A review of the role of female gender in autism spectrum disorders.

Kirkovski et al. (2013) looked at every paper they could find on girls with autism. They wanted to know why females are often missed or diagnosed late.

The team read studies, case reports, and expert opinions. They did not run new tests. They stitched the clues together like a detective story.

Girls with ASD often hide in plain sight. Their social struggles can look like shyness, not autism.

Most research was built around boys, so the usual checklists miss the quieter female signs. High-functioning girls are the most likely to slip through.

Rutherford et al. (2016) later counted real clinic charts and proved the delay: girls get referred later than boys.

Bottini et al. (2025) showed why. Clinicians rated the exact same autism story as more severe when the child was labeled female, revealing hidden bias.

Backer van Ommeren et al. (2017) gave a concrete example: girls with ASD played back-and-forth games better than boys with ASD, so they can pass social tests and still need help.

If you screen with boy-shaped lenses, you will miss the girls. Add sex-aware questions to your intake forms. Watch for subtle signs: a girl who clings to one friend, copies peers word-for-word, or melts down only at home. Trust parent worries even when school reports look fine. Earlier identification means earlier intervention and better long-term outcomes.