Are We Still Missing Autism in Girls? What New Research Means for Clinicians

Autism diagnoses among girls are rising, but pediatric age girls are still diagnosed later than boys.

That’s the central takeaway from a large new study by Messias and colleagues, published in JAMA Network Open in July 2026, which analyzed health records from more than 171,000 patients between 2016 and 2024.

Researchers found that after 2020, autism diagnoses recorded among girls increased sharply, while diagnoses among boys remained stable or declined. The largest increases occurred among pediatric and adolescent girls, where new diagnoses rose roughly 17% and 22% per year, respectively. The study also found that pediatric aged girls are diagnosed ~1.5 years later than their boy peers.

The findings suggest something encouraging: clinicians may be getting better at recognizing autism in girls who might once have been overlooked. However, the study also raises an important question: What are we still missing?

Autism doesn’t always look the way we expect

Historically, autism research, and many diagnostic tools, have been based largely on boys (Cook, Hull, & Mandy, 2024). As a result, some girls may present in ways that don’t immediately raise concern. Their interests may appear age-appropriate, even when unusually intense or inflexible. They may seek friendships but struggle with the unwritten social rules, like group dynamics, managing conflict, interpreting subtle social cues, or maintaining back-and-forth relationships. Some become highly skilled observers, learning to imitate peers, rehearse conversations, or memorize social scripts, a phenomenon that researchers call camouflaging or masking (Cook, Hull, Crane, & Mandy, 2021).

These strategies can make a child appear more socially comfortable than she feels. They may also require considerable effort. A child who seems to manage well at school or during an appointment may become exhausted, overwhelmed, or distressed afterward.

Camouflaging is not limited to girls, and there is no single way autism looks in girls. The goal should not be to replace one stereotype with another. Instead, clinicians and families should consider the full picture of how a child communicates, adapts, regulates emotions, and participates in daily life.

The child who “does fine” at a clinic visit may struggle at home

One of the biggest diagnostic pitfalls is assuming that successful performance during a clinic visit reflects everyday functioning.

Autism-related differences may become easier to see as school and social expectations become more complicated. A young child may do well when an adult directs play but struggle during unstructured play with peers. An older child may participate in conversations but have difficulty keeping up with changing friendships, group projects, sleepovers, or the unwritten rules of social life.

Some children appear to cope during the school day but become overwhelmed once they are home. Others may manage a structured office visit but struggle during transitions, family routines, homework, community outings, or sibling interactions.

When concerns are subtle, clinicians may find it helpful to ask families and educators questions such as:

• Are friendships difficult to start, understand, or maintain?
• Does the child copy peers or rely on rehearsed phrases in social situations?
• Does she spend significant time preparing for or recovering from social interactions?
• Do changes in routine, sensory demands, or unclear expectations lead to distress?
• Does the child appear to manage at school but become exhausted or overwhelmed at home?
• Could anxiety, perfectionism, withdrawal, or emotional distress be making developmental differences harder to recognize?

No single answer indicates autism, and these experiences are not unique to autistic children. Together, however, they may suggest that additional screening or a comprehensive developmental evaluation would be helpful.

A strong evaluation draws on several sources of information, including the child’s developmental history, direct observation, caregiver input, school reports, and information about how the child functions across settings. Screening tools can support this process, but they should not replace a thorough assessment and clinical judgment (Cook, Hull, & Mandy, 2024).

What the new JAMA study does not tell us

The findings have important limitations.

The researchers examined diagnoses recorded within one healthcare system. A diagnosis that was new to that health record may not have been the person’s first diagnosis.

The participants were also mostly White and had at least one healthcare visit every year from 2016 through 2024. The findings may therefore be less representative of families who have inconsistent access to healthcare or come from different backgrounds.

The study shows that diagnosis patterns changed, but it cannot tell us exactly why. Greater public awareness, improved clinician recognition, changing referral practices, pandemic-related disruptions, and other factors may all have played a role (Messias et al., 2026).

The findings suggest a meaningful shift in who is being identified. They do not show that delayed or missed diagnosis in girls has been resolved.

Information across settings matters

This research reinforces an important principle: no single appointment tells the whole story.

Children often show different strengths and challenges across settings. A child who appears socially engaged during a structured evaluation may struggle with unstructured peer interactions, transitions, family routines, or the sensory demands of everyday life. Understanding those differences is essential to making an accurate diagnosis and developing meaningful supports.

That’s why collaboration matters. Pediatricians, psychologists, educators, speech-language pathologists, occupational therapists, behavior analysts, and families each contribute a different perspective. When those observations are considered together, clinicians gain a more complete understanding of how a child functions in daily life.

At Kyo, ABA therapy takes place in the home and community, where clinicians can observe how children navigate everyday routines and collaborate with pediatricians, psychologists, speech-language pathologists, occupational therapists, educators, and families. By combining real-world observations with insights from the broader care team, we help develop individualized goals that are meaningful, coordinated, and relevant to a child’s daily life.

The goal isn’t to create a new checklist for identifying autism in girls. It’s to approach every child with curiosity, listen carefully, and consider how they function across people, settings, and demands. This new research suggests we’re making progress—but it also reminds us that earlier recognition remains an important opportunity to help more children receive the support they need.

Frequently Asked Questions

Why is autism often diagnosed later in girls than in boys?
Many diagnostic tools were built largely from studies of boys, and some girls mask their traits, so their presentation may not raise concern. In the 2026 JAMA study, girls were diagnosed a mean of 3.4 years later than boys.

What is masking, or camouflaging, in autistic girls?
Imitating peers, rehearsing conversations, or memorizing social scripts to seem more socially comfortable than she feels, often at the cost of exhaustion afterward.

Can a child mask autism at school but struggle at home?
Yes, some cope through a structured school day or office visit, then become overwhelmed at home or during transitions, which is why information from multiple settings matters.

Does the new research mean underdiagnosis of autism in girls is solved?
No, it shows a shift in who is identified, not that late or missed diagnosis is resolved.

For Further Reading

Cited Research

Messias E, Casanova E, Huang R, et al. “Autism Spectrum Disorder Incidence by Age and Sex in a US Health Care System, 2016 to 2024.” JAMA Network Open. 2026;9(7):e2624561.
https://doi.org/10.1001/jamanetworkopen.2026.24561

Cook J, Hull L, Mandy W. “Improving Diagnostic Procedures in Autism for Girls and Women: A Narrative Review.” Neuropsychiatric Disease and Treatment. 2024;20:505–514.
https://doi.org/10.2147/NDT.S372723

Cook J, Hull L, Crane L, Mandy W. “Camouflaging in Autism: A Systematic Review.” Clinical Psychology Review. 2021;89:102080.
https://doi.org/10.1016/j.cpr.2021.102080

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