The short answer
- Women have been diagnosed later and less oftenAutistica, the autism research charity, says women and girls are less likely to be diagnosed than men and boys with similar autistic traits, and tend to be diagnosed later.
- Masking hides autism and takes a lot of energyThe NHS says adults who mask can find everyday activities and social situations exhausting and stressful. It is one reason women are diagnosed later.
- Other diagnoses often come firstAnxiety, depression and eating disorders are more common in autistic people, and autistic women may be diagnosed with these while the autism is overlooked.
- A GP is the first step to an assessmentOnly an assessment by a trained team can say whether someone is autistic. An online test cannot. In England you can choose which NHS service does the assessment.
This page says autistic woman rather than woman with autism, which the National Autistic Society notes many autistic people prefer. If you use different words about yourself, use yours. Nothing here is a checklist for diagnosing yourself or anyone else.
Why women were missed
Why autistic women and girls have often been missed
Autism is a difference in how the brain develops that affects how a person experiences the world, communicates and responds to light, sound and touch. The NHS is clear it is not an illness. For decades autism research focused mostly on men and boys, and many girls who did not fit that picture grew up without anyone suggesting it.
The picture of autism was drawn from boys
Autistica, 2019
Masking hides the signs
NHS and National Autistic Society
Friendships and good marks
National Autistic Society
Anxiety or depression gets noticed instead
National Autistic Society
The numbers show the gap. The National Autistic Society notes that estimates of how many more males than females are autistic have ranged from 2 to 1 up to 16 to 1, and that the most up to date estimate is about 3 to 1. Autistica's briefing on diagnosing autistic women and girls adds that the difference between men and women is smaller in autistic adults, which suggests that more autistic women grow up undiagnosed. The gap is also narrower among people who have a learning disability, which Autistica says suggests that more women without a learning disability are being missed.
None of this means autism looks one way in women and another in men. The NHS points out that autistic men can mask too, and some girls are diagnosed in childhood. It means the older assessment habits were more likely to miss women, and many of the women they missed are adults now. The National Autistic Society's page on autistic women and girls covers this in more depth, and our guide to autism in adults sets out the wider picture, from support at home to work and money.
Masking
What masking is, and what it costs
The National Autistic Society describes masking as a strategy some autistic people use, consciously or without realising it, to appear non-autistic. Autistic people describe it as constantly watching for, and adapting to, what the people around them expect. Some people call it camouflaging.
Words you will come across
- Masking
- Hiding autistic traits to fit in. Examples the National Autistic Society gives include copying other people's facial expressions, forcing eye contact, and changing your tone of voice to sound less direct.
- Scripting
- Planning in advance what you will say in a conversation, sometimes word for word, so that it goes the way it is expected to.
- Stimming
- Repeated movements or sounds, such as hand flapping, rocking or repeating words, that help a person regulate. Masking often means holding these in.
- Autistic burnout
- Exhaustion that builds over time, when the demands on a person, including the effort of masking, outrun what they have left. Skills that were there before can become harder for a while.
- Alexithymia
- Difficulty recognising and describing your own emotions. The National Autistic Society mentions it as one reason some autistic people find it hard to ask for help.
Masking can work well enough that nobody around the person suspects anything, including a GP, a partner, or the person herself. The NHS says that some autistic adults have learned to hide the signs, and that this can make everyday activities and social interactions feel exhausting and stressful. The National Autistic Society lists what masking can cost: mental and physical exhaustion, which can lead to autistic burnout, mental health difficulties, and a loss of a sense of self, where a person no longer knows who she is underneath it.
For a family, this is the part to understand. A mother, sister or wife who seemed to manage a busy day well may have needed the whole evening alone to recover from it. Needing to be alone afterwards is not rudeness, and it is not a sign that the day was unpleasant. Autistic burnout explains the slower, longer exhaustion that can follow years of masking, and what helps.
Other diagnoses first
The conditions and misdiagnoses that often come first
Two different things happen here, and it helps to keep them apart. Some conditions are more common in autistic people and can be present alongside autism. Separately, some women are given a diagnosis that does not fit, because nobody has considered autism.
| What the sources say | Why it matters | |
|---|---|---|
| Anxiety and depression | The NHS says autistic people are more likely to have anxiety and depression, and that autistic women are more likely than autistic men to have a mental health condition. | These can be real and need treatment. They can also be the only thing a professional sees, so the autism underneath is missed. |
| Eating disorders | The NHS lists eating disorders among the conditions more common in autistic people. Autistica notes that women and girls often reach eating disorder services before an autism diagnosis. | If treatment has not helped, it is reasonable to ask the eating disorder team whether autism has been considered. |
| Borderline personality disorder | Researchers writing in the journal Autism in Adulthood in 2024 describe misdiagnosis with borderline personality disorder, or borderline traits, as particularly common among autistic women. | Some traits look similar from the outside but have different causes, and the right support is different. |
| ADHD | The NHS says ADHD is more common in autistic people. | A person can have both. An assessment team may look for signs of ADHD and refer on. |
| Epilepsy | The NHS lists epilepsy among the conditions autistic people are more likely to have. | A physical health condition. It needs its own care from the GP or a specialist. |
Anxiety and depression
- What the sources say
- The NHS says autistic people are more likely to have anxiety and depression, and that autistic women are more likely than autistic men to have a mental health condition.
- Why it matters
- These can be real and need treatment. They can also be the only thing a professional sees, so the autism underneath is missed.
Eating disorders
- What the sources say
- The NHS lists eating disorders among the conditions more common in autistic people. Autistica notes that women and girls often reach eating disorder services before an autism diagnosis.
- Why it matters
- If treatment has not helped, it is reasonable to ask the eating disorder team whether autism has been considered.
Borderline personality disorder
- What the sources say
- Researchers writing in the journal Autism in Adulthood in 2024 describe misdiagnosis with borderline personality disorder, or borderline traits, as particularly common among autistic women.
- Why it matters
- Some traits look similar from the outside but have different causes, and the right support is different.
ADHD
- What the sources say
- The NHS says ADHD is more common in autistic people.
- Why it matters
- A person can have both. An assessment team may look for signs of ADHD and refer on.
Epilepsy
- What the sources say
- The NHS lists epilepsy among the conditions autistic people are more likely to have.
- Why it matters
- A physical health condition. It needs its own care from the GP or a specialist.
Sources: NHS pages on autism and on the signs of autism in adults, the National Autistic Society, Autistica's 2019 briefing, and McQuaid, Strang and Jack (2024). Autism is not a mental illness, although autistic people can also have one.
A wrong or partial diagnosis can shape years of someone's life. In a study of women diagnosed as autistic after the age of 40, several described being given diagnoses that did not explain their experience, doubting their own judgement as a result, and in one case giving up on asking for help. A 2015 review in The Lancet Psychiatry, on adults diagnosed late, advised clinicians to consider possible misdiagnosis, especially in women.
If a relative has been treated for years for anxiety, depression or an eating disorder and it has never quite fitted, it is reasonable to ask her GP or mental health team whether autism has been considered. NICE guidance on autism in adults lists previous or current contact with mental health services among the things that should prompt clinicians to consider an assessment. Autism and mental health covers getting mental health care that works for an autistic adult.
Getting assessed
How to ask for an autism assessment as an adult
Only an assessment by trained professionals can say whether someone is autistic. Online questionnaires and lists of traits can be a reason to ask, but they cannot answer the question, and neither can a family member, however well they know the person.
- 1
Write down why you are asking
Before the appointmentA page of examples from now and from childhood: what is hard, what takes a long time to recover from, what people have said. It helps in a short GP appointment, and it helps anyone who finds it hard to explain things on the spot. - 2
Ask the GP for a referral
The NHS routeThe NHS says GPs can often refer adults to a local autism team. A mental health professional can also recommend a referral. If you cannot get one, you can ask to see another GP for a second opinion. - 3
Ask about Right to Choose
England onlyIn England you can choose which NHS service carries out the assessment, and you may find one with a shorter wait. You can also pay for a private assessment from a professional outside the NHS. - 4
Expect a wait
A few months or longerThe NHS says an assessment can take a few months or longer once a referral is accepted. Ask the GP what support is available locally while you wait. - 5
The assessment itself
One or more appointmentsA team may ask you to fill in questionnaires, ask about your early life and your life now, and talk to someone who knew you as a child. For someone in her sixties, school reports or an older sibling can help. - 6
The report
AfterwardsYou get a report saying what the team found, including whether you are autistic, your strengths, where you may need support, and any other conditions they noticed.
NICE guidance says assessments should be adapted where needed, including the setting, how long they last and how fast they go. If bright waiting rooms, phone calls or long appointments are hard, say so when you are referred. The NHS page on autism assessments sets out the route, and autism diagnosis as an adult covers the waits, private assessments and what to do if a referral is refused.
What changes after
What people say changed after a late diagnosis
A diagnosis does not change who someone is. What it can change is how she understands the past, how she treats herself, and what she can ask for. The layout below sets out what adults diagnosed in mid-life or later told researchers, side by side, together with the harder feelings that people also describe.
- 1
Making sense of yourself
Before
Years of feeling different without knowing why. Several women in the Sheffield study had come to believe the fault was theirs, using words such as wrong, broken or defective about themselves.
After
An explanation that fits. The same women described relief, calm and a feeling of being validated, and the end of a long search to understand how they experience the world.
Reported in: Leedham and others, 2020
- 2
Fitting in
Before
A lot of effort spent appearing like everyone else: copying other people, planning conversations in advance, and hiding movements such as hand flapping. Some described it as exhausting.
After
More permission to meet their own needs. People described doing the social things they could manage, letting go of the guilt about the rest, and noticing how much they had been masking.
Reported in: Leedham and others, 2020; National Autistic Society
- 3
Mental health
Before
Treatment for anxiety and depression, sometimes for years. Some women had been given other diagnoses that did not match their experience, and one stopped asking for help altogether.
After
A better understanding of what leads to overwhelm, and coping plans built around it. Mental health difficulties did not disappear, and people said so.
Reported in: Stagg and Belcher, 2019; Leedham and others, 2020
- 4
How people see themselves
Before
Harsh self-criticism, and a sense of being on the outside of groups despite trying hard to belong.
After
A move from self-criticism towards self-compassion, a greater sense of control over their own lives, and for some, pride. Both studies describe a new way of understanding the self.
Reported in: Leedham and others, 2020; Stagg and Belcher, 2019
- 5
Family and partners
Before
Being described as shy, quiet or anxious. Some women had hidden their differences even from very close family.
After
Mixed reactions. One husband read up on autism and the couple understood old arguments differently. Other relatives dismissed the diagnosis, which made it harder to talk to them.
Reported in: Leedham and others, 2020; Autistica, 2019
- 6
Getting support
Before
Help aimed at the wrong problem, and support that was missed because nobody had considered autism.
After
Adjustments at work for several people. Others described a continuing battle for support, and some lost mental health support after the diagnosis.
Reported in: Leedham and others, 2020
What people also describe after a late diagnosis
- Grief for the years before, and sadness for the person they had been
- Anger that it was missed, sometimes at family or professionals
- Coming to terms with it over a long period, not in one appointment
- No single right way to feel, which the National Autistic Society says plainly
The National Autistic Society says people describe a diagnosis as a significant life event, and that a person can feel relief at having an answer while also worrying about how hard it may be to get support. How you may feel after an autism diagnosis suggests local and online groups of other autistic people as a place to start.
A diagnosis can also open doors. The NHS says autism is considered a disability under the Equality Act 2010 and that an employer must make reasonable adjustments if you need them, and autism and work covers how. A council needs assessment looks at what someone cannot manage without help, and getting social care support as an autistic adult explains how to ask for one. Benefits for autistic adults covers what may be claimable.
Some people want practical help at home, with or without a diagnosis: someone to help with shopping and meals during burnout, or a regular hour with the same person each week. On PrimeCarers you can search for carers near you and compare their rates. PrimeCarers is an introductory service, not an agency. The person, or her family if she wants them involved, chooses the carer, meets them first, and agrees the hours and the routine directly with them, and can keep the same person for as long as it suits them both. For many autistic adults the same face at the same time each week matters a great deal.
Motherhood, menopause, later life
Motherhood, menopause, and diagnosis in later life
For some women the question of autism comes up at a point of change, such as becoming a mother or reaching menopause. Research is still limited and the studies below are small, but they describe what autistic women and older adults told researchers.
- As a mother
Pregnancy, birth and bringing up children
In a 2020 survey of 355 autistic and 132 non-autistic mothers, autistic mothers were more likely to report depression before or after birth, to feel misunderstood by professionals, and to find motherhood isolating. They also put their children's needs first.
- From services
Support that includes women, parents and older people
NICE tells local autism services to make sure support can be reached by groups including women, older people and autistic parents. You can point to this if a service seems not to have you in mind.
- Around menopause
Feeling more autistic
In a small study, autistic women described menopause as intensifying sensory, social and emotional difficulties. The National Autistic Society says some people discover they are autistic at this point, because their traits become more obvious.
- In later life
Diagnosis later in life, for women and men
In a study of nine adults in their early fifties, five women and four men, participants had been treated for anxiety and depression, and saw their diagnosis as a positive step.
On menopause, the National Autistic Society's guide to menopause describes stronger sensory sensitivities and difficulty with emotional regulation, and suggests talking through the benefits and risks of hormone replacement therapy with a GP. It also notes that difficulty recognising and describing what is happening in your own body can make it harder to ask for help, so writing symptoms down before an appointment is worth doing. The study mentioned above, When my autism broke, is where the phrase "feeling more autistic" comes from.
On motherhood, 54% of the autistic mothers in the 2020 study agreed that professionals involved with their child often did not believe them, compared with 31% of the other mothers. The full study calls for better understanding among the professionals autistic mothers meet, and better-tailored support.
Late diagnosis is not only something that happens to women. Men who grew up when autism was barely recognised can reach their sixties or seventies without a diagnosis too, and the same route through the GP applies at any age. For an older relative, autism in later life covers health, care and what changes with age. The NHS guide to autism and adult life covers work, benefits and relationships.
Questions
Questions people ask about autistic women and late diagnosis
The NHS says it can be harder to see signs of autism in women because of masking, and that autistic women are more likely to copy how other people behave, appear to cope well with social situations, stay very quiet and hide their feelings in difficult situations, and have a mental health condition such as anxiety, depression or an eating disorder. These are reasons to talk to a GP, not a way to diagnose yourself or anyone else.
No. Online questionnaires can help you decide whether to ask for an assessment, and some clinicians use short questionnaires as a first screen. Only an assessment by a trained team can say whether someone is autistic. Some people describe themselves as autistic before or without a formal assessment, and that is their choice to make.
Only the person can decide. In a study of nine adults diagnosed late and interviewed in their early fifties, the participants described the diagnosis as a positive step that helped them understand themselves and their needs. Women diagnosed after 40 in another study also described grief for the years before. A diagnosis can support a request for adjustments at work and in health care.
Asperger syndrome was a diagnosis given to some autistic people who did not have a learning disability. The National Autistic Society explains that it was retired in 2013 in the American diagnostic manual and in 2019 in the international classification, and is no longer given as a diagnosis. Some people diagnosed with it still use the word about themselves.
Menopause does not cause autism. In a small study, autistic women described feeling more autistic around menopause, with stronger sensory, social and emotional difficulties. The National Autistic Society suggests talking to a GP about treatment, including hormone replacement therapy, and some women first recognise they are autistic at this time.
Ask her what she wants rather than assuming. In one study, a husband who read about autism said it helped the couple understand old arguments. In the same study, relatives who dismissed the diagnosis made it harder for women to talk to them. Let her decide who is told, and give her time to come to terms with it.