Autism in Women: TikTok Diagnosis or Self-Correction? |
Find a therapist to help with autism
There has been a recent increase in late-diagnosed autism for "high masking" women.
This increase in diagnoses has led to a debate in the mental health community.
The debate centers on whether this is due to social media influences, or more information about autism traits.
The history of the diagnosis, as well as how women have been treated in mental health, should be considered.
Four years ago, I saw “Sara” for a therapy intake. When asked what brought her in, she tearfully recounted that she had been using social media to watch videos about her interests, and videos started filtering in content related to being a late-diagnosed autistic adult. Wondering why these videos were showing up in her feed, she watched a few. As she watched, she had the realization that she was likely autistic. She had scheduled therapy with myself in order to learn more, and scheduled testing with a clinical psychologist, who gave her an autism diagnosis.
While Sara was the first “high masking” woman to come to me for therapy, she was not the last. I had others come in due to:
Realizing they were autistic after their child(ren) were diagnosed
Struggling with autistic burnout
Reviewing the latest research on the female autism phenotype
I personally fall into the latter category. When I researched how neurodivergence presents differently in females and began to realize that I was likely autistic, I was embarrassed. How could I have worked with autistic people for over 20 years and not know? I then reflected that most of the research was less than 5 years old. I already knew that historical research on autism previously focused on males. This was why I was researching autistic women/girls in the first place. Now, I was seeing the impacts of this missing information, not just in my therapy practice, but in my own life.
If you are unfamiliar with this history, in the United States, Leo Kanner led research on autism starting in the late 1930s and published his findings on early infantile autism in 1943. His sample only included white males. Hans Asperger in Germany included girls in his studies, but then focused on the boys, making the case that his “little professors” should be spared, as their unique brains would benefit the Nazi regime. This same case was not made for the girls, who were put to death.
This focus on males continued, which led to the development of testing measures that were normed and validated for male-presenting traits of autism. Currently, the diagnostic rate is 3-4 boys for every 1 girl identified. When you look at individuals with co-occurring intellectual disabilities, however, the diagnostic rate is close to 1:1. Is this because autism is more likely to occur in males unless there is a co-occurring intellectual disability, or because the psychological community is not aware of, and therefore not looking for, signs of autism in women and girls?
A recent study in Sweden suggests the latter. Fyfe et al. (2026) followed 2.7 million individuals born between 1985 and 2020 and found that by early adulthood, the diagnostic gap between the genders disappeared. This study indicates that the psychological community may be missing the identification of as many as 75% of autistic girls.
For the women who were coming into my clinic with their own recent diagnoses, most felt relief. They had always felt different or broken; now they knew they were autistic. Many needed to process grief over living so long without this information. Many had been misdiagnosed and, when they didn’t get better from typical treatments, providers told them they were not trying hard enough. Because I had the missing information, I was able to support them in many of the same ways I had other autistic clients with higher support needs, and most experienced progress in ways they never had previously because prior therapy had not included modifications for their neurodivergent brains.
Over the last 4 years, I have rarely questioned the validity of an autism diagnosis, whether the person was officially diagnosed or not. I usually agreed that reported traits were consistent with autism, and I started to wonder if I was biased. I then came across a book by Hartman et al. (2023) and was relieved to read that the authors also tended to agree with their clients, noting that clients often had done extensive research before making a testing appointment.
Find a therapist to help with autism
This, however, is not the experience or opinion of many professionals. More recently, I have been seeing pushback against the rise in women being diagnosed with autism. This pushback has included everything from sarcastic social media posts to clients going to see other providers who have told them that they can’t be autistic for a variety of reasons, even when clients have provided reports of neuropsychological testing. This month, influential autism researcher Uta Frith gave an interview stating that she does not believe autism is a spectrum. She acknowledged that many of the women receiving autism diagnoses have “problems,” but feels they should be labeled as “hypersensitive.”
This pushback against women being diagnosed with autism feels all too familiar. There is a history of women being misunderstood and misdiagnosed. This has included diagnoses of “hysteria” or wandering uteri, and higher rates of women being sent to asylums, given lobotomies, given tranquilizers, or sterilized.
Is comparing the skepticism of autism in high masking women to lobotomies and eugenics an over-exaggeration? Am I engaging in my own histrionics? Having sat across from client after client sobbing through the story of how a professional told them that the autism diagnosis they had been given, which led to so much personal growth, was incorrect, it doesn’t seem like an exaggeration. In light of the history of how the mental health system has treated women, it seems like more of the same. We as a profession need to ensure that we check our biases and continue to stay on top of research. I for example, need to check my own bias and make sure that I think critically through differential diagnoses. Other mental health professionals need to examine their own biases and adjust accordingly. If you haven’t looked at the research on how autism presents in women and girls in the last few years, it’s well past time to do so. This is how we as a profession ensure that we "do no harm."
Amas, H. (2026, March 4). Uta Frith: why I no longer think autism is a spectrum. Tes Magazine. https://www.tes.com/magazine/teaching-learning/general/uta-frith-interv…
Cook, J. (2018). Autism in heels: The untold story of a female life on the spectrum. Skyhorse.
Doyle, J.K., O'Donnell-Killen, T., Hartman, D., (2023). The adult autism assessment handbook: A neurodiversity affirmative approach. Jessica Kingsley Publishers.
Fyfe C, Winell H, Dougherty J, Gutmann D H, Kolevzon A, Marrus N et al. Time trends in the male to female ratio for autism incidence: population based, prospectively collected, birth cohort study. BMJ 2026; 392: e084164 doi:10.1136/bmj-2025-084164
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Henderson, D., White, J., & Wayland, S. (2023). Is this autism? A guide for clinicians and everyone else. Routledge Press.
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Price, D. (2022). Unmasking autism: Discovering the new faces of neurodiversity. Harmony Books.
Schembari, M. (2024). A little less broken: How an autism diagnosis finally made me whole. Flatiron Books.
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Tone, A. & Koziol, M. (2018). Failing women in psychiatry: Lessons from a painful past. CMAJ. 190(20):E624-E625. doi: 10.1503/cmaj.171277.
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