Why Many Neurodivergent Girls, Women, and AFAB Individuals are Missed
By: Ella Gilmour and Holly Smallbone
Understanding the Mental Health Impact of Late Diagnosis
What is neurodivergence?
In recent years, there has been a welcome shift from neurological differences being viewed as inherently broken or impaired traits (medical model) towards a more inclusive strengths-based model that acknowledges differences are naturally occurring and required for human society to thrive.
The neurodiversity movement recognises that there are many different ways people think, learn, communicate, process information, and experience the world. Today, neurodivergence is widely used as an umbrella term to describe people whose brains work differently, including autistic people, people with ADHD, OCD, dyslexia, and other cognitive and learning differences.
Awareness and identification of autism and ADHD have increased significantly in recent years, driven by improved diagnostic understanding, advocacy, and access to assessment (Brugha et al., 2016). However, many neurodivergent girls, women, and assigned female at birth (AFAB) people continue to be overlooked, misdiagnosed, or identified later in life, often after years of navigating challenges without the understanding or support they needed.
"The neurodiversity movement recognises that there are many different ways people think, learn, communicate, process information, and experience the world."
Gender differences and neurodivergence
Historically, autism and ADHD were considered more common in boys and men. However, recent research is now suggesting that this difference is likely influenced, at least in part, by the fact that many neurodivergent girls and women have been missed or misunderstood until later in life (Maciver et al., 2026). In fact, McCrossin (2020) estimated that approximately 80% of autistic females remain undiagnosed by age 18.
One key reason for this is that early research and diagnostic criteria were largely based on observable behaviours and presentations more commonly seen in boys. A classic example of this is boys with ADHD who are hyperactive, impulsive, and distractable - a child who repeatedly disrupts his classmates and teacher, is more likely to be identified early for assessment and be offered supports to help adaptive functioning in the classroom.
Because girls are more likely to internalise their challenges, they are more likely to be overlooked. For many girls, neurodivergence presents as perfectionism, anxiety, emotional overwhelm, exhaustion, or feeling like they need to work much harder than others to keep up with social and cognitive demands (Lockwood Estrin et al., 2021). Another factor is masking; the process of consciously or unconsciously hiding parts of yourself in order to fit in or meet social expectations. Research has found that neurodivergent girls and women are more likely to engage in masking behaviours, such as mimicking how others communicate, forcing themselves through uncomfortable situations, or constantly monitoring their behaviour.
While it can be effective in the short term, masking can become exhausting over time. Many neurodivergent people describe experiencing burnout, feeling disconnected from themselves, or facing mental health difficulties after years of trying to appear as though everything is fine (Ai et al., 2022; Livingston et al., 2019). Many neurodivergent women are diagnosed following puberty, motherhood or during perimenopause when compensatory behaviours such as masking fall down due to the many additional responsibilities and psychological and physiological changes that occur (Gu, Dawson, & Engelhard, (2023)).
Because their experiences are often less visible, many neurodivergent girls and women are diagnosed later in life or receive other diagnoses first, such as anxiety, depression, eating disorders, or personality disorders. While these conditions may be genuine and require support, they may not always capture the full picture of someone’s experiences, especially the underlying neurological differences that may be contributing to their presentation (Carpita et al., 2023; Smith et al., 2024).
“Parents often hear 'she’s just anxious', 'she’ll grow out of it', 'she’s doing fine at school."' — Monique Mitchelson, Neurodivergent Clinical Psychologist
The mental health impacts of being unseen
Living in a world designed around neurotypical expectations can be challenging for many neurodivergent people. Differences in sensory processing, communication, attention, and executive functioning can make everyday demands more difficult and lead to chronic stress, particularly when environments are not designed with these differences in mind (De Vaan et al., 2020).
Research shows that autistic people and people with ADHD experience higher rates of anxiety, depression, eating disorders, substance use difficulties, self-harm, and suicidal thoughts compared with the general population (Huke et al., 2013; Hargitai et al., 2026). However, these difficulties are not simply inherent to being neurodivergent. For many girls and women, mental health difficulties develop after years of feeling overlooked, misunderstood, or expected to “cope” or push through without adequate recognition or support, and without ever receiving an explanation for why certain things feel so hard.
Over time, experiences such as chronic stress, masking, perfectionism, and repeated feelings of being “different” can take a significant toll. Many neurodivergent girls and women describe struggling with anxiety, low self-worth, burnout, self-criticism, and a general sense of disconnection from who they truly are.
Understanding this connection is crucial. Rather than viewing anxiety, depression, or burnout as separate from neurodivergence, we must consider how chronic stress, sensory overload, unmet needs, and invalidation can accumulate and contribute to emotional distress over time (Hargitai et al., 2026).
"Research shows that autistic people and people with ADHD experience higher rates of anxiety, depression, eating disorders, substance use difficulties, self-harm, and suicidal thoughts compared with the general population."
Supporting neurodivergent girls and women to be who they are
The good news is that many of the challenges experienced by neurodivergent people are not fixed or inevitable. When people are understood, accepted, and supported, their wellbeing can improve significantly. Research consistently highlights the importance of acceptance, validation, and supportive relationships in promoting positive outcomes for neurodivergent people. This includes creating environments where people do not have to constantly hide who they are, and where their differences are recognised as part of who they are rather than something to change or overcome (Ferenc et al., 2023; Milton & Sims, 2016).
From a practical perspective, some helpful approaches include:
· Creating spaces where people feel safe to be themselves without needing to mask
· Recognising and celebrating individual strengths and differences
· Listening to lived experience as valuable expertise
· Providing practical accommodations for sensory, communication, and executive functioning needs
· Supporting the development of a positive neurodivergent identity
· Making assessment and support more accessible
In psychology, this approach is referred to as neurodiversity-affirming care. Rather than trying to “fix” neurodivergent traits or help someone conform to neurotypical expectations, the focus is on understanding how a person’s brain works and adapting support to fit them (Chapman, R., & Botha, M., 2023., Flower et al., 2025). In other words, it is about working with rather than against a person’s neurodivergence.
Therapeutic work often involves developing self-compassion, improving emotional regulation, exploring identity, building strategies that work with someone’s natural thinking style, and reducing the impact of shame or self-blame (Mason et al., 2023; Graf‐Kurtulus & Gelo, 2025). For many girls and women who have spent years feeling misunderstood, receiving support that recognises their experiences can be an important step towards greater self-understanding, confidence, and wellbeing.
As a neurodiversity-affirming psychologist, I am passionate about creating spaces where autistic, ADHD, and other neurodivergent adolescents and adults feel understood, supported, and empowered. I aim to help people better understand themselves, develop practical tools and strategies, and build a life that feels meaningful and authentic to them.
About the Author
Ella is a Clinical Psychology Registrar and a warm, person-centred psychologist who is passionate about supporting and empowering individuals across all stages of life. She takes a gentle, collaborative approach, valuing the input of clients as the experts in their own experiences and striving to meet people where they are at with curiosity, respect, and genuineness.
She is currently accepting new referrals at our new practice in Toowong.
Contact
If you or a young person you care about are seeking support with mental health difficulties, My Psych Clinic has trained clinical and generally registered psychologists who are available to provide treatment and management of a variety of problems. You can enquire about sessions by calling our friendly reception team on 07 3349 5511 or by submitting an online enquiry via our website.
My Psych Clinic is not an emergency or crisis service. We are unable to respond to communication of a crisis nature through social media, our website or when the practice is closed. Please use the support services below for crisis or emergency and for general enquiries, contact us during our office hours.
If you are seriously injured or know someone who is at risk of harm right now, call Triple Zero (000).
If you require crisis support or immediate counselling, contact Lifeline 13 11 14 or Beyond Blue 1300 22 4636 for 24/7 support. Alternatively, present to your doctor or nearest hospital Emergency Department.
Helpful Resources:
Yellow Ladybugs: a non-government organisation, dedicated to the happiness, success and celebration of autistic girls, women and gender diverse individuals across Australia.
The Neurodivergent Women Podcast: a podcast hosted by Australian psychologists Monique Mitchelson and Michelle Livock that explores the lived experiences of neurodivergent women through compassionate interviews, practical strategies, and the latest research.
Autism Connect: Call 1300 308 699 (open weekdays 8 am - 7 pm) for free national autism information, advice, and referrals
ADHD Foundation Helpline: Call 1300 39 39 19 for support and enquiries regarding ADHD
References:
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