Assessment of Autism in Women and AFAB Adults in Richmond, VA

What autism can look like in women and AFAB adults

Autistic presentations in women and AFAB individuals often look very different from what’s typically depicted in diagnostic literature. While the underlying challenges with social understanding are real, they may be less visible on the surface.

• Social exhaustion: You may appear socially capable but feel deeply drained afterward. Interactions that look natural require significant effort and leave you depleted.

• Learned social rules: You’ve become skilled at following social scripts, but it feels rule-based rather than intuitive, as if you figured out a code others were born knowing.

• Sensory sensitivities: Research suggests women with autism tend to experience more sensory issues than autistic men (Moseley et al., 2018)

• Focused interests: Intense interests in areas like pop culture, fictional characters, or anime are common and often more socially accepted, making them less visible as autistic traits.

• Health co-occurrences: Autistic women and AFAB individuals were more likely than autistic men and neurotypical people to have co-occurring health conditions, including epilepsy (Lukmanji et al., 2019)

You may have better eye contact, share interests naturally, and respond appropriately in conversations and still be autistic. The underlying difficulty with social understanding exists even when the outward presentation looks fine.

Masking: When coping looks like not having a problem

One of the primary reasons autism is underdiagnosed in women and AFAB individuals is masking, the conscious or unconscious process of suppressing autistic traits to appear neurotypical. AFAB autistic people camouflage at higher rates and for longer periods of time than autistic men.

While masking can support day-to-day functioning, it comes at a real cost. Research links higher camouflaging with significantly worse mental health outcomes and elevated risk for suicidality (Wood-Downie et al., 2020).

Being able to mask successfully does not mean you don't meet criteria for autism. For clinicians, the question "if they seem to function, do they really qualify?" misses the point entirely. The approach to social situations matters: autistic people navigate social interactions from a rule-based, learned framework and not from intuition. That difference is meaningful, regardless of outcome.

The exhaustion of constantly performing neurotypically is real. It deserves to be taken seriously and not used as evidence that you’re fine.

Could it be autism, or something else?

Because of clinical bias and the underrepresentation of AFAB individuals in autism research, many women and AFAB adults are misdiagnosed, often with anxiety, OCD, PTSD, or borderline personality disorder (BPD). The overlap in symptoms is real, and these conditions can co-occur with autism, which further complicate the picture.

Higher rates of masking are also linked to greater depression and suicidality, meaning that by the time many woman and AFAB adults seek an evaluation, they may be carrying a significant mental health burden alongside an unrecognized autism diagnosis.

A thorough evaluation can help untangle what’s actually going on and give you the most accurate and complete picture of yourself.

Assessing Autism in High-Masking Adults

Standard autism instruments were not designed with high-masking presentations in mind (Minutoli et al., 2026). A meaningful evaluation for women and AFAB adults requires more nuance. At Campbell Psychological Wellness, our evaluations include:

• Masking and camouflaging measures.

• Self-report autism symptom inventories.

• Full developmental history.

• Cognitive measures to better understand how you process information and engage with the world

• Collateral observations. When available and appropriate, input from people who know you well adds important context.

• Comprehensive Clinical Inventory. A comprehensive clinical inventory to identify any co-occurring conditions and rule-out other explanations.