She was the quiet, well-behaved girl who read in the corner at every family party. Years later, after anxiety, burnout and a sense of always being slightly out of step, she wonders whether she’s autistic. This guide is for her, and for parents of girls like her.
Autism in girls and women is often missed because many learn to hide their differences, their interests can look ordinary, and they’re often treated first for anxiety, depression or an eating disorder. Boys are diagnosed far more often, but the real gap is smaller: closer to three to one.
What autism is
Autism is a lifelong difference in how a person communicates, relates to others and experiences the world, with strong routines, focused interests and sensory differences. It’s the same condition in women and men. What differs is how it often shows, and how often people notice. Our guide to autism in adults covers the basics.
Why it gets missed
The picture of autism was built on boys
Autism is often described as four times more common in boys. A 2017 review of 54 studies, covering almost 14 million people, found the gap was closer to three to one when researchers screened whole populations rather than counting existing diagnoses. Its authors concluded that girls who meet the criteria are more likely than boys to go undiagnosed.
The UK’s NICE guideline on autism in children and young people warns clinicians that autism “may be under-recognised in girls”.
Many girls and women mask
Masking, or camouflaging, means hiding autistic traits to fit in: copying how others talk and behave, rehearsing conversations, forcing eye contact and holding back discomfort. The NHS says autistic women may be more likely to:
- copy how other people behave
- appear to cope well with social situations
- be very quiet in situations they find difficult, and hide their feelings
- show fewer repetitive behaviours than autistic men
In a 2020 online survey of 306 autistic and 472 non-autistic adults, autistic women reported more camouflaging than autistic men, while non-autistic men and women didn’t differ. Men can mask too.
Masking works for a while, but it’s tiring. In a 2017 study of 92 autistic adults, people described exhaustion and harm to how they saw themselves.
Her interests look ordinary
Autistic people often have intense, long-lasting interests. In girls these may be in more typical, sociable topics, such as animals or arts and crafts, so adults see a normal hobby rather than how deep it goes. The differences shouldn’t be overstated: a 2024 US study of 1,921 autistic young people found boys’ and girls’ interests were more similar than different, with differences mostly along typical gender lines.
A quiet girl doesn’t worry anyone
Disruptive behaviour gets noticed at school. A girl who goes silent, follows every rule and keeps to one friend is often praised as well brought up, or called shy. At home, she may be pushed to greet visitors, help in the kitchen at parties and “stop being proud”, and get through it by copying her sisters and cousins. Her difficulties stay invisible until demands grow, at university, at work or after marriage and children.
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Something else gets diagnosed first
The NHS notes that autism can be harder to see when someone also has anxiety, depression, an eating disorder or ADHD, and that autistic women are more likely to have anxiety, depression or an eating disorder. Many adults are treated for these for years before anyone thinks of autism.
- Eating disorders. In a 2024 review of 22 studies with 1,172 people with anorexia, 29% scored above the cut-off on a standard autism assessment. That’s a high score, not a diagnosis, but it’s a reason to ask the question. Read more about eating disorders.
- Borderline personality disorder. The two can look alike, with difficulties managing emotions and relationships. A 2021 review found the research too weak to say how often one is mistaken for the other. If you’ve been diagnosed with BPD and it never quite fitted, it’s reasonable to ask about autism.
So she’s diagnosed later, or never
In a 2013 Dutch study of 2,275 autistic people, girls were identified later than boys, and adult women later than adult men. In the UK, recorded autism diagnoses rose almost ninefold between 1998 and 2018, and faster among women and adults than among men and children. The researchers thought better recognition, rather than more autism, was the likely reason.
Signs to look for
One sign alone doesn’t mean autism. Look for a pattern that goes back to childhood.
In girls, according to the NHS, autism may show as copying how other children play, being quiet in situations she finds difficult, seeming to cope socially, and fewer repetitive behaviours than autistic boys. You may also notice:
- few close friends, and more time alone
- strong reactions to noise, light, smells, tastes or textures, such as school uniforms or loud church services
- getting very upset when plans or routines change
- a need to follow rules, and distress when others don’t
In women, the signs may include:
- finding conversation tiring, or following scripts and “rules” you’ve worked out
- needing long recovery time alone after socialising
- finding friendships and romantic relationships hard to work out
- sensory overload at work, in markets or at crowded events
- anxiety, low mood or burnout that keeps coming back
Culture matters here. In many Nigerian homes, avoiding eye contact with elders is respect, not a sign of autism.
Getting assessed as a woman
Online tests can’t diagnose autism, and our guide to autism in adults explains why, with steps for finding an assessment in Nigeria. Options are limited: the public services that describe autism assessment online mostly see children, so start with an adult psychiatry clinic or a clinical psychologist and ask whether they assess adults.
A few things help women in particular:
- Say that you think you mask, and give examples of what it costs you: the rehearsing, the exhaustion, the time you need to recover.
- List past diagnoses such as anxiety, depression or an eating disorder, and what helped or didn’t.
- Bring someone who knew you as a child, or old school reports. Teachers’ comments such as “very quiet” or “keeps to herself” may be useful.
- Ask about other conditions, such as ADHD, which often come with autism. Read about ADHD in adults.
If you think your daughter is autistic
Start with her school and a family doctor or paediatrician, who can refer her for assessment. When we last checked, the child and adolescent services at the federal neuropsychiatric hospitals in Yaba and Kaduna described autism assessment on their websites. Our guides to autism in Nigeria and choosing an autism school or centre in Lagos cover children in more detail.
Mytherapist.ng is for adults, so we can’t see your daughter. But if you’re finding it hard, you can talk to a family and parenting therapist for yourself.
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Looking after your mental health
Anxiety and depression are common in autistic adults, each affecting about 1 in 4 at any one time. Suicide risk is also higher, roughly three times the general rate. Both are treatable, and help works best early.
Therapy for anxiety or depression can be adapted for autistic people, with more structure, written material and plain language. You can find a therapist who works with neurodevelopmental conditions by video, voice or chat, or read a first-hand account of working life with autism.
If you’re thinking about ending your life, call 112, or 767 in Lagos. To talk to someone at any hour, call Safe Place Nigeria on 0800 800 2000. It’s toll-free and answered 24 hours a day. The full list is on our helplines page.
See also our pages on neurodevelopmental conditions and autism spectrum disorder.
Frequently asked questions
What are the signs of autism in women?
Lifelong differences in social communication, focused interests, strong routines and sensory sensitivities, often hidden by copying others. Many autistic women describe exhaustion after socialising and years of anxiety or depression before anyone considered autism.
Why is autism missed in girls?
Many girls mask their differences, their interests can look typical, and quiet, rule-following behaviour rarely worries adults. Clinicians have also tended to look for the way autism shows in boys.
Is there an autism checklist for girls?
Lists of signs, like the one above, can help you decide whether to ask for an assessment. No checklist or online test can diagnose autism. Only a trained clinician can.
Can autism be mistaken for anxiety or BPD?
Autism is often missed when someone also has anxiety or depression, and some features overlap with borderline personality disorder. Research can’t yet say how often one is mistaken for the other, so if a diagnosis never fitted, ask about autism.
Can an adult woman be diagnosed with autism in Nigeria?
Yes, though options are limited. Start with an adult psychiatry clinic or a clinical psychologist, ask whether they assess adults for autism, and bring examples from childhood to now.
This article is awaiting clinical review. It’s based on published research and health guidelines, and we’ll update it once a clinician has reviewed it.
Suggested read: Choosing an Autism School or Centre in Lagos
