Four years ago I wrote “Sara” for a therapy consumption When asked what brought him on, he tearfully shared that he had been using Social media to watch videos about his interests and videos on late diagnosed related content started filtering autism older Wondering why these videos were showing up on her channel, she watched a few. As she watched, she realized she might be autistic. He scheduled therapy with me to learn more and scheduled an evaluation with a clinical psychologist who diagnosed him with autism.
While Sarah was the first “tall to disguiseShe was not the last woman to come to me for treatment.
- Social media
- They realized they had autism after their child(ren) was diagnosed
- Fighting autism burn
- A review of recent research on the female autism phenotype
I personally fall into the latter category. When I researched how neurodivergence is different in women and realized I might be autistic, I was embarrassed. How could I have worked with autistic people for over 20 years and not know? Then I thought most of the research was less than 5 years old. I already knew that historical research on autism had previously focused on males. This is why I was researching autistic women/girls in the first place. Now, I see the impact of this missing information not only in my therapeutic practice, but in my own life.
If you’re not familiar with this history, in the United States, Leo Kanner led autism research beginning in the late 1930s and published his findings on early childhood autism in 1943. His sample included only white men. Hans Asperger’s in Germany he recruited girls, but then focused on boys, claiming that his “little professors” should be let go because their unique brains would benefit the Nazi regime. The same case was not made against the girls who were executed.
This focus on males has continued, leading to the development of test measures that have been established and validated for male characteristics of autism. At present, the diagnosis rate is 3-4 boys for every identified girl. However, when you look at people with intellectual disabilities, the diagnosis rate is close to 1:1. Is it because autism is more likely to occur in males unless there is an intellectual disability, or is it because the psychiatric community is not aware of the symptoms of autism in women and girls and therefore does not look for it?
A recent study in Sweden suggests the latter. Fyfe et al. (2026) followed 2.7 million people born between 1985 and 2020 and found that the diagnostic gap between the sexes disappears at an early age. This study shows that the psychiatric community can identify up to 75% of girls with autism.
For the women who came to my clinic with their latest diagnoses, most felt relief. They always felt different or broken; now they know they have autism. Many have to process sadness who lived without this information for a long time. Many were misdiagnosed, and when they didn’t improve with conventional treatments, providers told them they weren’t trying hard enough. Because I had the missing information, I was able to support them in the same ways that I had other autistic clients with greater support needs and make more progress in ways that they hadn’t before because previous therapy didn’t address their neurodivergent brain changes.
Over the past 4 years, I have rarely questioned the validity of an autism diagnosis, whether or not the person has been officially diagnosed. I generally agreed that the traits reported were consistent with autism, and I wondered if I was biased. Then I found the book by Hartman et al. (2023) and was relieved to read that the authors also tended to agree with their clients, noting that clients often did extensive research before ordering a test.
However, this is not the experience or opinion of many professionals. Recently, I’ve noticed a backlash against the growing number of women with autism. This push includes everything from mocking social media posts to clients being asked to see other providers who have been told they cannot be autistic for various reasons, even when clients have reported neuropsychological testing. This month, prominent autism researcher Uta Frith said in an interview that she doesn’t believe autism is a spectrum. She acknowledged that many women diagnosed with autism have “problems” but thinks they should be labeled as “highly sensitive.”
This reliance is very familiar to women with autism. There is a history of women being misunderstood and misdiagnosed. These include diagnoses of “hysteria” or uterine wandering and higher rates of women being sent to asylums for lobotomies, given tranquilizers, or sterilized.
Is it too much of an exaggeration to compare the suspicion of autism in masked women to lobotomy and eugenics? Am I obsessed with my history? After sitting in front of a crying client, the story of how a professional told them that the autism diagnosis that had given them so much personality growth was wrong is no exaggeration. In light of the history of how the mental health system has treated women, it seems more like this. We as a profession must be confident in checking our biases and staying on top of research. For example, I have to check myself bias and make sure I think critically through differential diagnoses. Other mental health professionals should examine their own biases and adjust accordingly. If you haven’t looked at the research on how autism affects women and girls in the past few years, it’s time to do so. This is why we as a profession ensure to “do no harm”.
