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 & 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/descriptive interviews — is left out, girls highly skilled at masking can be underdiagnosed.
Diagnostic & Assessment Services
We, at Creative Minds Consulting Inc. provide Private psychological assessments (ASD, ADHD, learning/developmental), led by Registered Psychologist Carolina Hall with ADOS‑2 and ADI‑R expertise.
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 behaviors 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.