Masking: Autistic Women Are Misdiagnosed Often

Image portrays an autistic woman masking in public

Autistic women hide behind a mask (Masking)

Women who are autistic tend to hide or mask or camouflage their autistic symptoms more than men. They employ strategies to compensate for their natural autistic behaviours in social situations.

These strategies are often used to prevent the amount of prejudice they face while also reducing social awkwardness and help with meeting their work or educational goals.

Doing this can result in internalization of symptoms that can lead mental health crisis, autistic burnout, ever present exhaustion, suicidal ideation and loss of sense of self.

How Do we know this?

The CAT-Q (Camouflaging Autistic Traits Questionnaire) Measurement tool was developed to analyse the gender differences between male and female people with autism and also compared these to non autistic individuals to see if the differences were actually gender based and not just unique to women with autism.

Masking (hiding their autistic behaviours) and Assimilation (trying to fit in social interactions) were two variables that women scored significantly higher in. This shows that women with autism hide their symptoms more than men, while trying to fit societal standards of normal.

Interestingly, there was no significant difference in the Compensation subscale in both genders. This suggests that both men and women make use of the same cognitive strategies to navigate social hurdles like memorizing scripts for conversation and copying facial expressions.

There was no significant differences in non autistic male and females, showing that this camouflaging intensity is unique to women with autism. From research, Gender roles in culture and expectation from women by the society may be a contributing factor to the higher scores for Masking and Assimilation in autistic women.

Masking may lead to misdiagnosis and delayed diagnosis

It is estimated that nearly 80% of autistic females have been previously misdiagnosed. The findings of the CAT-Q tool may be the part of the reason that this occurs. Women with autism are often mislabelled as having depression, anxiety, bipolar or eating disorders.

A different qualitative study conducted in the UK established that women with Autism and ADHD are diagnosed much later than their male counterparts. This signifies a double burden as 50-70% of Individuals who have autism also have ADHD.

Women aged 35 to 65 years of age either diagnosed with autism & ADHD or on the waiting list to be diagnosed were the participants of this study and some themes were found to be related to why women are diagnosed later in life.

First, clinicians do not understand and tend to dismiss women who approach them with symptoms of autism. This happens because women seem “too successful” and “competent” as clinicians often base their phenotype of an autistic individual on how young boys with autism historically presented. Women often felt frustrated with their healthcare providers because they label them with other diagnosis. The way women present simply does not fit what they know autism to be.

Second, gender discrimination was a strong reason for not taking women with autism as serious. This is evidenced by post diagnosis practices. Even after diagnosis, women were not often followed up by their health providers and were left to navigate the difficulties of a new diagnosis alone.

Lastly, the diagnostic process is very difficult and takes a long time, with women reporting waiting periods often exceeding 3 years and sometimes even reaching up to 8 years. These women often felt abandoned and were left with little or no support during the waiting period.

Let’s conclude

Women do not show obvious symptoms of autism and this may well be one of the reasons health workers find it difficult to see that these women are truly autistic.

The facade they present to meet society’s approval and the internalization of their true selves may lead to anxiety, depression, autistic burnout, late or missed diagnosis. Autistic women have to wear a mask to please others but this mask ends up having several negative effects on them.

The gap between men and women with autism needs to be bridged. More clinicians should be trained to better recognise autism in women. Perhaps different criteria for suspicion of autism in women should be created apart from those for men and society at large needs to modify the expectations they have of women, especially those facing difficulties with their mental health.

References

1. Hull L, Lai MC, Baron-Cohen S, Allison C, Smith P, Petrides KV, et al. Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism. 2020;24(2):352-63.

2. Wills V, Chakraborty R. A qualitative study on the experiences of adult females with late diagnosis of ASD and ADHD in the UK. Healthcare. 2026;14(2):209.

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