If you’ve ever wondered whether your daughter might be neurodivergent but couldn’t quite explain why (because she makes eye contact, does fine in school, and doesn’t fit the picture you have in your head of autism) you’re far from alone. On a recent episode of Kids These Days, Dr. Courtney sat down with Dr. Stephanie Pinch, a Denver-based clinical psychologist who specializes in autism evaluation and neurodiversity, to talk about why so many girls and women go undiagnosed, sometimes for decades.
The Autism We Picture Isn't the Whole Picture
Most of us carry around the same mental image when we hear the word “autism”: a young boy who struggles to sit still, avoids eye contact, or has very visible, repetitive behaviors. Dr. Pinch points out that this image comes largely from how diagnostic tools were originally developed and studied, mostly on boys. Because of that, the traits clinicians are trained to look for tend to reflect a male presentation of autism, which means girls who experience things differently can slip through the cracks entirely. The research backs this up in a striking way: roughly 80% of autistic girls remain undiagnosed by the time they turn 18.
That gap doesn’t mean autism is rarer in girls. It means it looks different, and our tools haven’t fully caught up.
Why Autism Looks "Quieter" in Girls
According to Dr. Pinch, girls with autism tend to internalize their experience rather than express it outwardly. Where a boy might visibly flap his hands or bounce with excitement, a girl might quietly rub her ear or move her fingers in a small, repetitive way that’s easy to miss unless you’re really paying attention. Restricted interests can look similar an intense fixation on books, stuffed animals, or collections of dolls and figures can seem like a totally normal childhood hobby, when in reality it’s taking up so much mental and emotional space that it affects daily functioning.
Even social skills can be deceptive. Brain imaging research Dr. Pinch references shows that in some autistic girls, the social-processing regions of the brain activate in ways that resemble neurotypical boys, meaning these girls have learned to absorb and mimic social cues well enough to function, even though it doesn’t come naturally. That learned performance has a name: masking.
What Masking Actually Costs a Child
Masking is the work of consciously studying and copying social behavior that doesn’t come intuitively. This might look like remembering to make eye contact, rehearsing how long is appropriate to chat with someone in a hallway, or suppressing self-soothing behaviors like stimming because they draw attention. Dr. Pinch describes clients who have had to consciously calculate rules that come effortlessly to most people: how long to talk to a classmate, whether to say hello to a stranger at the store, when a conversation is supposed to end.
This is exhausting work, and it often has a cost that shows up at home. Many parents describe a child who “does fine” at school and then falls apart the moment they walk through the front door meltdowns that seem to come out of nowhere. In reality, that child has been holding it together all day and finally has a safe place to let go.
Masking is also part of why so many neurodivergent girls are diagnosed with anxiety or depression before anyone considers autism. The exhaustion and stress of constantly monitoring social rules can genuinely produce anxious or depressive symptoms, but treating those symptoms without addressing what’s driving them means the underlying cause never gets support.
Subtle Signs Parents Can Watch For
Dr. Pinch offers a handful of quieter signs that are easy to overlook: toe walking that isn’t tied to a specific activity like dance, conversations that follow a predictable script rather than flowing naturally, eye contact that looks present but isn’t paired with genuine communicative intent, and difficulty distinguishing between a classmate, a teammate, and an actual close friend. She also points to something as simple as how a child describes their own emotions. A child who explains happiness through a sensory experience (“it feels like sunshine on my face”) rather than more typical emotional language may be showing early signs of alexithymia, a common trait in neurodivergent individuals.
None of these signs are meant to be diagnostic on their own. But Dr. Pinch’s larger point is one worth holding onto: parents are the experts on their own kids. If something consistently feels harder than it should, that instinct is worth following, even if a teacher or well-meaning family member insists everything is fine.
Why So Many Women Are Diagnosed as Adults
One of the more powerful parts of the conversation is Dr. Pinch’s explanation of why so many women aren’t diagnosed until their 30s, 40s, or later, often only after their own child is evaluated and they start recognizing familiar patterns in themselves. Diagnostic criteria didn’t allow autism and ADHD to be diagnosed together until 2013, meaning many neurodivergent girls were given an ADHD diagnosis alone, even when autism was also present. For adult women, a late diagnosis often brings a complicated mix of grief and relief, grief over years spent feeling like something was wrong with them, and relief in finally understanding that their brain simply processes the world differently.
Moving From Labels to Meaning
Dr. Pinch is careful to frame diagnosis not as a limiting label but as a tool for understanding. Naming what’s happening — whether it’s autism, ADHD, or another form of neurodivergence — can help a child (or adult) stop internalizing the message that they’re “too much” or “not trying hard enough.” It opens the door to real support: structuring a schedule around a child’s actual capacity, celebrating self-soothing behaviors instead of suppressing them, and building a home where a child doesn’t have to perform “normal” to feel loved.
Resources
If this conversation resonated with you, Dr. Stephanie Pinch’s practice, Pinch Psychology, specializes in exactly this kind of work with children, teens, and families. And if you’re looking for a therapeutic team here in Denver to support your family through an evaluation or beyond, Integrated Behavioral Health is here to help.
- Learn more about Dr. Stephanie Pinch and Pinch Psychology
- Learn more about ASD evaluations at IBH
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