Why are autistic girls and verbally able children missed for so long?

The short answer

Autism may be missed when a child does not match familiar stereotypes, speaks fluently, attains well or uses observation, rehearsal and imitation to navigate social situations. Girls are one group at risk of under-recognition, but gender does not determine a single autistic presentation and children of any gender may camouflage. Look beyond sociability and attainment to independence, misunderstandings, sensory experience, flexibility, effort and recovery. An assessment should consider developmental history and information from different settings, and NICE says eye contact, affection, pretend play or apparently typical language should not be used alone to rule autism out.

• Recognisable strengths can coexist with substantial hidden support needs.
• Girls do not share one distinctive autism profile, and boys and non-binary children may also be missed.
• Copying or rehearsing can produce a capable appearance without making interaction effortless.
• Attainment does not measure sensory load, daily living, safety or recovery.
• Concrete examples across time and settings are more useful than labels such as masking or high functioning.