Gender-specific aspects of diagnosing autism in girls: a qualitative study of parent and professional perspectives

Abstract

Abstract

Purpose The purpose of this study is to gain a deeper understanding of the diagnostic process of autism spectrum disorders (ASD) in girls from the perspectives of parents and professionals. It seeks to identify factors that facilitate or hinder diagnosis and to describe the role of gender expectations and symptom camouflaging in clinical practice. The broader literature on autistic girls and women is used to contextualise the empirical findings, but the study itself is based on parent and professional accounts rather than direct accounts from autistic girls or women. Design/methodology/approach This study uses a qualitative research design based on nine semi-structured interviews with three parents of girls with ASD, four special educators and two psychologists. Data were analysed using grounded theory procedures, including open, axial and selective coding, to capture the complexity of the diagnostic process. Findings The findings reveal a “systemic invisibility” of autism in girls, resulting from an interplay of individual adaptive strategies (camouflaging), gender-insensitive diagnostic frameworks, the inherent complexity of autism assessment and systemic fragmentation. Results indicate that the inconspicuous nature of difficulties often leads to a diagnostic blind spot, causing delayed diagnoses that may carry significant psychological costs, such as increased anxiety and exhaustion. More specifically, the findings suggest that diagnostic visibility is reduced through the interaction of inconspicuous presentation, compensatory social behaviour, gendered interpretations, variable professional experience and fragmented assessment pathways. Research limitations/implications The study is limited by its small qualitative sample size, specific institutional context and the absence of direct accounts from autistic girls and women. Future research should incorporate the voices of autistic girls and women themselves, include a broader range of clinical and educational settings, and examine how gender intersects with age, intellectual and language profile, socioeconomic position, ethnicity, family resources and school context in shaping diagnostic trajectories. Practical implications The results underscore the need for a gender-sensitive and context-sensitive approach to ASD assessment, while also recognising the genuine complexity of differential diagnosis. Effective diagnosis requires thorough developmental history, interdisciplinary collaboration between families, schools and professionals, careful consideration of symptom overlap with other conditions and systematic accounting for camouflaging strategies. Clinicians should compare behaviour across settings, attend to discrepancies between public coping and post-social exhaustion and avoid relying solely on standardised scores without integrating broader contextual information. Social implications By addressing structural gaps and coordination challenges in current diagnostic practices, this research advocates for more responsive support and improved quality of life for girls who may otherwise be misunderstood or isolated due to delayed diagnosis. The findings also have relevance for understanding the later experiences of women who receive an autism diagnosis in adolescence or adulthood, although women were not directly included as participants in the present study. Originality/value This study contributes to the field by offering an integrated process-oriented model of diagnostic invisibility that brings together individual, relational and service-level factors. It conceptualises late or complicated diagnosis not as an individual failure or as a simple failure of professionals, but as a complex interaction between subtle presentation, compensatory behaviour, diagnostic uncertainty, gendered expectations and fragmented assessment pathways. The study extends existing camouflaging-focused accounts by showing how these factors interact across the diagnostic process to reduce recognition of autism in girls.