Hidden struggles: how girls bypass autism diagnosis and face mental health tolls

Autistic girls often go undiagnosed for years due to camouflaging and atypical presentations, leading to increased mental health risks and missed opportunities for support, as families share heartbreaking stories of delay and tragedy.

Ruby Hobbs-Leffler’s story is a painful example of how autism in girls can hide in plain sight for years, even as the signs become impossible to miss in retrospect. Her mother, Jessica Leffler, said Ruby was bright, articulate and intensely sensitive to noise, touch, taste and change, yet too often was seen as difficult rather than overwhelmed. By the time Ruby was diagnosed with autism at 14, the family already had years of confusion, missed opportunities and growing distress behind them.

That delay matters because girls with autism are often identified much later than boys, especially when they do not have an intellectual disability. Researchers have found that boys are more likely to be diagnosed in early childhood, while girls are more often recognised either very young or not until adolescence. According to a 2024 review of medical records cited in the reporting, girls are frequently first diagnosed with depression or anxiety before autism is considered, which can push the correct diagnosis even further away.

Specialists say the problem is not simply that girls are less likely to have autism, but that the condition often looks different in them. Lauren Kenworthy, chief of neuropsychology at Children’s National in Washington, said girl autism often does not match the checklist clinicians have been trained to expect. Boys are more likely to show obvious repetitive movements or limited eye contact, while girls may become skilled at mimicking eye contact, social responses and classroom behaviour. Their interests can be just as intense as boys’, but may appear more typical on the surface, which makes them easier to overlook.

That effort to blend in is often described as camouflaging or masking. A 2024 study published in the journal Child and Adolescent Mental Health found that camouflaging is common as girls move into adolescence and is linked with depression and anxiety. Another 2024 study of women and men with autism found that higher levels of camouflaging were associated with a later autism diagnosis. Researchers say that can create a damaging cycle: girls are praised for coping, when in fact they are working constantly to hide the strain.

The consequences can be serious. Research cited in the article shows that autistic girls and women face elevated risks of anxiety, depression and suicidal behaviour, with teenage years often marking a sharp rise in mental health difficulties. A 2024 Duke University analysis of hospital records found that girls later diagnosed with autism were also likely to have received prior diagnoses of anxiety or depression. That pattern can obscure the real issue, said Matthew Engelhard, a Duke biostatistician, because treatment aimed at mood symptoms alone may miss the underlying neurodevelopmental condition.

For some families, that delay ends in tragedy. After her daughter Maisa, 13, attempted suicide in 2023, Samia McCall began reading about neurodiversity and became convinced that autism fit her daughter’s experience. She said doctors and a therapist dismissed the idea because Maisa was verbally fluent, did well in school and seemed empathetic. Maisa died by suicide later that year, while still waiting for a formal evaluation. McCall, Leffler and another grieving mother have since launched the Seen Movement, arguing that children showing signs of distress need earlier recognition and support, not just crisis response.

The research does not suggest that diagnosis alone prevents mental health harm, but it does point to a different and often overlooked benefit: understanding. Anne Kirby of Trinity College Dublin, who has interviewed autistic adults about suicide and diagnosis, says many women who are identified later in life describe a sense of relief once they can name what has long felt wrong. They may still struggle, but they are better able to make adjustments, ask for breaks and stop blaming themselves for traits they were never meant to suppress. For Ruby’s mother, that is the missed chance that hurts most.

Ruby, Leffler said, thrived once she understood herself. She loved online learning, enjoyed her jobs, and had plans for the future. But after a series of medical and mental health crises in 2024, and after providers dismissed her autism as unimportant, she died by suicide at 15. Leffler now talks about her daughter as a reminder of what can happen when a girl spends years learning that her needs are a problem rather than a clue. “She was a bright, cuddly, sparkly person,” she said. “She deserves to be loved and missed.”