Dhruv Shenai explores how females have been left behind in conversations on autism by discussing the history and lack of female representation within the field.
Neuroscientist Gina Rippon has spent years challenging the male-centred bias in autism research. Her new book, The Lost Girls of Autism, reveals how decades of narrow studies have left many autistic people, particularly women, unseen. While awareness of neurodiversity has grown, public understanding remains limited and often distorted. Rippon calls this the male spotlight problem of autism, a bias that continues to shape both science and culture. This article explores how that spotlight formed, its consequences, and what it will take to achieve genuine inclusion.
The Unseen World of Autistic Girls and Women
A 4:1 ratio of autistic males to autistic females is often cited in the literature. This ‘undeniable fact’ is now entrenched in many people’s perception of autism: ‘Oh, autism is a male condition.’ Inevitably, scenes from The Big Bang Theory or The Good Doctor start playing in your head.
However, Rippon’s studies have shown that there is a large population of undiagnosed autistic girls and women. This is largely due to their symptoms, which differ from those of autistic boys and men. Social expectations teach autistic girls to mask behaviours to escape ostracism — from their families, who might see them as ‘unladylike’, and from their classmates, who might see them as ‘weird’ or ‘different’. This coping mechanism has been termed camouflaging or the “chameleon effect”. Crucially, camouflaging is also seen in many males and gender-nonconforming people. It challenges the myth that autistic people are inherently withdrawn or anti-social. Instead, it shows a desire to belong and to fit in.
A deeper problem lies in the way we diagnose Autism Spectrum Condition (ASC). Diagnostic criteria were developed primarily by studying males, and the assessments therefore reflect this bias. In a 2021 survey of 1400 research studies, over 30% only included autistic males and 75% of the remaining papers didn’t test for gender differences. Rippon comments,
“Using large autism databases, researchers found that when ADOS (Autism Diagnostic Observation Schedule) assessment data was used, the male:female ratio was around 7:1 but where the datasets relied on community diagnoses or screening, the ratios varied from 0.68-1.8 to 1.”
This suggests a feedback loop: the data used to define ASC reinforce the very patterns that exclude women and non-binary people from being diagnosed.
The consequences are serious for public perception. If our GPs, teachers and families perceive ASC as a primarily male condition, autistic women and girls are less likely to be referred for autism testing. This has been referred to as the ‘leaky pipeline’, where autistic women are falsely diagnosed with anxiety, borderline personality disorder, or eating disorders. They therefore receive treatment for symptoms whilst their underlying neurodivergence goes unnoticed.
How History Shapes Perception
Hans Asperger, the namesake physician of Asperger’s syndrome, claimed in the 1940s that ‘he had never met a girl with the fully fledged picture of autism’. This set a lasting bias in the field.
However, modern scholarship has revealed a darker reality. Case files showed he did identify autistic girls and that he was directly involved with the Am Spiegelgrund children’s clinic in Austria, a Nazi clinic that euthanised children deemed ‘unworthy of life’. Asperger once described a three-year-old girl as an ‘unbearable burden’ to her family and recommended ‘permanent placement’ at Am Spiegelgrund. Beyond the harrowing lack of morality, his writings reveal a gendered pattern: a fascination with ‘his little professors’, autistic boys showing intellectual promise, contrasted with indifference towards girls with similar traits. As Rippon puts it, “we’re raising our girls to be perfect and our boys to be brave.” When research privileges one group, everyone outside it becomes invisible.
Modern Theories Shaping the Narrative
More than eighty years later, autism research and the public understanding remain caught in the same male spotlight. Cambridge-based psychologist Simon Baron-Cohen (SBC) popularised ideas like the systemising/empathising model, the extreme male brain hypothesis, and the Theory of Mind deficit in the 2000s. These frameworks have profoundly affected how scientists, clinicians, and the public think about autism.
The extreme male brain theory is no doubt the most far-reaching as it has entrenched the idea of autism as a stereotypically male condition. Rippon explains,
“It boils down to the idea that male brains are better at rule-based, abstract systems and are more likely to be a ‘systemiser’, and since autistic behaviour is at the extreme end of systemising behaviour, autistic people must have extreme male brains.”
This male-lens approach is based on many assumptions. It assumes there are clear biological differences between male and female brains, and that systemising and empathising are opposing skills.
Contemporary research challenges these binaries. Large-scale neuroimaging and behavioural studies have shown extensive overlap between sexes in cognitive trials. Social influences, from how parents talk to their children, to the toys they give them, shape brain development before testing even begins. Secondly, we have already explained that many autistic people show heightened emotional empathy (though they may struggle with cognitive empathy). This has been revised in SBC’s updated systemising-based theory to be known as empathic disequilibrium.
Fundamentally, there is a deeper problem: the search for a single, unified theory of autism. The reality is that each person is different. Rippon’s catchphrase is: ‘If you’ve met one person with autism, you’ve met one person with autism’. When research overlooks this diversity, it validates some but excludes others.
Changing the Conversation
SBC has himself acknowledged the need for revision. His more recent Pattern Seekers theory attempts to frame autistic cognition more neutrally, highlighting strengths such as attention to detail and deep focus. However, it still remains unclear whether this newer framework fully embraces a nongendered view. Elements of his earlier systemising–empathising model, and its association with the extreme male brain theory, still underpin the work. Notably, The Pattern Seekers book features numerous historical examples of men but relatively few women with systemising ability, and it offers limited perspectives from neurodivergent girls and women.
Moving beyond SBC, across neuroscience and psychology, more researchers are now reevaluating the gendered assumptions that have guided autism research. Studies now highlight the diversity of autistic expression — from camouflaging to sensory differences — aspects that previous male-focused frameworks often overlooked. This growing body of research is redefining what autism looks like, signalling an overdue move towards inclusive understanding.
While such scientific revisions are welcome, real progress depends on preserving nuance, deepening awareness, and fostering a safer, more informed public conversation around neurodiversity.
Towards Inclusion and Understanding
If the science has been distorted, then the resolution must begin with listening. Researchers are increasingly calling for autistic people to contribute to the design of studies and shape the language used to describe their experiences. Diagnosis, too, must move beyond rigid criteria to account for different behaviours, camouflaging among them.
For Rippon, it’s a call to action: “We’ve welcomed them. Now we need to make the world a better place for them.” That means not only creating systems that recognise differences but protecting those systems from distortion. We need to challenge misinformation, resist panic about over-diagnosis, and remember that autism is not a social trend to debate, but a lived reality to understand.
As Rippon argues, only by confronting the biases that have shaped our past theories can we create a framework grounded in empathy, inclusion, and precision. Real progress comes when curiosity replaces fear, when policy follows empathy, and when every autistic person can see themselves reflected in the science that seeks to understand them.
Dhruv Shenai is a 4th year undergradaute Materials Scientist at Christ’s College. The article was written in Cambridge’s student-run science magazine BlueSci
