‘She Masked, She Masked, She Masked’: How Undetected Autism Affects Girls

# Summary

# What the reporting found

• Children with autism are more likely than neurotypical peers to have co-occurring conditions such as anxiety and depression and to think about or die by suicide.
• Girls who do not have intellectual disability tend to be diagnosed much later than boys. While boys are diagnosed most often between ages 3 and 11, girls are diagnosed either before age 3 or after age 11 according to a 2024 review of electronic health records.
• Because diagnostic tools and clinician expectations are based largely on boys' behavioral profiles, girls' presentations frequently do not "check the behavioral boxes." As Lauren Kenworthy, chief of neuropsychology and director of the Center for Au..., put it in the story: "Girl autism really does not check the behavioral boxes that we, as clinicians and researchers, have been taught to look for."
• Masking — conscious or unconscious suppression of autistic traits to blend in — is common among girls and can be exhausting and harmful over time.

# Why later diagnosis happens

• After early childhood, boys are identified at far higher rates than girls, producing diagnostic samples and screening tools that reflect boys' typical autism signs.
• Girls who can mask or who present with internalizing symptoms (anxiety, depression) may instead receive psychiatric diagnoses first.

# Practical implications

• Clinicians and schools should look beyond external behavior checklists and consider sensory profiles, chronic overwhelm, and sustained masking when assessing girls.
• When adolescents — especially girls — present with anxiety, depression, or suicidal thoughts, clinicians should include autism in differential diagnoses if there are sensory issues or social camouflage patterns.
• Families seeking answers may need to ask for autism-specific evaluation if standard behavioral explanations don't fit the child's reported sensory experiences or if masking is suspected.

# Closing takeaway Late identification of autism in girls can mean missing years when early supports might reduce stress and improve coping. The story argues for changing assessment practices so girls' autism is recognized earlier and treated with approaches that address sensory, social, and mental health needs.