Practical Tips for Reducing Gender Bias from Autism Diagnostics
Gender bias within the field of autism diagnosis and reserach can, and does, leave many young girls and women without the support they need.
While a systemic approach is essential to providing nationwide improvements to diagnostics and care for women and girls with autism spectrum disorder (ASD), it can start with you. Discover how gender bias impacts autism diagnostics, and practical tips to avoid this bias in your own practice.
The Male-to-Female Ratio in Autism Diagnosis
The male-to-female prevalence ratios amongst children have recently narrowed from 4.2: in 2018, to 3.8 in 2020, and 3.4 in 2022 (Shaw, 2025). This latest number is closer to the findings of Loomes et al., who 2017 reviewed 54 studies and determined that the more accurate ratio of ASD prevalence between the sexes was 3:1 (2017).
The drastic increase in prevalence rates suggests new and refined diagnostic tools are more accurately identifying and diagnosing ASD in girls who previously went without support.
Bias, however, still exists. Therapists and counselors must proactively address this bias to better serve the children they work with.
Causes for Gender Bias in Diagnosis
The gender bias in ASD diagnosis is a complicated topic, mostly due to the fact that the causes behind the bias are multi-pronged. One of the easiest ways you can avoid or reduce gender bias in your own work is by simply being aware of the leading causes of gender bias.
Emphasis on the Male Autism Phenotype
The male autism phenotype is comprised of the observable characteristics most professionals are familiar with. By focusing on externalizing behaviors, which are more common in males with ASD, practitioners inevitably overlook autism in girls and women, who tend to internalize behaviors more often (Hull et al., 2020).
This greater emphasis on the male phenotype also plays a role in women with ASD as well, who do not identify with the ASD traits they see, and therefore do not seek out diagnosis, even when they are older (Gaffney, 2017).
Diagnostic Overshadowing
Females are more likely to be misdiagnosed. This is due to several factors, starting with an unfamiliarity with the female autism phenotype. Autistic females are more likely to experience low mood or anxiety, which is then misdiagnosed as conditions like major depressive disorder, rather than internalized symptoms of undiagnosed ASD (Cook et al., 2024).
Gender Socialization
One of the leading reasons researchers believe girls often internalize behaviors is socialization. Societal expectations can lead many girls to mask their behaviors and responses so they stand out less from their peers (Hoominfar, 2021). By masking, girls are less likely to be identified with autism characteristics than boys.
How to Avoid Gender Bias in Your Diagnostics
The best way to avoid gender bias in your diagnostics is to first be aware of the bias, and then to use a multi-diagnostic, collaborative approach, which is consistently recommended by advocates and researchers (Bhargava & Ashwin, 2025).
Single diagnostic tools provide false positives, or may not be enough to catch characteristics when the child is masking. Learn how you can improve your diagnostic capabilities and help more children by adding (ADOS®-2) Autism Diagnostic Observation Schedule, Second Edition and (ADI®-R) Autism Diagnostic Interview to your toolkit.
