Unmasking Autism: The Rising Awareness of Autism Spectrum Disorder in Adults and Across Genders

Over the years, there has been greater awareness (in research, practice, and the general population) of Autism Spectrum Disorder (ASD) and its detection across a person’s lifespan. This growing recognition and heightened understanding are reflected in the surge in ASD diagnoses among adults¹. In addition, the clinical community and the public have come to appreciate the important research that continues today. That said, this growing interest is sparking demand for an assessment tailored specifically for adulthood.

As outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), ASD is a developmental disorder that affects an individual’s communication, behavior, and social interactions with others². The broad range of symptoms and related concerns fall along a continuum of severity, highlighting the various levels of intellectual- and adaptive-functioning challenges experienced by autistic individuals.

Individuals with ASD often face behavioral and functional challenges. Some can experience cognitive impairments. Many experience verbal and non-verbal communication deficits, including delayed language development and difficulties interpreting social cues; other behavioral problems can include emotional outbursts and aggression, often due to overstimulation or changes in their daily routine or environment^3,4. These individuals may also experience difficulties with everyday tasks, such as planning and organizing their to-do lists. These challenges can sometimes be related to feelings of overstimulation due to sensitivities to sounds, lights, textures and/or smells⁵.

As of 2024, approximately 2.78% (i.e., 1 in 36) of children and 2.21% (i.e., 1 in 45) of adults are diagnosed with ASD in the U.S.⁶. However, one particular research trend noted a difference in ASD rates between genders, with studies indicating that ASD is approximately four times more commonly diagnosed in males than in females^6,7.

This gender discrepancy has sparked in-depth discussions about how ASD presents across genders. Understanding these differences is crucial for developing effective measures to accurately identify ASD. By recognizing and addressing these gender-specific variations, we can improve diagnostic tools and ensure that individuals with ASD receive the support and resources they need.

Gender differences in ASD

• Social impairments: Men and boys with ASD often face more significant social challenges compared to women and girls with ASD⁸. Research suggests that this difference may be due to an overall motivation in women to be more empathetic and socially adept⁹.
• Behavioral differences: Autistic men tend to exhibit poor emotional skills and a tendency to express their feelings outwardly, which can present as behavioral problems and inattention¹⁰. In contrast, autistic women often showcase internalizing behaviors, manifesting as anxiety, depression, and social withdrawal.
• Stereotypical behaviors: Autistic men often show more stereotypical behaviors, like repetitive actions and interests in mechanical subjects (e.g., the inner workings of engines, gears, and machinery). Autistic women tend to have repetitive behaviors related to more typically gendered social norms, such as interests in art, animals, and literature⁸. They are less likely to show stereotypical movements like hand-flapping or rocking. Instead, females often have strict routines¹¹ and perfectionist tendencies¹², which can cause distress if disrupted.

What is “masking” and why is it a challenge to diagnose?

A significant factor that contributes to differences in autism-related symptoms between genders is “camouflaging” or “masking,” which is the conscious or unconscious suppression of traits and behaviors related to ASD to conform to social norms.

Research has shown that autistic women tend to mask for functional purposes, such as assimilating in the workplace and educational settings. In contrast, autistic men mask for social comfortability¹³. Overall, studies have shown that masking is more common among women⁸ because they may face more stigma than men for displaying stereotypical traits, such as being disruptive or less empathetic, which contributes to the perceived “need” to mask their ASD traits¹⁴. As a result, autistic women often display increased self-control and intricate empathy skills, which are efforts to hide traits of autism¹⁵.

Some argue that it also makes these individuals more prone to additional stressors. Masking is a taxing process requiring emotional labor and is considered a predictor of psychological distress and functional challenges. These challenges can appear as difficulties with impulse control, emotional regulation, and social deficits¹³. Masking, as a growing understanding shows, is associated with generalized and social anxiety, depression, and exhaustion. It has also been found to negatively affect self-perception, leading to feelings of deception, isolation, and alienation¹³.

Despite these stressors, masking can also serve as a coping strategy for many autistic individuals. The act of masking can become an unconscious, undetectable process as people age, and a habit that cannot be easily broken. Thus, masking can pose a challenge in making a proper diagnosis, as some symptoms and features related to traditional identification and diagnoses of autism may be suppressed or difficult to observe, especially in women with ASD.

Misdiagnoses and underdiagnoses: Other challenges for assessing ASD

In addition to masking, other factors pose challenges for diagnosing ASD in females (as compared to males). The similarities in characteristics between ASD and other mental health conditions, such as Anorexia Nervosa and Borderline Personality Disorder (BPD), may contribute to the misdiagnosis and underdiagnosis of ASD in females.

Several epidemiological studies have highlighted the overlaps between Anorexia Nervosa and ASD¹⁶. Many individuals with ASD may only eat a limited range of foods they consider “safe” due to sensory issues with certain textures, tastes, or smells in food¹⁷. This restricted eating pattern closely resembles what is typical of individuals with anorexia¹⁸. Additionally, patients with anorexia have reported social difficulties, a lack of emotional reciprocity, and an altered theory of mind, all of which are also prevalent in ASD¹⁶.

As for overlaps between ASD and BPD, patients with BPD (typically female), display symptoms that include reduced empathy and socioemotional reciprocity, difficulties with regulating emotions, altered reactions to stimuli, outbursts of anger, and increased self-injuring or suicidal behaviours¹⁶–all similar to individuals with ASD.

Unique challenges for ASD assessment

The profile of ASD is significantly complex. Integrating this critical information around ASD can greatly inform the assessment process. For instance, standardized assessments, such as the Autism Spectrum Rating Scales™ (ASRS^®) — designed for use with children and adolescents aged two to 18¹⁹ — can provide multi-informant perspectives to help identify symptoms that are present in some settings (e.g., at home and observable by a parent or partner), but may be masked at work or in social settings (e.g., invisible to a peer or colleague). With the increasing awareness and understanding of ASD, the need for further research and tailored assessments continues to grow. These initiatives will lead to more accuracy in the diagnostic process and ensure that individuals obtain the necessary resources and accommodations to excel in their daily lives.

While MHS currently offers the ASRS for young children and youth, we are excited to announce that a solution for adults is in the works. Stay engaged through MHS’ newsletter for the latest developments on how we plan to measure and identify ASD in adults.

Have any questions? Contact us today to learn more about our MHS solutions for health care and clinical assessment needs.

  References

¹ Mundell, E. (2024, October 30). Autism diagnoses rising among U.S. children, adults. Medical Xpress.
² American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev).
³ Autism Research Institute. (2024a, September 10). Treating challenging behaviors.
⁴ Autism Research Institute. (2024b, September 10). Challenging behaviors and autism.
⁵ Neuro Launch. (2024, August 11). High-functioning autism and sensory issues: Navigating challenges and solutions.
⁶ Centers for Disease Control and Prevention. (2024, May 15). Data and statistics on autism spectrum disorder.
⁷ Solmi, M., Song, M., Yon, D. K., Lee, S-W., Fombonne, E., Kim, M. S., Park, S., Lee, M., Hwang, J., Keller, R., Koyanagi, A., Jacob, L., Dragioti, E., Smith, L., Correll, C., Fusar-Poli, P., Croatto, G., Carvalho, A., Oh, J. W., & Cortese, S. (2022). Incidence, prevalence, and global burden of autism spectrum disorder from 1990 to 2019 across 204 countries. Molecular Psychiatry, 27(10), 1–9.
⁸ Rujeedawa, T., & Zaman, S. H. (2022). The diagnosis and management of autism spectrum disorder (ASD) in adult females in the presence or absence of an intellectual disability. International Journal of Environmental Research and Public Health, 19(3), 1315.
⁹ Guy-Evans, O. (2025, January 2). Autistic female friendships: Challenges & strengths. Simply Psychology.
¹⁰ Altman, L., & Turk, J. (2016). Comparison of autistic profiles in young females and males with autism spectrum disorder: A review of the literature. Journal of the American Academy of Child and Adolescent Psychiatry, 55(10), S106–S106.
¹¹ Zauderer, S. (2024, February 24). High functioning autism in women: Challenges and strengths. Cross River Therapy. 
¹² Harvard Medical School. (2023, November 16). How is autism different in women. Adult Autism Health Resources.
¹³ Alaghband-rad, J., Hajikarim-Hamedani, A., & Motamed, M. (2023). Camouflage and masking behavior in adult autism. Frontiers in Psychiatry, 14, 1108110–1108110.
¹⁴ Schuck, R. K., Flores, R. E., & Fung, L. K. (2019). Brief report: Sex/gender differences in symptomology and camouflaging in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 49(6), 2597–2604.
¹⁵ Tubío-Fungueiriño, M., Cruz, S., Sampaio, A., Carracedo, A., & Fernández-Prieto, M. (2021). Social camouflaging in females with autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 51(7), 2190–2199.
¹⁶ Dell’Osso, L., & Carpita, B. (2023). What misdiagnoses do women with autism spectrum disorder receive in the DSM-5? CNS Spectrums, 28(3), 269–270.
¹⁷ Blair, M. (2022, December 6). The overlap between anorexia and autism. Psychology Today.
¹⁸ Westwood, H., & Tchanturia, K. (2017). Autism spectrum disorder in anorexia nervosa: An updated literature review. Current Psychiatry Reports, 19(41).
¹⁹ Goldstein, S. & Naglieri, J. A. (2013). Autism Spectrum Rating Scales. Multi-Health Systems, Inc.