, researchers examined connection patterns within this network and its interactions with other brain networks in 45 transgender youth – encompassing neurotypical individuals, autistic individuals, and those exhibiting high autistic traits without formal diagnosis.
Findings indicated heightened connectivity within the default mode network in autistic transgender individuals. Researchers interpreted this as reflecting increased self-monitoring – a continuous quest for identity characterized by persistent self-reflection and comparisons with peers.
Notably, this pattern was more pronounced in individuals assigned female at birth.
This aligns with existing research demonstrating greater self-monitoring in females during tasks engaging the “social brain,” which governs social interactions.
This brain region undergoes significant development during adolescence, a period when autism traits may become more prominent in previously undiagnosed autistic girls.
Brain changes during adolescence, coupled with increasingly complex social expectations, can dismantle previously effective camouflaging strategies used during primary school. This potentially intensifies the yearning for social identity.
The Importance of Identity Recognition
Identity issues have been historically marginalized in the context of autism, yet they are demonstrably crucial, particularly for females who have been overlooked by current diagnostic approaches.
Beyond lacking crucial support and intervention, these women may also be denied a fundamental sense of self.
Adapted from “The Lost Girls of Autism” by Gina Rippon (Macmillan, £22), released on April 3rd. © Gina Rippon 2025.