Article: “Why autism isn’t diagnosed in girls and women” by Matt Villano, CNN
Original URL: https://www.cnn.com/2025/04/02/health/autism-women-girls-diagnosis-...

Autism has long been considered a predominantly male condition, but growing research and first-hand experiences reveal that this assumption has led to the widespread underdiagnosis of girls and women. In his CNN article, Matt Villano explores why traditional autism diagnosis criteria have failed females and highlights the work of neuroscientist Gina Rippon, whose recent book, Off the Spectrum, delves into this systemic bias.

Rippon argues that many of the behavioral criteria used to diagnose autism are based almost exclusively on how the condition manifests in boys. A 2020 review found that boys are ten times more likely than girls to be referred for autism assessments. A 2023 study revealed that as many as 80% of girls and women are misdiagnosed with other conditions—such as social anxiety, eating disorders, or borderline personality disorder—before receiving an accurate autism diagnosis.

This gender bias has roots in research design. Rippon’s review of 120 autism studies found that nearly 70% tested only male participants, and less than 10% of over 4,000 study participants were women. Consequently, diagnostic tools and practices were built on a narrow male-centric model, causing many girls to be overlooked.

Several key differences explain why autism in girls often goes undetected. First, autistic girls tend to internalize their challenges, presenting as shy, quiet, or anxious rather than disruptive. While boys may act out physically—drawing adult attention—girls often mask their struggles, adapting their behavior to fit in socially. Rippon refers to these children as “chameleons,” who begin mimicking peer behavior to avoid standing out as early as age four or five.

Rippon cites examples of educators interpreting identical behavioral descriptions differently depending on the child's gender. A hypothetical child named “Jack” exhibiting certain traits is more likely to be flagged for autism than the same child labeled “Chloe,” highlighting a bias in expectations.

Another challenge is the limited awareness of sensory sensitivity—such as hypersensitivity to lights, sounds, or clothing textures—often more pronounced in autistic girls. While now included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), these characteristics were long overlooked in formal diagnostic criteria.

For girls, receiving an accurate diagnosis often brings a sense of relief. Many express that the diagnosis helps explain their lifelong feelings of difference and validates their experiences. Some older women, however, report regret and sadness for having struggled without support for so long.

Rippon emphasizes that real progress lies in involving autistic individuals in research and clinical decision-making. Participatory research allows autistic people to guide how studies are framed and interpreted, improving both accuracy and empathy in findings. One such effort, the video Here Come the Girls, shares the lived experiences of autistic women to promote understanding.

To better support autistic girls in schools, Rippon advocates for increased awareness, early screening, sensory accommodations (like quiet testing spaces or headphones), and fostering kindness among peers. Recognizing autism in girls is not about lowering standards—it’s about removing blind spots from outdated models.

In sum, Rippon’s work calls for a major paradigm shift: acknowledging that autism is not a male-only condition and adapting diagnostic practices to reflect the broader spectrum of how autism manifests across genders.

Source: Villano, M. (2025, April 2). Why autism isn’t diagnosed in girls and women. CNN. https://www.cnn.com/2025/04/02/health/autism-women-girls-diagnosis-...