The shocking experiences of autistic young women – and the REAL reason why so many of them are identifying as trans or non-binary, by top neuroscientist GINA RIPPON

‘The odd girl out’. ‘Pretending to be normal’. ‘Standing on the outside looking in’.

These are just some of the ways autistic females have described themselves in many powerful personal testimonies about their lives before finally being diagnosed, their deep social unease exposing their desperation to disguise any visible symptoms of their condition.

For from a very early age they report struggling to find an identity that ensures they are welcomed and included, rather than ostracised and excluded. They try to camouflage or adopt different ‘masks’ to hide their autistic self. This camouflaging or masking is emerging as a key characteristic of the many autistic women who have, to date, been overlooked in the autism story.

It’s an exhausting and stressful strategy, and one which can have a profound impact on their sense of identity and self-understanding.

As I explored in the first part of this exclusive series in Good Health last week, blinkered clinicians have long insisted autism was something just for ‘the boys’, with many quoting as ‘proof’ the statistic that boys were four times more likely to be diagnosed as autistic than girls, and relying on skewed assessments that viewed autism through an almost entirely male lens.

This belief has had a damaging impact on autistic females: girls on the spectrum can feel that they face a ‘double whammy’, with the world dismissing their autistic identity because they are not male, and powerful social forces enforcing a rigid view of what they should be like because they are a girl.

One young girl with autism, Grace, eloquently described the difficulties she had: ‘All girls are under immense pressure to fit in and to be a certain way according to what they are told being a girl means. It’s even worse for girls with autism because they are also trying to fit in with what being a human means.’

I’m a professor of cognitive neuroimaging who uses state-of-the-art brain-imaging techniques to investigate autistic brains.

But I wanted to know more about the autistic girls and women who, because of the ‘boys-only’ bias of autism science, had rarely appeared in my studies, and who had been diagnosed much later than the males – often been misdiagnosed with everything from bipolar disorder to anorexia.

So I got out from under my scanner and asked them: ‘What is it like to be you?’ The answers, across all ages, almost universally spoke of navigating difficulties with social expectations, of constant attacks on their self-esteem, of being bullied or called weird; of feeling like an outsider.

It revealed the intense importance to these females of belonging, of needing an identity, of trying to find a place for themselves in a society where they didn’t seem to fit, no matter how hard they tried.

And then the positive impact of at last discovering they were autistic: the profound sense of relief that, at last, they had a true identity, they had ‘found their tribe’, where their lives and experiences finally made sense.

The question then arises: if a key aspect of autistic experience is of uncertainty about your identity, about who you are, and realising that you don’t live up to the expectations of a world that has inflexible views of what you should be like, then this could well extend to wider questions of self-identity, including gender.

Could this be why there are higher rates of gender diversity in autistic populations than in non-autistic populations?

Research shows that rates of autism are between three and six times higher in transgender and gender-diverse populations than in other populations.

Up to 15 per cent of autistic adults identify as trans or non-binary, but the rates are higher among those assigned female at birth, possibly over 30 per cent.

Understanding this intersection of autism with gender identity is more than just an academic point, it is a real and live health issue: emerging evidence has found that being both transgender and autistic is associated with higher rates of mental health problems. They need our care, help and sympathy.

When academics from the Centre for Applied Autism Research at the University of Bath interviewed autistic adults about their experiences, they described their distress in living in a world which was not accepting of either gender diversity or neurodiversity.

Some of those assigned female had very negative experiences around the ‘trappings’ of being female, such as sensory dysphoria – physical discomfort associated with autism-related sensitivities, caused by the stereotypical female clothes they were ‘supposed’ to wear, such as woolly tights or frills. They also report sensory challenges around puberty including periods, such as dealing with the smell of blood and growing body hair.

One of those interviewed commented: ‘Being autistic is like everybody else has got the rulebook and you didn’t, so you can understand why gender would come into it because that was in the rulebook you do not get.’ Autistic girls report a lifetime of being bullied and of being made to feel they don’t belong.

Add to this mix the popular conception of autism as a male thing and girls on the spectrum may well feel that they want to be aligned to a different sex, or even to none at all. The drive to belong is as powerful in autistic girls as it is in typical girls, if not more so, so seeking a community different from the one that appears to reject them is understandable.

The hyper-femininity that characterises social media and marketing may also play a part.

If the alleged characteristics associated with your ‘assigned’ female identity – be it having a serious make-up habit or liking the colour pink – doesn’t chime with what you think best defines you, then you may well seek a different identity altogether, especially in order to belong to a group you might identify with: i.e. males. The higher levels of gender identity non-conformity among autistic females could well be a response to this. There are possible biological explanations, too.

Neuroscientists are starting to compare brain activity patterns in individuals with both autism and gender identity diversity to explore potential areas of overlap. One 2023 US study focused on something known as the ‘default mode network’, sometimes known as the daydreaming network. This is when you’re allegedly not engaged in any particular task, but are actually almost invariably thinking about yourself, or real or imagined events involving yourself.

Using brain scans, researchers looked at the patterns of connections within this network, and between other brain networks, in 45 transgender youths – some non-autistic, others autistic, or with high levels of autistic traits but who had not been diagnosed.

The researchers found evidence of greater connectivity in this network in the brains of autistic transgender individuals, which they interpreted as reflecting higher levels of self-monitoring –an ongoing quest for some kind of identity, marked both by persistent self-reflection or repeated self-comparisons with those around you.

Overall, this pattern was more closely associated with those assigned female at birth.

This is consistent with other studies showing much more evidence of self-monitoring in females generally during tasks that activate our ‘social’ brain, which helps us navigate social interactions (our social satnav).

This part of the brain undergoes dramatic reorganisation during adolescence, and is the time when the signs of autism may become more marked in previously unidentified autistic girls.

Changes in their adolescent brains, together with a vastly more complex set of social demands, undermine the previously hard-won protective camouflage that kept these girls under the radar during their primary school years – which potentially makes their longing for a social ‘identity’ even more pressing.

Issues of identity have long been overlooked in autistic populations, but they clearly have enormous significance, particularly for females who have been overlooked by the current diagnostic process.

For as well as being deprived of help and support, they may be deprived of an identity.

Adapted from The Lost Girls of Autism by Gina Rippon (Macmillan, £22), to be published on April 3. © Gina Rippon 2025.

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