Why the Diagnosis Debate Misses the Point: Autism, Patriarchy, and the Erasure of Women, Girls, and Gender-Diverse Voices
A meme recently circulated attempting to highlight why girls are so often under-diagnosed with autism (above). Its message is well-meaning and raises points worth discussing, but its framing leaves much to be desired. The way it presents the issue subtly reinforces the very biases it seeks to critique. For one, it doesn’t explicitly define who it means by “girls,” leaving an unspoken assumption that the subject is cisgender, AFAB (assigned female at birth) individuals. This oversight erases the experiences of trans, nonbinary, and other gender-diverse autistic people, who are already marginalised in discussions about neurodivergence. Autism doesn’t exist in isolation from gender, yet conversations about diagnostic gaps too often ignore this intersectionality, furthering a narrative that doesn’t account for the full spectrum of autistic experiences.
The meme’s approach reflects a broader societal issue: discussions about autism are overwhelmingly shaped by patriarchal, ableist, and cisnormative frameworks. The diagnostic gap for girls is not just about flawed tools or a lack of research, though these are certainly factors. At its heart, this gap is a result of systemic biases that devalue women, girls, and anyone who doesn’t conform to societal norms. Autism, like so many other aspects of healthcare and psychology, has been studied and defined through the lens of white, cisgender, neuro-majority men. As a result, those who don’t fit this mould—including AFAB individuals, trans and nonbinary people, and marginalised ethnic groups—are often erased or misdiagnosed. These exclusions aren’t accidental; they are embedded in the structures of patriarchy and ableism that prioritise certain bodies and experiences whilst rendering others invisible.
The issue, then, isn’t simply a matter of improving diagnostic tools or educating professionals about the subtler presentations of autism. It’s about addressing the systems that have historically devalued and excluded anyone who doesn’t fit the narrow, male-centric standard. When we fail to acknowledge how patriarchy, ableism, and cisnormativity intersect to shape these systems, we not only perpetuate the erasure of countless neurodivergent individuals but also reinforce the very power structures that marginalise them in the first place. It’s time for a broader, more inclusive approach that sees autistic people in all their diversity—not as deviations from a norm, but as valid and valuable in their own right.
The Diagnostic Gap and the Boy Default
The diagnostic gap in autism is rooted in a history of bias and exclusion, one that stems from how autism was first studied and understood. Early research into autism, particularly in the West, was based on narrow, patriarchal, and ableist assumptions. The work of figures like Leo Kanner and Hans Asperger exemplifies this. Both men focused exclusively on boys and approached autism through a lens that was less about understanding neurodivergence and more about determining utility—who could be moulded into productive workers and who could not. Asperger’s ties to the Nazi regime and the Viennese medical establishment’s active participation in the euthanasia of disabled children reveal the dark underpinnings of early autism research in the West. Under Nazi rule, the medical profession became a willing collaborator in the systemic targeting of those deemed “unfit,” with children who exhibited signs of neurodivergence often sent to their deaths. This eugenic framework profoundly influenced how autism came to be understood—not as a natural variation of the human neurotype, but as a pathology to be categorised, controlled, and, if possible, eradicated. After the war, much of this medical knowledge was exported to the West through programmes like Operation Paperclip, further entrenching these dehumanising assumptions into the foundation of Western approaches to autism diagnosis and treatment.
Contrast this with the work of Dr. Grunya Sukhareva in the Soviet Union, whose research into autism predates Kanner and Asperger by over a decade. Her studies included both boys and girls, and her focus was not on productivity or pathology but on how best to nurture and educate neurodivergent children. Sukhareva’s approach, centred on care and inclusion, offered a glimpse of what an alternative understanding of autism might look like. Unfortunately, Dr. Sukhareva’s work was largely ignored in the West, a consequence of Cold War paranoia and the Iron Curtain’s effective blockade of Soviet scholarship and research. The Western dismissal of Soviet contributions to science and medicine, rooted in ideological hostility, meant that her inclusive and forward-thinking approach to autism was overshadowed by the patriarchal and exclusionary framework of Kanner and Asperger. In stark contrast to the Soviet system, which officially promoted the principle of equal rights for all, Western medical and social systems remained deeply entrenched in patriarchal values that devalued the experiences of women and marginalised groups. This history helps explain why girls, women, and gender-diverse individuals were left out of autism research and diagnostic criteria—they were never considered part of the equation in a system that prioritised conformity to male-centric and patriarchal norms.
The meme in question reflects this history in its framing. By highlighting how girls are under-diagnosed, it positions boys as the default against which everyone else is measured. AFAB girls are presented as a deviation from the norm, rather than as individuals whose experiences of autism are valid in their own right. This framing reinforces patriarchal thinking, as well as a rigid gender binary. There’s no space in this conversation for trans or gender-diverse individuals, whose experiences of autism are equally shaped by their gender. As a trans woman and an autistic person, my own experience—and the experiences of countless others like me—could add depth and value to the discussion. Yet, we are rarely, if ever, included. Likewise, AFAB trans men are often completely ignored, their experiences erased as though they do not exist.
This exclusion is not a coincidence but a reflection of what society chooses to prioritise. Diagnostic tools are shaped by the same systems that determine whose lives and perspectives are considered valuable. Patriarchy has long devalued the experiences of women, AFAB individuals, and anyone who doesn’t conform to cisnormative expectations. When diagnostic criteria are rooted in these same systems, it is no surprise that they fail to account for the diversity of autistic experiences. The result is a framework that serves only a narrow slice of the population while leaving the rest of us to navigate a world that doesn’t see us, let alone value us. The problem, then, is not just about flawed tools—it’s about the societal biases that shape them and the structures that uphold those biases.
The Burden of Masking and Gendered Expectations
Masking, for many autistic people, is a survival mechanism—one that has deep roots in the patriarchal and Calvinist traditions of the West. The expectation that children, particularly girls, should be “seen and not heard” stems from a rigid social framework built on conformity and control. Calvinism and Puritanism, with their strict moral codes and disdain for individual expression, cultivated an environment where deviation from societal norms was harshly punished. Within this context, girls were socialised to suppress their authentic selves, internalising the message that their worth was tied to how well they could conform to expectations of obedience, passivity, and “femininity.” For autistic girls, this pressure is doubly cruel, as it demands not only adherence to patriarchal gender norms but also the erasure of their neurodivergence.
Masking, then, is not an intrinsic “girl trait” or a natural behaviour—it is a response to systemic oppression. Patriarchal and cisnormative norms place an immense burden on those who do not fit neatly into their rigid frameworks. Autistic girls and women learn to mask because society punishes their authenticity, often labelling their natural behaviours as inappropriate or undesirable. This constant effort to “fit in” comes at a significant cost, draining mental and emotional resources and leading to higher rates of anxiety, depression, and burnout. What is often framed as a skill or a coping mechanism is, in reality, a form of survival under oppressive conditions.
The meme above fails to interrogate this systemic oppression, instead framing masking as an isolated issue faced by autistic girls. By focusing on the fact that girls mask without exploring why they are forced to do so, the meme avoids addressing the root cause: societal demands for conformity. It risks perpetuating the idea that masking is an inherent part of the autistic girl’s experience, rather than a harmful response to a world unwilling to accept difference. Moreover, the meme’s narrow framing excludes the experiences of trans and nonbinary autistic people, who face unique pressures to mask due to the intersection of transphobia, ableism, and patriarchal expectations.
For trans and nonbinary autistic individuals, masking often involves suppressing not only their neurodivergence but also their gender identity. The compounding pressures of societal conformity mean that many feel forced to present in ways that align with cisnormative expectations, further erasing their authentic selves. This double burden amplifies the mental health toll of masking, yet their experiences are routinely ignored in discussions about autism and gender. To truly understand the impact of masking, we must move beyond a narrow focus on girls and instead examine the oppressive systems that force so many neurodivergent people, regardless of gender, to hide who they are.
Autism, Patriarchy, and the Erasure of Women and AFAB Experiences
The devaluation of women’s and AFAB individuals’ experiences is not new—it is a deeply ingrained feature of Western society, stretching back centuries. Autism research, like much of medical science, has been shaped by this bias. My own experience with erythromelalgia, a chronic nerve condition that has been documented for over a hundred years and is sometimes called “Man on Fire Syndrome,” is a stark example of this centring of men. Despite its long history, erythromelalgia remains poorly understood, with research often focused on men as though their experiences represent the universal standard. This bias leaves critical gaps in understanding how conditions like mine might manifest or change in women and AFAB individuals. Since beginning HRT, I’ve noticed that my experience of erythromelalgia has changed for the worse, yet I could find nothing in the medical literature to suggest this might happen—or even to acknowledge the possibility. This neglect is mirrored in autism research, where diagnostic criteria were developed based almost entirely on boys, rendering the experiences of others, particularly women and AFAB individuals, invisible and misunderstood.
Gendered socialisation compounds this problem. From a young age, AFAB individuals are pressured to suppress their authentic selves, forced to prioritise conformity over their own needs and identities. Calvinism and Puritanism, with their rigid moral codes, have infiltrated every corner of Western society, shaping the norms for women and girls. These expectations demand that they be passive, obedient, and compliant, leaving no room for the authenticity that neurodivergence demands. The result is a societal system that not only discourages but actively punishes divergence from these norms. This dynamic doesn’t just affect cisgender AFAB individuals—it also invades trans spaces. Online communities for trans women, for example, often insist on a single, “acceptable” presentation of femininity (“Do I pass?”), one that fits neatly into patriarchal ideals. As a 2.1m tall trans woman, I don’t remotely fit that mould, yet the pressure to conform remains relentless.
The meme’s treatment of “special interests” exemplifies a systemic bias, but it also highlights a deeper misunderstanding of autistic experiences. Many autistic adults bristle at having the things we enjoy framed as “special interests,” as though our passions are somehow fetishistic or abnormal. We like things, just as others like things. There’s nothing inherently unusual about that—it’s simply a part of our natural way of being, a way that is perfectly normal for us. Framing these interests as “special” pathologises what is simply an expression of our individuality and reinforces harmful stereotypes, particularly for women and AFAB autistic people.
This framing also has troubling historical roots. The devaluation of women’s and girls’ interests is tied to a long history of patriarchal control, especially as it relates to property rights. In many societies, women and girls have been viewed as the property of their fathers, their worth tied to how well they conform to his will. Any deviation from these expectations was labelled as disobedience, a flaw that could diminish her “value” in terms of marriage prospects or threaten the perceived purity of the bloodline. These historical attitudes linger today, shaping how society views women and AFAB individuals who step outside prescribed norms. When autistic girls express interests that align with societal expectations, those interests are trivialised or dismissed as “the same as other girls their age.” Conversely, when their passions deviate from the norm, they are often pathologised.
This dynamic reflects a broader societal bias about what is deemed “worthy” of attention or study. Historically, women’s interests and contributions have been minimised or dismissed outright, and the same pattern persists in autism discourse. Boys’ interests are often seen as markers of neurodivergence, whilst girls’ are reduced to quirks, phases, or extensions of their social roles, further erasing their authentic experiences. By framing the natural way we engage with the world as something extraordinary or pathological, society continues to reinforce these oppressive norms, failing to see autistic people—and especially autistic women and AFAB individuals—as fully human and entirely valid just as we are.
The erasure of women and AFAB individuals from autism discourse is not an accident—it is a symptom of the patriarchal systems that continue to shape what is valued and who is seen. Until we dismantle these systems, the experiences of countless autistic people will remain overlooked and undervalued.
Trans and Gender-Diverse Voices in Autism
The intersection of neurodivergence and gender diversity is a critical yet often overlooked part of the autistic community. Substantial research demonstrates that neurodivergent individuals are significantly more likely to be trans or gender-diverse than their neurotypical peers, with some studies showing that they are six times more likely to report gender incongruence. For example, research has found strong correlations between dimensional autistic traits—such as challenges with social communication—and gender diversity, highlighting that this connection is not limited to categorical diagnoses but extends to broader autistic experiences (Mo et al., 2024).
Gender diversity is especially pronounced among autistic youth, who report both binary and nonbinary identities at higher rates than neurotypical children. This trend has been confirmed through both self-reports and parent reports, illustrating a clear and consistent difference that underscores the need for tailored support (Corbett et al., 2022). Additionally, transgender and gender-diverse individuals frequently exhibit elevated autism traits, such as sensory sensitivity and unique ways of processing empathy, compared to cisgender individuals (Warrier et al., 2020). These findings suggest that autism and gender diversity are not merely coincidental but deeply intertwined, reflecting a shared experience of navigating societal norms and expectations.
Despite this growing body of evidence, discussions about autism and gender often exclude the voices of trans and nonbinary autistic people, erasing their unique experiences. Research has shown that autistic transgender youth face heightened challenges, including intensified gender dysphoria and societal stigma, which require affirming and inclusive care models to address their needs (Strang et al., 2018). Community-designed clinical programs have proven effective in creating safe spaces for these youth, offering role models and support systems that affirm both their neurodivergence and their gender identity (Strang et al., 2020). Yet such initiatives remain the exception rather than the norm.
The exclusion of trans and gender-diverse voices is further compounded by systemic delays in autism diagnosis for these individuals. Gender-diverse people are often diagnosed with autism later in life, particularly those assigned female at birth, as their traits are frequently overlooked or misinterpreted (McQuaid et al., 2024). This delay reflects both the limitations of diagnostic frameworks, which are still rooted in patriarchal and cisnormative assumptions, and the broader societal failure to recognise the full diversity of autistic experiences.
Far-right narratives have seized upon this intersection to push harmful conspiracies, such as the claim that platforms like TikTok are “making autistic kids trans.” These reductive and dehumanising views not only dismiss the validity of neurodivergent and gender-diverse identities but also fuel stigma against an already marginalised community. The reality, as supported by extensive research, is that autistic trans and nonbinary people deserve recognition, affirmation, and care that accounts for the unique ways their identities intersect. It is past time for these voices to be centred in the conversation.
This erasure is further perpetuated by diagnostic frameworks and research that fail to account for the experiences of trans and nonbinary individuals. Diagnostic criteria have long been shaped by cisnormative assumptions, leading to the systematic exclusion of those who don’t conform to binary gender norms. For example, an AFAB child who speaks on cue and has no visible behavioural challenges is often dismissed as “not autistic” and misdiagnosed with something else. Only after years—or even decades—of navigating incorrect labels, stigma, and misunderstandings do many people AFAB finally receive an accurate autism diagnosis. The problem is not that their autism was invisible, but that the diagnostic framework wasn’t designed to see them.
For trans and gender-diverse autistic individuals, the challenges of diagnosis are compounded by factors like gender dysphoria, social pressures, and the need to mask. My own experience with HRT has made me question these systems even more. Since starting HRT, I’ve noticed changes in my ability to communicate—does this mean I’m no longer autistic because I can speak and write more fluently? Or that my more tranquil state somehow invalidates my diagnosis? These shifts raise critical questions about how diagnostic tools fail to account for the dynamic and evolving experiences of trans and nonbinary autistic people.
The meme in question reinforces these cisnormative assumptions, centring AFAB girls without acknowledging the existence of trans and gender-diverse individuals in the autistic community. By failing to include these voices, it perpetuates a conversation that is incomplete at best and exclusionary at worst. If we are to truly understand and support autistic individuals, we must broaden the discourse to include the full spectrum of experiences, recognising that gender and neurodivergence are inextricably linked for so many of us. Anything less is a failure to see us as whole, valid, and fully human.
The Role of Capitalism in Maintaining Inequities
Capitalism plays a central role in maintaining inequities in autism research and diagnostic tools, shaping priorities not by need but by profitability. Under this system, where shareholder value often takes precedence over human value, the experiences of women, AFAB individuals, and gender-diverse people are routinely deprioritised. Research into their specific needs is often deemed unworthy of investment, as these individuals are not seen as lucrative markets. The horrid reality is that society continues to frame these groups as less economically valuable—AFAB individuals, for example, are still stereotyped as likely to “just stay home with the kids,” a reflection of deeply entrenched patriarchal and capitalist assumptions. This bias is well-documented, as shown in studies like Alcalde-Rubio et al.’s review of gender disparities in clinical practice, which highlights how interventions to address bias often fail because they clash with systems prioritising profit over equity (2020).
The intersection of patriarchy, ableism, and capitalism further entrenches these inequities. These systems are not merely overlapping but mutually reinforcing, creating a feedback loop that marginalises certain groups while privileging others. Patriarchy devalues the experiences of women and AFAB individuals, framing their needs as secondary to those of men. Ableism pathologises neurodivergent people, reducing their worth to how well they can conform to societal norms. Capitalism, in turn, leverages both systems, focusing resources on those who are deemed economically productive while sidelining those who do not fit this mould. Kocabıçak (2013) describes this dynamic as a “win-win” scenario for patriarchy and capitalism, where both systems profit from the exploitation and exclusion of marginalised groups.
Even seemingly well-intentioned messages, like the meme above, critiquing the under-diagnosis of autistic girls, are not free from these influences. The meme subtly persuades its audience to accept its framing without question, encouraging us to nod along and say, “that’s right, that’s me,” whilst failing to interrogate the systems behind the inequity it describes. It avoids questioning why diagnostic frameworks have centred boys or why research has ignored marginalised groups in the first place. The unspoken answer, of course, is that under capitalism, the people most in need of care and understanding are often the least profitable to serve.
To address diagnostic inequities, we must look beyond individual tools and consider the broader structures that shape their creation. Patriarchy, ableism, and capitalism have together dictated whose lives are seen as valuable, whose experiences are worth studying, and whose voices are heard. Until we dismantle these systems and centre equity over profitability, the needs of marginalised groups will continue to go unmet. The conversation about autism—and about diagnostic inequity as a whole—must shift from asking what is profitable to asking what is just.
Toward an Inclusive and Intersectional Understanding of Autism
To move toward a more inclusive and intersectional understanding of autism, we must begin by reframing the narrative itself. For far too long, discussions about autism have defaulted to comparisons with boys or relied on narrow diagnostic criteria shaped by patriarchal, ableist, and cisnormative assumptions. This approach has failed to recognise the vast diversity within the autistic community, erasing the experiences of women, AFAB individuals, and gender-diverse people. Instead of perpetuating these biases, we must centre autistic experiences as valid and complete in their own right, without measuring them against a male-centric standard.
An essential step in this reframing is advocating for tools and research that reflect the diverse ways autism manifests across genders and lived experiences. Diagnostic frameworks must evolve to account for the full spectrum of autistic expression, from the quiet masking of a young girl trying to navigate a rigidly gendered school environment to the compounded challenges faced by a trans autistic adult navigating systemic erasure. Current tools, shaped by outdated assumptions, have left too many people invisible and unsupported. To address this, we need research that is inclusive by design, amplifying the voices of those who have historically been silenced and prioritising equity over conformity to existing norms.
Diversity must be acknowledged and valued as a strength within the autistic community. Every autistic person brings unique perspectives that enrich our understanding of what it means to be neurodivergent. Their experiences challenge stereotypes and expand the boundaries of how autism is defined and understood. By recognising the value of these perspectives, we can move away from a deficit-based model of autism that focuses on what individuals lack and toward one that celebrates the richness of autistic ways of being.
This shift requires not only systemic change but also a cultural reimagining of how we view autism and neurodiversity as a whole. It is about creating a world where all autistic people are seen, heard, and supported in ways that affirm their authenticity and dignity. By embracing an inclusive and intersectional approach, we can ensure that the autistic community is no longer constrained by the biases of the past but instead empowered to thrive in its full diversity.
Final thoughts …
Beyond the meme and its well-meaning attempt to highlight the under-diagnosis of autistic girls lies a much deeper issue. The problem isn’t just about diagnostic tools or the gaps in research—it’s about the systemic biases that shape those tools and the societies in which they are used. Patriarchy, ableism, and cisnormativity have dictated whose experiences are seen as valid, whose voices are amplified, and whose needs are met. These systems have excluded more than half the autistic population from autism discourse, leaving them to navigate a world that neither sees nor values them for who they are.
What is needed now is nothing less than a paradigm shift in how we talk about autism. This requires stepping away from narrow definitions and comparisons, away from frameworks that measure individuals against outdated and exclusionary norms. Instead, we must embrace an understanding of autism that values all autistic experiences—regardless of gender, presentation, or conformity to societal expectations. Such a shift means rethinking how we research, diagnose, and support neurodivergent people, ensuring that the full spectrum of autistic expression is recognised and affirmed.
The vision of this future is one of hope: a world where the neurodivergent community is fully seen, valued, and understood in all its diversity. A world where autistic people are not pathologised but celebrated for the richness they bring to humanity. A world where diagnostic tools are built on principles of equity and inclusion, and where the voices of all autistic people, not just the mothers of autistic boys are at the centre of the conversation. By challenging the systems that have upheld exclusion and embracing the full breadth of autistic experiences, we can create a future where every autistic person is supported to thrive as their authentic self. This isn’t just an aspiration—it’s a necessity for building a more just and compassionate world.