FEMALE AUTISM AND DIAGNOSTIC CHALLENGES: UNDERDIAGNOSIS AND ITS REPERCUSSIONS ON MENTAL HEALTH

Abstract

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by persistent difficulties in social communication and interaction, associated with restricted, repetitive patterns of behavior, interests, or activities. Although autism has historically been identified predominantly in males, contemporary evidence indicates that girls and women may exhibit clinical manifestations that are distinct or less recognized by traditionally used diagnostic tools. This difference contributes to the underdiagnosis or delayed diagnosis of ASD in females, particularly among women with higher cognitive ability and those who develop social compensation strategies. The phenomenon known as social camouflaging, or "masking," involves conscious or automated behaviors aimed at concealing social-communication difficulties and reproducing socially expected patterns. While it may facilitate apparent adaptation to the environment, the prolonged maintenance of these strategies can be associated with exhaustion, psychological distress, anxiety, depression, low self-esteem, social isolation, and difficulties in identity formation. Delayed diagnosis can also hinder access to appropriate interventions and lead to misinterpretations of clinical manifestations. This article presents a narrative review regarding the specific characteristics of ASD in women, key factors related to underdiagnosis, challenges in clinical assessment, and the potential mental health repercussions of delayed recognition. It emphasizes the need for individualized, longitudinal, and multidimensional assessment to avoid both under-identification and overdiagnosis.