Autism is more common in men than in women. Various studies suggest that the ratio of autistic males to females ranges from 2:1 to 16:1. The most-up-to-date estimate is 3:1.

Traditionally, clinicians have been trained to recognize stereotypical male-associated restricted interests, such as transportation, dinosaurs, or space. In contrast, autistic women may develop interests that are more closely aligned with societal norms, such as animals, art, celebrities, or literature.

This divergence can contribute to the misconception that women with these types of restricted interests are simply displaying enthusiastic hobbies rather than autistic traits. Repetitive patterns of behavior in women may manifest as classic autistic behaviors like rocking or hand/finger movements. However, they may also appear as behaviors not necessarily associated with autism, such as perfectionistic tendencies or restrictive patterns of eating/eating disorders.

Impediments to an ASD diagnosis: Overshadowing, masking, and camouflaging.

Overshadowing

Diagnostic overshadowing occurs when autistic traits are mistaken for, or hidden by, another condition. As a result, autism may go unrecognized.

For example:

• An autistic child may be diagnosed only with ADHD, while autistic traits are overlooked.
• An autistic adult experiencing anxiety or depression may receive treatment for those conditions without anyone recognizing the underlying autism.
• Sensory sensitivities may be interpreted as behavioral problems rather than part of autism.

Overshadowing can delay diagnosis and prevent individuals from receiving appropriate support.

Masking

Masking is the conscious or unconscious effort to hide autistic traits in order to fit social expectations.

Examples include:

• Forcing eye contact even when it feels uncomfortable
• Rehearsing conversations beforehand
• Copying other people’s facial expressions, gestures, or social behaviors
• Suppressing stimming behaviors such as hand-flapping, rocking, or fidgeting

Many autistic people mask to avoid bullying, criticism, or social exclusion. However, masking can be mentally exhausting and may contribute to anxiety, stress, and burnout.

Camouflaging

Camouflaging is a broader term that includes masking but goes beyond simply hiding autistic traits. It involves actively developing strategies to appear neurotypical in social situations.

Examples include:

• Studying social interactions and memorizing social rules
• Creating scripts for common conversations
• Carefully monitoring body language and facial expressions
• Learning to imitate peers in order to blend in

While masking is primarily about concealing autistic traits, camouflaging includes both concealing traits and compensating for social differences through learned strategies.

Based on behavioral history, women may be more apt to receive diagnoses such as anxiety, mood disorders, learning disorders, and/or eating disorders rather than autism. This phenomenon is called diagnostic overshadowing, which occurs when a person’s symptoms are attributed to a psychiatric problem versus an underlying medical condition or a developmental delay such as autism. This can complicate the diagnostic process, as the focus may be on managing these secondary conditions rather than recognizing the underlying autistic traits.

Autistic women are also more likely to develop compensatory strategies to mask their challenges. For example, women often have stronger social imitation skills and the ability to mimic social behavior compared to men. Due to their social foundation, girls may develop one or two close friendships, helping them absorb social rules and norms. Their strong social interest may lead them to “camouflage” or compensate for social understanding and communication challenges, making these vulnerabilities difficult to detect in everyday interactions or larger classroom or employment settings. As a result of these differences, women are often more likely to be diagnosed later in life, if at all.