Neurodiverse Girls

Gender Differences in Autism and ADHD

Neurodiversity is a framework that provides an understanding of neurological differences as natural variations of human functioning, rather than deficits or disorders. This perspective includes conditions like autism, ADHD and dyslexia, and recognises both strengths and support needs. However, in girls and women, neurodivergence has historically been under-recognised and poorly understood, largely due to research and diagnostic criteria being based predominantly on male presentations (Loomes et al., 2017; Quinn & Madhoo, 2014).

One of the key challenges is underdiagnosis and misdiagnosis. Early research into autism and ADHD focused heavily on males, which has shaped diagnostic frameworks that do not always reflect how these present in females. As a result, many girls and women may not meet traditional diagnostic expectations, despite experiencing significant challenges (Loomes et al., 2017). This contributes to delayed or missed identification, especially during childhood and adolescence.

Differences in presentation also play an important role. For example, girls with ADHD are more likely to present with inattentive symptoms rather than hyperactivity, which can make their difficulties less visible in structured environments such as school (Quinn & Madhoo, 2014). The hyperactivity may not be the stereotypical physical energy and restlessness, but cognitive anxiety. The hyperactivity can be internalised as worrying, brain noise, ruminations and intrusive thoughts. Similarly, autistic girls and women may engage in higher levels of social camouflaging and masking behaviours, consciously or unconsciously mimicking social norms and appearing socially competent. Masking requires huge amounts of internal resources and leads to exhaustion and burnout (Bargiela et al., 2016; Milner et al., 2023).

Autistic burnout is an increasingly recognised experience, particularly among autistic women, and is characterised by chronic exhaustion, depression and anxiety, and a loss of previously accessible skills due to prolonged stress and demands (Higgins et al., 2021; Raymaker et al., 2020). Burnout is often linked to the cumulative impact of masking and ongoing efforts to meet social expectations, especially pronounced for women who have spent decades camouflaging their differences (Raymaker et al., 2020). Importantly, autistic burnout is different from clinical depression or occupational burnout because it is specifically tied to the experience of being autistic in a world not designed to meet neurodivergent needs (Higgins et al., 2021). Healing from neurodivergent burnout is a process of connecting to the human underneath the mask, the authentic self, and learning what the mind and body truly needs to self-regulate and thrive.

Social and cultural expectations further shape how neurodivergence is expressed and perceived. Gender norms often encourage girls to be socially attuned, compliant, and emotionally sensitive. As a result, neurodivergent girls may work harder to conform, adapting critical thinking skills, self-monitoring behaviours and conscious "analysing" of people and situations in order to understand and fit in. This can contribute to higher rates of anxiety, depression, and low self-esteem, becoming the primary focus of clinical attention rather than correctly identifying their underlying neurodevelopmental profile (Bargiela et al., 2016).

Co-occurring mental health conditions are also common and can complicate accurate diagnosis and treatment. Neurodivergent women are more likely to experience anxiety, depression, obsessive–compulsive symptoms, eating disorders, trauma and be diagnosed with personality disorders (Quinn & Madhoo, 2014).

Many women are therefore diagnosed later in life. Late diagnosis can bring relief and clarity, but can also bring sense of grief, particularly if earlier challenges were misunderstood and lead to missed opportunities (Bargiela et al., 2016). Therefore, neuroaffirming therapy highlights the strengths of having a different brain, such as creativity, intense focus and knowledge in key areas, problem-solving, attention to detail, and high emotional intelligence (Jaarsma & Welin, 2012).

Overall, understanding neurodiversity in girls and women requires an sensitivity to societal and cultural expectations along side identifying the core features of neurodevelopmental conditions. A thorough psychological assessment and developmental history is essential to getting the correct diagnosis and should never by rushed for risk of misdiagnosis. At Lilly Pilly we recommend finding a psychotherapist, psychologist or psychiatrist who takes a thoughtful, personalised approach to understanding you.

References

Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294.

Higgins, J. M., Arnold, S. R. C., Weise, J., Pellicano, E., & Trollor, J. N. (2021). Defining autistic burnout through experts by lived experience: Grounded Delphi method investigating #AutisticBurnout. Autism, 25(8), 2356–2369.

Jaarsma, P., & Welin, S. (2012). Autism as a natural human variation: Reflections on the claims of the neurodiversity movement. Health Care Analysis, 20(1), 20–30.

Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 466–474.

Milner, V., Mandy, W., Happé, F., & Colvert, E. (2023). Sex differences in predictors and outcomes of camouflaging: Comparing diagnosed autistic, high autistic trait and low autistic trait young adults. Autism, 27(2), 402–414.

Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3), PCC.

Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M.,

Joyce, A., & Nicolaidis, C. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism in Adulthood, 2(2), 132–143.