The Cost of Fitting In: Masking in Neurodivergent Girls

Masking in girls is often more fluent.

My friend and I were catching up. We were taking turns speaking, asking questions, and showing interest in each other's lives; everything seemed fine. There were no obvious red flags, but something felt different. There was no natural flow to the conversation.

The questions were along the lines of the following:

"How are you?"

"Tell me more."

"What about this?"

Then it would be the other person's turn to ask.

You could say,

"Sukanksha, that's completely normal."

And on the surface, it was, but it felt different from conversations I have with my other girlfriends because she was masking.

Girls suppress and camouflage to fit in and they do it quite well.

The conversation felt rehearsed. Information was gathered, safe topics were discussed, and the questions were often similar. What was missing were the natural connections between ideas, the spontaneous

"Oh, something similar happened to me too"

that takes a conversation in an unexpected direction.

Instead, the conversation happened in chunks. One person spoke, the other responded, and then it was their turn. To an untrained eye, the interaction would seem absolutely normal.

Masking in girls often looks exactly like that. The social rules have been learned so well that the conversation appears typical. It's only when you pay attention to the rhythm of the interaction that you notice something feels different. So what’s so different about the girls?

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Why is Masking Different for Girls?

It will come as no surprise to anyone that over the years I have taught more boys than girls. Earlier in my career, we were often told that boys are more likely to be neurodivergent, while girls are more likely to present with difficulties such as dyslexia and dyscalculia and are on the milder side and, in some ways, more aligned with traditional female stereotypes.

As I advanced in my career, however, I realised that girls were not necessarily experiencing fewer difficulties. They were simply presenting them differently; they just cared about different things. This is just my observation, not necessarily a general rule but that made me curious. 

Many of the boys I worked with wanted to fit in but often did not actively seek out social conventions or try to change their behaviour to match them. Instead, they expected the environment to adapt, and quite often, it did. The girls, on the other hand, frequently wanted to make the effort to fit in. They wanted to camouflage. Their difficulties were often hidden behind stereotypes such as

"Girls just aren't good at math."

In conversations with my students over the years, I have heard girls ask questions such as,

"What makes me so different?"

"What do I need to change?"

Most of my observations come from working with middle schoolers and teenagers, but research suggests this process can begin much earlier. A study by Dean et al. found that girls with Autism Spectrum Disorder used compensatory behaviours in elementary school, such as staying in close proximity to peers and weaving in and out of activities.

These behaviours appeared to mask their social challenges and question the common assumption that autistic children are socially isolated, leaving them undiagnosed.

Research shows that autism is diagnosed more often in boys than girls. Clinical studies often report a ratio of about 4:1, boys to girls, but when researchers actively look for autism in the wider population, the ratio drops closer to 3:1. (Hull et al., 2017). This suggests that girls may be overlooked or diagnosed later because their autism presents differently and is harder to recognise, which to me really feels like a gap that needs to be filled fast.

We are failing them by not recognising them.

A similar pattern appears in ADHD. The more research I read, the more I find evidence that girls are often diagnosed later than boys. During childhood, the ratio of boys to girls diagnosed with ADHD is approximately 3:1. By adulthood, however, that ratio is much closer to 1:1, suggesting that many women and girls were simply missed earlier. (Attoe & Climie, 2023) 

Part of the reason may be that girls do not always present in ways that fit our expectations. A girl may not fidget or move around the room in the same way as a boy. Instead, she may be highly talkative, interrupt conversations, or be described as "bubbly".

I remember one consultation where a girl's presentation seemed consistent with ADHD, and I suggested exploring the possibility further. The parent's response was,

"She's just boyish. She'd rather play sports with the guys."

There is, of course, nothing wrong with playing sports or preferring the company of boys. That was not the concern. The concerns were her impulsivity, high energy levels, and other ADHD-related characteristics. They were present, but perhaps not elevated enough to fit the stereotypical image many people have of ADHD.

Reducing her behaviour to being

"boyish,"

"lively," or

"full of energy"

reflects a pattern consistently reported in research. Girls often require more severe symptom thresholds than boys before they are referred for ADHD assessment, creating a systemic delay in diagnosis. (Attoe & Climie, 2023)

There is another aspect worth considering.

Girls do camouflage when it comes to learning differences, but they are also often the ones who ask for help rather than resist it. They will approach a teacher for an explanation, confide in a parent that they are struggling, or simply work harder to compensate, and often, that effort works. They improve their grades – they achieve average or even above-average results. So they are left unrecognised, and from the outside, everything appears fine.

The consequences of this become visible when we look at identification rates. In the UK, 1.5 million children received SEN support in a single school year, yet only about 500,000 were girls. Girls made up just 34% to 36% of students receiving support across most of the country (Daniel & Wang, 2023).

Girls are not struggling less, but the environment is really failing them somewhere by not noticing them. 

It is tempting to assume that boys simply experience more learning difficulties. But when the same pattern appears across autism, ADHD, and learning differences, it raises a different possibility: maybe girls are not struggling less, but the environment is really failing them somewhere by not noticing them. 

So what is the cost of that?

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What is the cost of masking?

Remember my friend?

She lives quite independently and, by most standards, is doing very well. If you look closely, however, many of the systems she relies on to manage daily life have been developed over years of trial and error. Some came from specialists, but many came from friends, observations, and a constant effort to understand what works.

She has a large social circle, yet still struggles to form the deeper connections she wants. She often second-guesses her own judgement in social situations and seeks reassurance from others. Professionally, she performs extremely well, but organisation and planning can sometimes feel scattered and effortful.

Exercise is another example. She trains consistently and often tells me that without it, she would struggle to manage her energy levels. The strategy works. At times, it also feels as though she is paying a physical price to maintain that balance.

This is one of the hidden costs of masking and compensating for years.

From the outside, it can look like success. The person is functioning, achieving, and coping. What we don't always see is the amount of energy required to maintain those systems.

Over time, that effort can contribute to burnout, chronic stress, anxiety, depression, and a sense of exhaustion that is difficult to explain to others. The strategies work, but sometimes they are held together by sheer effort rather than sustainability.

The cost is spending years trying to solve a problem without knowing what the problem is. When difficulties remain unnamed, people often blame themselves. They assume they are lazy, disorganised, overly sensitive, socially awkward, or simply not trying hard enough. A diagnosis does not create difficulties; it gives context to difficulties that already exist.

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What helps?

Training

The good news is that we are starting to pay more attention to how neurodivergence presents in girls and women. However, awareness alone is not enough. Awareness is one place to start, but awareness is not as simple as handing teachers a checklist and asking them to tick boxes.

Some difficulties are easier to identify because there is very little interpretation involved. If a child has a visual impairment, an assessment can usually tell us whether there is a difficulty or not. The problem exists whether we notice it or not.

Neurodivergence is different. It relies heavily on observation and interpretation – a teacher notices a pattern, a parent feels something is not quite right, or a clinician pieces together behaviours that may look unrelated on the surface. The challenge is that girls often do not fit the picture people expect.

Think about the conversation with my friend. To an untrained eye, everything was fine. The conversation was appropriate, polite, and socially acceptable.

If there is no obvious problem, why go looking for one?

That is often how girls slip through the cracks. When identification depends on human judgement, awareness matters. The more we understand how girls present, the more likely we are to notice the quieter signs that may otherwise be dismissed as personality, maturity, shyness, being "bubbly", or simply trying hard.

This is why training needs to go beyond checklists. We need a better understanding of behaviour, context, coping strategies, and masking. Sometimes the difficulty is not hidden because it isn't there. It is hidden because the person has become very good at compensating for it.

Diagnosis also matters.

I have argued this for years: it does not matter whether a diagnosis comes in childhood, adolescence, or adulthood. For many individuals, a diagnosis provides an explanation for experiences they have been struggling to understand for years. It opens the door to more targeted support, sustainable coping strategies, and greater self-awareness.

Research has found that adult diagnosis can bring measurable relief (Attoe & Climie, 2023). Women often report reduced shame, improved self-esteem, and a greater sense of control once they understand why certain aspects of life have always felt more difficult.

Assessment tools:

We also need better assessment tools. Many of the diagnostic criteria and assessment measures currently used were developed using predominantly male samples. As a result, girls and women who present differently can still be overlooked, even when they are assessed.

If we want earlier and more accurate identification, our research, assessment tools, and understanding of neurodiversity need to continue evolving.

The goal is not to teach girls how to fit the diagnostic criteria. The goal is to ensure our understanding of neurodiversity is broad enough to recognise them when they do not.

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Learning differences are rarely just about what we can see.

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References:

1. Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8

2. Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M.-C., & Mandy, W. (2017). "Putting on my best normal": Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534. https://doi.org/10.1007/s10803-017-3166-5

3. Lai, M.-C., Lombardo, M. V., Ruigrok, A. N. V., Chakrabarti, B., Auyeung, B., Szatmari, P., Happé, F., Baron-Cohen, S., & MRC AIMS Consortium. (2017). Quantifying and exploring camouflaging in men and women with autism. Autism, 21(6), 690–702. https://doi.org/10.1177/1362361316671012

4. Dean, M., Harwood, R., & Kasari, C. (2017). The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder. Autism, 21(6), 678–689. https://doi.org/10.1177/1362361316671845

5. Ratto, A. B., Kenworthy, L., Yerys, B. E., Bascom, J., Wieckowski, A. T., White, S. W., Wallace, G. L., Pugliese, C., Schultz, R. T., Ollendick, T. H., Scarpa, A., Seese, S., Register-Brown, K., Martin, A., & Anthony, L. G. (2018). What about the girls? Sex-based differences in autistic traits and adaptive skills. Journal of Autism and Developmental Disorders, 48(5), 1698–1711. https://doi.org/10.1007/s10803-017-3413-9

6. Attoe, D. E., & Climie, E. A. (2023). Miss. diagnosis: A systematic review of ADHD in adult women. Journal of Attention Disorders, 27(7), 645–657. https://doi.org/10.1177/10870547231161533

7. Daniel, J., & Wang, H. (2023). Gender differences in special educational needs identification. Review of Education, 11(3). https://doi.org/10.1002/rev3.3437

8. Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 56(6), 466–474. https://doi.org/10.1016/j.jaac.2017.03.013