Autism Across Populations - Rethinking Presentation and Diagnosis

Historically, autism has been studied and diagnosed through a narrow lens; primarily based on the behaviors of young, cisgender white boys. As a result, autistic individuals who fall outside that mold particularly females, Black and other people of color, and gender diverse individuals are frequently underdiagnosed or misdiagnosed, delaying crucial access to care and support.

Presentation in Assigned-Female Individuals

Autistic women and girls often exhibit internalizing behaviors (e.g., anxiety, perfectionism, selective mutism) rather than the externalizing behaviors clinicians are trained to identify. They may:

• Mask autistic traits through mimicry and social camouflaging

• Develop age typical interests but engage with them in highly intense or ritualistic ways

• Experience significant social fatigue and emotional burnout

• Present with eating disorders or mood instability that overshadow ASD symptoms

These differences stem in part from gendered socialization. Girls are more often taught to conform, be polite, and hide discomfort, which makes their autism less visible and more likely to be dismissed as a personality quirk, mood, or personality disorder.

Presentation in Black and Other Racialized Populations

Black and Brown children are frequently misinterpreted in clinical and educational settings. For example:

• Autistic Black boys may be viewed as aggressive or defiant rather than socially struggling.

• Black girls may be diagnosed with behavioral or mood disorders instead of ASD.

• Cultural language differences, spiritual beliefs, and emotional expression styles are often pathologized rather than contextualized.

Clinicians may rely on biased assessment tools or lack training in cultural humility, leading to missed diagnoses. These disparities often result in fewer support services, inappropriate educational placements, and higher rates of school discipline or police contact.

The Role of Masking and Intersectionality

Many autistic individuals, especially those at the intersections of race, gender, and class—learn to mask from an early age to avoid marginalization. While masking can help with short-term survival, it increases the risk of long-term psychological harm, including suicidality, depression, and identity confusion.

Moving Toward Inclusive Diagnosis and Care

To dismantle diagnostic inequity, clinicians and researchers must:

• Use culturally responsive screening tools

• Understand social masking and sensory differences in context

• Involve community voices in developing treatment protocols

• Train providers on how intersectionality impacts presentation and care

Autism is not a monolith. Recognizing and respecting the diversity within the spectrum is key to supporting autistic individuals on their own terms.