Diagnostic challenges of autism spectrum disorder in women without intellectual or language impairments: a narrative review.

This review found that autism in adult women is often missed or diagnosed late because women show different signs than men. Women with autism may hide their difficulties better and have different types of interests. They're more likely to be diagnosed with mental health conditions first before autism is recognized. Current tests for autism don't work as well for detecting autism in women, so better tools are needed.

This narrative review examines diagnostic challenges for autism spectrum disorder in adult women without intellectual or language impairments. The review found that autism in women is frequently under-recognized due to subtler manifestations, greater use of compensatory social strategies, and diagnostic frameworks developed from male presentations. Female-typical presentations include subtle social-communication differences, context-specific restricted interests, and higher levels of camouflaging behavior. Women are more likely to receive psychiatric diagnoses before autism is recognized, contributing to mental health burdens and poorer functional outcomes.

Current screening tools have limited capacity to detect female autism phenotypes, highlighting the need for gender-inclusive diagnostic approaches and updated assessment instruments.

Clinicians should incorporate camouflaging assessment and nuanced developmental histories when evaluating women for autism. Gender-inclusive screening instruments and awareness of female-typical presentations are essential to improve diagnostic equity and reduce misdiagnosis in women without intellectual or language impairments.

As a narrative review, findings are subject to selection bias and lack quantitative synthesis. Study heterogeneity prevented meta-analysis. The review does not provide specific data on diagnostic accuracy metrics or effect sizes for recommended interventions.

Autism Spectrum Disorder (ASD) in adult women without intellectual or language impairments is frequently under-recognized, due to subtler manifestations, greater use of compensatory social strategies, and reliance on diagnostic frameworks developed from male presentations. Diagnostic overshadowing, where autistic traits are misattributed to other psychiatric conditions, further delays accurate identification. This narrative review aims to critically evaluate recent evidence on the diagnostic challenges of ASD in adult women without intellectual or language impairments, assess the performance of widely used screening tools, and present recommendations for improving gender-sensitive diagnostic practices. A structured literature search was applied (PubMed, PsycINFO, Scopus; January 2010-July 2025; English language) targeting studies on females aged ≥18 years without intellectual or language impairment.

Diagnostic accuracy, screening tools, camouflaging, misdiagnosis, and psychosocial outcomes were examined. Original research, meta-analyses, and systematic reviews were included, and a narrative synthesis approach was chosen due to study heterogeneity. Female-typical presentations often include subtle social-communication differences, context-specific restricted interests, and higher camouflage levels than males, which decrease the sensitivity of standard screening tools. Women are more likely to receive prior psychiatric diagnoses before ASD is recognized, contributing to mental health burdens and poorer functional outcomes.

Current adult ASD screening tools have limited capacity to detect female phenotypes. Integrating camouflaging assessment, nuanced developmental histories, and updated, gender-inclusive screening instruments is essential to improving diagnostic equity.