Recognizing Autism in Women and Girls

Autism has long been considered a boys’ condition, but there is more to this story. The truth is, autism looks different in women and girls. They’re much better at “pretending to be normal” by masking their autistic characteristics.

How can professionals look behind the mask to recognize autism, when it has been so well camouflaged?
Recognizing Autism in Women and Girls: When It Has Been Hidden Well provides the perspective needed to see how autism manifests in gendered ways, allowing for a more accurate diagnosis.

In addition to describing each point in the diagnostic manual to include feminine presentations, Dr. Marsh has created five “Fictional Female Figures” who’ve been misdiagnosed because they also display symptoms of other similar conditions. She describes their behaviors, both obvious and hidden, from early childhood to adulthood, and demonstrates how these behaviors meet diagnostic criteria for autism spectrum disorder.

The “Behind the Mask” section provides helpful questions to ask during the autism assessment process to allow the professional to recognize autism, even when it has been successfully masked.

In addition, each chapter contains “In Her Own Words,” written by autistic women who describe their personal journeys from masking to diagnosis, and what it means to them.

Being recognized at last for who they truly are frees autistic women to stop hiding behind a mask and begin opening doors to success.

Recognizing Autism in Women and Girls: When It Has Been Hidden Well will be published by Future Horizons, Inc., launch date 5/2/2022. It is available for pre-order now. Follow one of the links below to reserve your copy, or ask for it at your favorite independent bookseller or library.

Autistic Women Undiagnosed:

The Myth, The Mask, The Message


Why is it that autism is still seen as a boys’ club?

Is it true that there are 4 times as many autistic boys and men as autistic girls and women,

or is that a MYTH?

Maybe we’re just really bad at recognizing feminine autism?

When we believe the myth that most autistic people are male,

we fail to recognize how girls and women present the same autistic characteristics, differently.

A little boy flaps his hands, walks on tiptoe, and spins around, and we say, autism!

A little girl does the same thing and we say, look, she’s dancing, she’s pretending her fingers are butterflies! So cute!

Then comes the MASK.

Once she gets to school, she realizes that the other little girls don’t do butterfly fingers, so she learns to do something less noticeable, like clenching her fists, biting the inside of her cheek, curling her toes. No one notices her new, subtle autistic mannerisms, so her autism goes unrecognized.

Girls are observant. Undiagnosed autistic girls notice that everyone else seems to have a secret handbook for how to play with other kids, how to carry on a conversation, how to make friends. Where’s her handbook? She watches others and imitates them. She learns to fake eye contact, and creates scripts in advance for social chatting. She stays on the sidelines and hopes no one realizes she doesn’t know what’s going on. The mask, pretending to be like everyone else, starts out as a survival strategy and becomes a permanent fixture. Don’t let the mask down, or people will find out you’re not like them. Except, they already know. So, mask harder! But masking comes with a cost.

Eventually, the constant stress of pretending to be someone you’re not is too much. It’s exhausting, and it leads to burn out, anxiety, depression.

So, what’s the MESSAGE here? Why is it important to us to know that there are so many undiagnosed autistic women masking their true selves? Because we can make a difference for them.

Many of you reading this are medical or mental health practitioners, doctors, counselors, social workers. When a woman in your care comes to you and says, “Can I get tested for autism?” Don’t brush them off. Don’t say, “You can’t be autistic, you made eye contact with me, you have a job, a family.” Autistic people teach themselves to make or fake eye contact. They do get married and have families, while autistic. I was married for almost 27 years to a late-diagnosed autistic man. Instead of telling them why you think they’re not autistic, try asking them why they think they are. Give them the respect of listening to them and believing what they share about their own lived experience. Help them get the answers they need.

Many of you will have a friend or family member confide in you, “I think I’m autistic.” When they do, don’t rush to say, “Oh, no, you’re not, there’s nothing wrong with you!” There’s nothing wrong with being autistic. It’s a different kind of brain, not a defective one. Listen to your friend, your sister, your daughter. Listen without interrupting or contradicting. Let them tell you all the things they’ve kept hidden from you behind their mask, and thank them for trusting you enough to share this. Then ask them how you can help.

Many of you are autistic, yourselves. You’ve dreamed of being accepted for who you are, without pretending to be someone you’re not.

Maybe you thought you were weak when the sounds, smells, and textures around you were too much to bear, and you saw everyone else handling the sensory nightmare with such strength and composure. You’re not weak. The people in the neuro-majority, like me, we don’t experience the sensory world the way you do. We’re not stronger, we just don’t feel things as deeply as you do. You’ve been in an environment that bombards your senses every day, and you keep going. You are strong.

Maybe you thought you were broken. Something in you was so different from everyone else, in a way you couldn’t understand, and it hurt. But, different is not damaged. There’s nothing wrong with you. You are your own, whole, autistic self, not a broken version of a neuro-typical person. You’re unbroken.

Maybe you thought you were unworthy. You dream of having a BFF, of being in with the crowd, of falling in love, but you keep floundering and failing. You are not unworthy. You may not have found your people yet, but there is a whole community of other late-diagnosed autistic folk, just like you, who will accept you because they truly understand you. The ugly duckling was never ugly. His problem wasn’t that he had to grow up to become beautiful, he was in the wrong environment. Put him in a nest of cygnets, there’s nothing ugly about him. You may have struggled to connect with people, but when you find your community, you’ll know it’s right.  And the people who are in your life now can learn to understand you and accept your differences when they know better. You have a right to your dream of connection and belonging, because you, exactly as you are, mask down, you are worthy of your dreams.

Learn more about

Adult Autism Assessment & Services








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