Why Girls and Nonbinary Kids Are Often Diagnosed with Autism Later

Why Are Girls and Nonbinary Kids Often Diagnosed with Autism Later?

For decades, autism research and diagnostic tools have centered on boys, which means many girls and nonbinary children grow up without the recognition or support they need. When a diagnosis finally arrives, it often follows years of confusion, burnout, and feeling misunderstood. Since early support can make a meaningful difference, it is important to understand why these later diagnoses happen and how we can create more accurate, affirming pathways for all children.

Diagnostic Tools Were Built with Boys in Mind

Much of what professionals use to identify autism was shaped by early research that focused almost entirely on cisgender boys. This created a clinical template that does not fully reflect how autism may show up in girls or nonbinary youth. Many experience the same core traits, such as sensory sensitivities, communication differences, and deep interests, but these traits are often expressed in quieter or more socially shaped ways. Because of this, early signs may appear subtle or be mistaken for personality style rather than neurodivergence.

Masking: A Survival Strategy That Delays Recognition

One of the biggest reasons traits go unnoticed is masking. Masking, sometimes called camouflaging, is when an autistic person hides or compensates for their natural behaviors in order to blend into social environments. This can look like forcing eye contact, copying speech patterns, hiding stims, rehearsing conversations, or smiling on cue even during distress.

Girls and nonbinary youth often mask more frequently because of social expectations to be agreeable, mature, or socially intuitive. Although masking can reduce bullying or unwanted attention, it comes at a significant cost. Many young people who mask experience exhaustion, anxiety, shutdowns, or long-term burnout. Since they appear to be coping, adults around them may miss signs of deeper overwhelm.

Internalizing vs. Externalizing Behaviors

Another barrier arises from how different children express distress. Boys are often diagnosed earlier because they may externalize their challenges, such as meltdowns, hyperactivity, or difficulty following school routines. These behaviors are visible and prompt evaluation.

Girls and nonbinary children often do the opposite. They internalize. A child may seem quiet, perfectionistic, overly accommodating, or socially anxious, yet deeply overwhelmed on the inside. Because these patterns look like shyness or sensitivity, adults may not recognize them as autistic traits.

As a result, many receive other diagnoses first, including anxiety, depression, ADHD, eating disorders, or borderline personality disorder. These diagnoses may reflect real symptoms, but they can miss the deeper root, the autistic needs that are actually driving the distress.

The Added Layer for Gender-Diverse Youth

For nonbinary, trans, and other gender-diverse young people, the path to diagnosis can be even harder to navigate. Some clinicians are unfamiliar with how autism intersects with gender identity. Autistic traits may be misread as part of gender exploration or dismissed entirely. This creates another layer of invisibility and can delay access to supportive, affirming care.

Autism and gender diversity can absolutely coexist. A child might need support with sensory differences, communication preferences, and gender expression. Recognizing one should never overshadow or invalidate the other.

Why This Matters

A delayed diagnosis is not a failure. It is a reflection of systems that were not built with certain people in mind. Without recognition, many girls and nonbinary youth spend years without language to describe their experiences or accommodations that would make daily life more manageable. Early identification, when possible, is not about labeling. It is about access. With the right understanding and support, young people can build stronger self-esteem, healthier coping tools, and more affirming relationships.

Helpful Resources to Learn More

• Autistic Girls Network
• SPARK for Autism - Girls and Women
• Behavioral Innovations - Autism Gender Differences
• Camouflage: The Hidden Lives of Autistic Women by Dr. Sarah Bargiela
• Odd Girl Out: An Autistic Woman in a Neurotypical World by Laura James
• 5 TedX Talks from Women with Autism - From the American Autism Association
• A Guide to Mental Health Issues in Girls and Young Women on the Autism Spectrum: Diagnosis, Intervention and Family Support by Dr. Judy Eaton

Looking for Support or Next Steps?

If you are seeking autism-friendly resources, diagnostic guidance, or support tailored to your child’s strengths, Alpaca Health connects families with local, independent clinicians who prioritize individualized care. Learn more about our providers and approach at AlpacaHealth.