Autism in women: signs, symptoms and getting diagnosed

Every autistic person is different and, as the NHS puts it, many will not show all the signs, or the signs may not always be obvious. The NHS lists these general signs for autistic adults. They can look different from person to person, and from day to day.

The NHS adds that if you are an autistic woman you may be more likely to copy how other people behave, appear to cope well with social situations, be very quiet in situations you find difficult and hide your feelings, show fewer signs of repetitive behaviours than autistic men, and have a mental health condition such as anxiety, depression or an eating disorder.

• Finding it hard to talk to other people, or spending more time alone than with others.

• Finding it hard to understand facial expressions, gestures or tone of voice.

• Taking things literally, such as not understanding a phrase like "a piece of cake".

• Having fixed ways of doing things and becoming distressed when routines change.

• Repetitive movements (stimming), such as rocking, flapping the hands or flicking the fingers.

• Being very focused on specialist interests.

• Being very sensitive, or not sensitive at all, to light, sounds, smells, tastes or textures (sensory differences).

• Other things the NHS says may go with autism: problems staying in education or a job, difficulty making friends and romantic relationships, mental health problems, and sometimes a learning disability.

Masking, sometimes called camouflaging, means adapting your behaviour so that your autistic traits are less noticeable. The NHS says it can make everyday activities and social interactions feel exhausting and stressful. The National Autistic Society says autistic women and girls may seem to have fewer social difficulties than autistic men and boys, but this could be because they are more likely to mask, and the stress of doing so can result in anxiety and overwhelm.

The NHS notes that autistic men can mask too, so masking is not limited to women. The National Autistic Society lists masking, or camouflaging, as one of the main theories for why autism in women and girls is missed or diagnosed late.

The NHS describes autism as a difference in how your brain develops compared to people who are not autistic. The National Autistic Society says it is understood as a spectrum, which today means each autistic person has a unique combination of characteristics and strengths and challenges, rather than being "more" or "less" autistic.

For a diagnosis, the National Autistic Society says a specialist team must agree that a person shows the core characteristics of autism. These are lifelong differences in communication, behaviours and interests compared with non-autistic people, and the behaviours and interests must be seen as affecting everyday functioning. Differences in sensory processing are considered as part of the behaviours and interests.

The National Autistic Society also says that around a third of autistic people have a learning disability, and that autistic people are more likely to experience mental health problems.

The National Autistic Society gives several reasons why women and girls are missed or misdiagnosed. It says none of the theories for the diagnosis gap have been conclusively proven, and that research and understanding are changing all the time.

• Masking: women and girls are more likely to mask or camouflage their differences.

• Friendships: at school, autistic girls may be more likely to be part of a friendship group, so teachers may not notice differences, and good academic results can hide difficulties elsewhere.

• Stereotyped interests: repetitive behaviours and focused interests may look similar to those of non-autistic women and girls, such as twirling hair and reading books, so they can go unnoticed despite being more intense.

• Professional knowledge: doctors can lack knowledge about how autism may present differently, and traits may be put down to mental health issues or missed amid the symptoms of co-occurring conditions.

• Assessment tools: some diagnostic tools are designed to pick up characteristics that are more common in autistic men and boys, so they may be less sensitive to those more common in women and girls.

The National Autistic Society says women and girls may be misdiagnosed with mental health issues, or their autistic traits missed amid the symptoms of other conditions. The NHS says signs of autism may be harder to see in someone who has other conditions, such as ADHD, an eating disorder, anxiety, depression or a learning disability.

This does not mean that having anxiety or ADHD means you are autistic. It means that if the pattern of difficulties has been there since childhood, a proper assessment should consider the possibility.

The NHS says to speak to a GP to find out how to get an autism assessment in your local area. GPs can often refer adults to a local autism team. You may also be referred when you are getting help for another condition, for example if a mental health professional notices signs of autism.

The NHS says that if your referral is accepted it can take a few months or longer to get an assessment, and that a GP can tell you what support is available while you are waiting. If you are finding it hard to get a referral, you can ask to speak to someone else, such as another GP, for a second opinion. In England, you can choose which NHS service does the assessment and may be able to find a clinic with shorter waiting times, which is called Right to Choose.

You may have one or more appointments with a team of different healthcare professionals. The NHS says the team may ask you to fill in questionnaires, ask about how you behave with other people and about your early life and your life at home, work or college, speak to someone who knew you as a child, speak to someone who knows you now, read GP reports, and ask for documents such as school reports.

After the assessment you are given a report. The NHS says it should say whether you are autistic, what you are good at, what you might need help with, and whether any other conditions were found. You may be offered a follow-up appointment a few weeks or months later, and may be given a care plan or information to support you.

If you do not agree with the result, the NHS says to ask the assessment team why they made their decision. You can ask the GP or assessment team to refer you to another team for a second opinion, or you can pay for another assessment by a professional you choose who works outside the NHS.

The NHS lists help and support from a GP or local autism team, your local council, your school, college or workplace, local support services and national charities, including the National Autistic Society.

The National Autistic Society says masking can lead to mental illness, and that autistic people are more likely to experience mental health problems. The NHS says to get advice from 111 or ask for an urgent GP appointment if you need urgent help for your mental health. You can get help online or call 111 and select the mental health option.

The NHS says to call 999 or go to A&E now if someone's life is at risk, for example if they have seriously injured themselves or taken an overdose, or if you do not feel you can keep yourself or someone else safe. The NHS also points to Samaritans, a free listening service, for anyone who needs to talk.

On the NHS, the route is usually through a GP to a local autism team or, in England, a service you choose under Right to Choose. Waiting times vary by area and can be long.

Some adults arrange a private assessment, usually to be seen sooner. As the NHS notes for second opinions, you can pay for an assessment by a professional who works outside the NHS. It is sensible to check that the assessor is registered with a professional body, has experience of autism in adults and in women, and will provide a written report, and to tell your GP so that any support is joined up.