Understanding High Masking in Girls with Autism

Autism can look different in girls and women compared with boys, and that often leads to later or missed diagnoses.

What is “masking”?

“Masking” (also called camouflaging) refers to consciously or unconsciously mimicking expected social behaviours to fit in or avoid standing out. Girls often:

• Use rehearsed social scripts
• Copy peers’ facial expressions or gestures
• Suppress stimming or intense interests
• Appear to engage socially but feel exhausted afterward

These strategies can hide core autistic traits during clinical assessments, especially if the assessor doesn’t specifically ask about internal experiences or how much effort social interaction takes.

Why it can be missed or misinterpreted

Because girls with ASD may:

• Have interests that seem socially acceptable (e.g., animals, books, fashion)
• Show internalized distress rather than obvious behaviours
• Mask well in structured settings like appointments
• Be mistakenly diagnosed with anxiety, depression, or ADHD instead of ASD
• Not show classic repetitive behaviours that tools were historically normed on

Traditional tools like the ADOS-2 and ADI-R are gold standards, but they can miss subtler presentations if the clinician doesn’t explore qualitative history (early development, sensory experiences, masking behaviours, exhaustion after socializing).

Gold-standard ASD assessment: what it should include

A thorough autism evaluation, especially for girls with high masking, usually involves:

Tracking developmental history

• Early social milestones
• Patterns of play
• Language and social communication
• Interests and routines

This is why the ADI-R (a detailed caregiver interview) is important: it looks back at early development.

Direct observation and interaction

• Observation of social communication
• Flexible tasks designed to reveal social response differences
• Not relying solely on “surface friendliness” or eye contact
• Considering the internal experience (energy cost of socializing)

Multiple data sources

Good assessments integrate:

• ADOS-2 (behavioural observation)
• ADI-R (developmental history)
• Cognitive or psycho-educational testing
• Reports from caregivers/teachers/school
• Sensory profiles, executive function evaluation

If any piece, especially detailed history or sensory and descriptive interviews, is left out, girls highly skilled at masking can be underdiagnosed.

Diagnostic and assessment services

We, at Creative Minds Consulting, provide private psychological assessments (ASD, ADHD, learning/developmental), led by Registered Psychologist Carolina Hall with ADOS-2 and ADI-R expertise. Learn about our autism assessments for children and teens or adult autism assessments.

Before the appointment

• Bring a timeline of developmental history from early childhood to present
• Note examples of masking you see at home or school (e.g., scripting, forced eye contact, resting fatigue after socializing)
• Bring teacher reports and historical reports, if available
• Describe sensory sensitivities and routines

During the assessment

• Share internal experiences, not just behaviour observed during the visit
• Discuss specific examples where your child had to force behaviours to fit in
• Highlight impact on daily functioning, not only test scores

Summary

Girls and women with autism can present differently than boys, often with strong masking that hides core traits. Standard tools like ADOS-2 and ADI-R are excellent when used thoroughly with developmental history, but can miss subtler presentations if not interpreted in context.

If you’re seeking assessment in Coquitlam, start with a specialist who understands these nuances, such as Carolina Hall at Creative Minds Consulting, and prepare detailed personal history and examples of everyday challenges to help the assessor see past masking.