Expanding Understanding of Autism Spectrum Disorder in Girls and Women: A New Paradigm

The definition of Autism Spectrum Disorder (ASD) has evolved since the diagnosis was first conceptualized. However, past and current understandings of ASD have largely been shaped by research focused on individuals assigned male at birth. This has influenced current diagnostic criteria, which often fail to capture female presentations and likely contribute to lower reported prevalence rates in girls. Recognizing female-specific presentations is critical to reducing misdiagnosis and underdiagnosis; therefore, this paper reviews research on how the DSM-5-TR two-factor model applies to girls. We then describe how female presentations of ASD are characterized by distinct cognitive profiles and frequent use of camouflaging to mask typical ASD symptoms, particularly social difficulties, which can obscure clinical presentation and delay diagnosis. Subsequently, we evaluate how current assessments and accommodations may fail to address the needs of females. Clauss-Ehlers introduces the Multimodal Autism Assessment for Girls and Women, which emphasizes the importance of assessing girls within an appropriate contextual lens. Finally, the paper calls for a gender-focused neurodiversity paradigm that highlights differences in presentation, promotes an approach focused on strength-based interventions, and outlines directions for future research and clinical implications based on this framework.