Many girls and women reach adulthood before anyone suggests that autism or ADHD might explain their experience. Some women say they were treated for anxiety or depression first. This page explains what research suggests about why that can happen, and is honest about what is still uncertain.
Two things first. Autism and ADHD show up in many different ways, and the patterns below do not apply to everyone. They are tendencies seen in groups, and they apply to people of all genders. We say “girls and women” because that is where much of the research on missed diagnosis has focused.
Are fewer girls and women diagnosed?
Yes, on the figures we have. Autism is diagnosed more often in boys and men, and boys are referred to ADHD clinics more often than girls. For autism, the authors of one large review concluded that girls who meet the criteria may be at greater risk of going undiagnosed. For ADHD, it is not known how often girls and women are missed.
These are figures from particular studies. They are not fixed facts about who is autistic or has ADHD. Diagnoses are also changing, and researchers are interested in whether some people are recognised later.
Why it can be missed
Research and criteria may be based more on boys and men. Much of the research on ADHD draws on mostly male samples. In autism, researchers have raised the possibility that diagnostic criteria may be less sensitive to how autism can look in females. This does not make assessment tools useless. It means a clinician needs to look beyond a checklist. NICE guidance for under 19s says clinicians should not rely on an autism-specific diagnostic tool alone, and should use information from all sources and their own judgement.
Signs can look different. Some researchers have proposed a “female autism phenotype”, which means a pattern in how autism may tend to show up in girls and women. It needs more study. In ADHD, hyperactive and impulsive behaviour is more often linked to referral, while inattention is quieter and easier to overlook. NICE guidance for under 19s says that autism may be under-recognised in girls, and that signs can be masked by coping strategies or a supportive environment.
Masking. Masking, also called camouflaging, means using strategies to hide or make up for autistic differences in social situations. Everyday examples might be rehearsing conversations or copying other people’s expressions. Research suggests that masking differs by sex and gender, and that more masking is linked with poorer mental health. The expert ADHD statement says masking may also hide ADHD in girls. The strongest evidence so far is about autism.
Something else gets the diagnosis. Anxiety and depression can happen alongside autism and ADHD. They are real, and they deserve treatment. The problem comes when they are the only thing anyone looks for. The expert ADHD statement reports that problems turned inward, such as anxiety and depression, are more often reported in females, and that a main diagnosis of one of these, or of a personality disorder, can delay recognition of ADHD. Women interviewed in one study described professionals treating their anxiety, depression or eating disorders without considering autism.
Who gets referred. Whether you are assessed at all depends on whether a parent, teacher or GP thinks to ask. The expert ADHD statement says the stereotype of the “disruptive boy” is likely to shape who is referred. In one study, some women said their GP dismissed their concerns and did not refer them.
What we do not know yet
- How often ADHD in particular is missed or misdiagnosed in females.
- How well the research on masking applies to everyone, because most of it relies on people describing their own experience, from samples that do not represent everyone.
- Whether hormonal life stages such as puberty, pregnancy and menopause play a part. The sources we reviewed do not establish firm claims, so we have not made any.
- People of any gender can mask, be missed or be misdiagnosed.
What can help
If you are wondering about yourself or your daughter, a few things help a clinician see the whole picture.
- Describe what is happening, and what it costs. Coping well in public and falling apart afterwards is useful information. So is how much effort an ordinary day takes.
- Bring examples from different settings. Think about home, school, work, friendships and relationships. NICE guidance for under 19s asks clinicians to consider whether signs are present across settings.
- Bring other views if you can. A parent, partner, school report or old paperwork can show patterns you no longer notice.
- Say if you have been treated for anxiety, depression or an eating disorder. Tell the clinician what helped and what did not.
You are allowed to ask whether autism or ADHD might be part of the picture, and to be listened to when you do.
If you would like to talk it through
Curious Minds offers a free 20-minute phone consultation, where you can ask questions and find out which route might suit you. Assessments take place in person in Dundee, across six pathways. You can read about the adult autism, adult ADHD, child autism and child ADHD assessments, compare NHS and private routes, read the FAQs or get in touch.
The research behind this pageOptional reading
- Autism ratios. A review of 54 studies, published between 1992 and 2011, found about four males diagnosed for every female, though the studies differed a great deal. In the better-quality studies, and those that checked whole groups of people rather than only those referred to clinics, the gap was nearer three to one.
- ADHD ratios. A UK expert statement reported that boys are referred to clinics anywhere from three to sixteen times as often as girls, depending on the study. In the wider community the gap is smaller, at around three to one. It is not known how often ADHD is missed or misdiagnosed in females. The statement was based on expert opinion and a selective review of the research, so read it as informed guidance, not settled fact. It also notes that the evidence often draws on mostly male samples, that compensating behaviours may mask ADHD symptoms in girls, that problems turned inward are more often reported in females, and that in studies where teachers read short written descriptions of a child with ADHD-like behaviour, the child was less likely to be referred for extra support when only the name and pronouns changed from male to female.
- Rising diagnoses. In UK primary care records from 1998 to 2018, recorded new autism diagnoses rose overall. The rise was slightly greater for females than for males, and greatest in adults. The authors thought this was more likely to reflect increased reporting and use of the diagnosis than a true increase in numbers.
- The female autism phenotype. A review found support for it in at least some autistic people, but said its features need more study across genders and ages.
- A Swedish twin study. The study looked at 9-year-old twins whose parents reported enough ADHD symptoms to meet the criteria. Of those children, 18.5% of boys and 12.1% of girls had a recorded ADHD diagnosis. Hyperactive and impulsive behaviour, and conduct problems, were linked with getting a diagnosis, more strongly for girls than for boys, though the differences were small. The authors suggested that females with ADHD may be more easily missed in the diagnostic process. The study did not look at anxiety or low mood.
- Camouflaging. A review of 29 studies found that camouflaging differs by sex and gender, and that more self-reported camouflaging was linked with poorer mental health. The studies measured it in different ways and the samples were limited, so the findings cannot be applied to every autistic person.
- Interviews with 14 women diagnosed with autism in late adolescence or adulthood. Several described “pretending to be normal”. Several felt professionals had expected obvious social difficulty, and so overlooked them. Almost all had mental health difficulties, most often anxiety, depression and eating disorders, and most said the professionals treating them never considered autism. Five of the 14 said their GP dismissed their concerns and did not refer them. It was a small study, so it shows how the experience can feel for some women, not a general picture.
Where this information comes from
This page is based on the official and published sources below, so you can read them yourself.
- Loomes R, Hull L, Mandy WPL. What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry. DOI: 10.1016/j.jaac.2017.03.013. Full text read via accepted manuscript: https://discovery-pp.ucl.ac.uk/1558343/1/Loomes.pdf. Published 2017. Accessed 2026-10-09.
- Young S, Adamo N, Asgeirsdottir BB, et al. Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry 2020;20:404. DOI: 10.1186/s12888-020-02707-9. https://link.springer.com/article/10.1186/s12888-020-02707-9. Published 12 August 2020. Accessed 2026-10-09.
- Russell G, Stapley S, Newlove-Delgado T, et al. Time trends in autism diagnosis over 20 years: a UK population-based cohort study. Journal of Child Psychology and Psychiatry. https://ore.exeter.ac.uk/repository/handle/10871/126929. Published online 19 August 2021. Accessed 2026-10-09.
- National Institute for Health and Care Excellence. Autism spectrum disorder in under 19s: recognition, referral and diagnosis (CG128), recommendations 1.2.5, 1.3.3, 1.5.10 and 1.5.11. https://www.nice.org.uk/guidance/cg128/chapter/Recommendations. Recommendations dated 2011, some amended 2017 (overall publication date not shown on the page read). Accessed 2026-10-09.
- Hull L, Petrides KV, Mandy W. The female autism phenotype and camouflaging: a narrative review. Review Journal of Autism and Developmental Disorders. DOI: 10.1007/s40489-020-00197-9. https://discovery.ucl.ac.uk/id/eprint/10091194/. Published 2020. Accessed 2026-10-09.
- Mowlem FD, Rosenqvist MA, Martin J, Lichtenstein P, Asherson P, Larsson H. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. European Child and Adolescent Psychiatry 2019;28(4):481-489. DOI: 10.1007/s00787-018-1211-3. https://link.springer.com/article/10.1007/s00787-018-1211-3. Published online 10 August 2018. Accessed 2026-10-09.
- Cook J, Hull L, Crane L, Mandy W. Camouflaging in autism: a systematic review. Clinical Psychology Review 2021;89:102080. https://research.birmingham.ac.uk/en/publications/camouflaging-in-autism-a-systematic-review/. Published online 6 September 2021. Accessed 2026-10-09.
- Bargiela S, Steward R, Mandy W. The experiences of late-diagnosed women with autism spectrum conditions: an investigation of the female autism phenotype. Journal of Autism and Developmental Disorders 2016;46(10):3281-3294. DOI: 10.1007/s10803-016-2872-8. https://discovery-pp.ucl.ac.uk/id/eprint/1506350/. Published 2016. Accessed 2026-10-09.
This page is general information. It is not a diagnosis or medical advice.
