The Pediatrician Next Door - Simple Advice on Parenting and Family Health

Episode: Why Autism in Girls Is Often Missed

Host: Dr. Wendy Hunter, MD
Guest: Dr. Maya Gittleson, Clinical Psychologist
Release Date: March 4, 2026

Episode Overview

In this engaging episode, Dr. Wendy Hunter explores the complex and often misunderstood topic of autism in girls. Alongside clinical psychologist Dr. Maya Gittleson, she unpacks why girls on the autism spectrum are frequently undiagnosed or misdiagnosed, and what parents, educators, and clinicians should look for. The conversation blends the latest understanding in neurodiversity with practical guidance for families, advocating for a more nuanced and compassionate approach to supporting girls with autism.

Main Discussion Points & Insights

1. The Gender Gap in Autism Diagnosis

• Statistical Surprise: Four times as many boys are diagnosed as girls, yet by age 20, the ratio balances out, suggesting girls are often missed (02:20).

• Reason for the Gap: Early autism research and diagnostic models were based mostly on boys, so girls’ symptoms are less likely to fit the traditional profile.

  “So maybe we just aren't diagnosing the girls. Yeah, all those girls, especially teenagers with diagnoses like anxiety and depression, some of them are actually on the autism spectrum.”
  — Dr. Wendy Hunter [03:10]

2. Autism in Girls: Presentation and Masking

• Masking Explained: Girls often become skilled at "masking," hiding their autistic traits by mimicking peers’ behaviors and forcing themselves to conform to social expectations (07:05).

• Exhaustion and Meltdowns: This effort to blend in leads to emotional fatigue. Girls may hold it together at school, only to have “meltdowns” in the safety of home (08:50).

  “Masking means hiding your struggles so other people don't see them. It’s when a girl studies the kids around her and copies what those girls are doing. She forces eye contact because she knows she’s supposed to...But inside, she’s working really hard, and that constant effort is exhausting.”
  — Dr. Wendy Hunter [07:23]

  “So you’re masking all day...You’re depleted. So that’s another way we see meltdowns, right?”
  — Dr. Maya Gittleson [08:50]

3. Why Autism in Girls is Overlooked

• Superficial Judgments: Clinicians tend to rely on observable, stereotypical behaviors found more commonly in boys (hand flapping, lining up toys, etc.), missing more subtle symptoms in girls (06:08).

• Girls as "Anxious" or "Perfectionistic": Instead of seeing autism, girls are labeled as anxious, perfectionistic, or sensitive.

  “We have a picture in our minds of what autism looks like. And girls with autism often don’t fit that picture.”
  — Dr. Wendy Hunter [07:45]

4. Sensory Processing and Emotional Regulation

• Sensory Overload: Many autistic individuals have difficulty filtering sensory input, causing emotional dysregulation and meltdowns (10:03).

  “They’re on sensory overload, and then that’s where that emotional dysregulation occurs. They just can't take it anymore.”
  — Dr. Maya Gittleson [10:03]

5. Misdiagnosis: Mood and Eating Disorders

• Common Mislabels: Girls are frequently misdiagnosed with anxiety, depression, bipolar disorder, or eating disorders rather than autism (15:14, 25:30).

• Consequences: These misdiagnoses lead to treatments and medications that don’t address the underlying issue.

  “They get discharged, most likely with a mood disorder...the difficulty is then that diagnosis...carries with them...And then the medications you put on for bipolar or mood disorder are not actually possibly what the child really needs if their underlying issue...is autism.”
  — Dr. Maya Gittleson [15:14]

  “We’ll get kids...treated by eating disorder specialist...But it was actually the rigidity and her obsessiveness in terms of what that fell on. It fell on food.”
  — Dr. Maya Gittleson [25:32]

6. Strengths and Hidden Advantages

• Intellectual Strengths: Some autistic girls demonstrate exceptional ability in specific areas (music, art, reading) – sometimes mistaken for being “advanced” in neurotypical terms, when it may be a hallmark of autism (11:28, 12:53).

  “They're like, it can’t be autism. My child can read and he’s three. And I'm thinking, well actually, that's more of a red flag to me...”
  — Dr. Maya Gittleson [12:43]

7. Diagnostic Challenges with Traditional Tools

• Inadequate Rating Scales: Common tools like the M-CHAT rely on markers that may not reflect how autism presents in girls, especially regarding eye contact and interests (13:09–14:50).

  “The quality is not necessarily visual connection and engagement...It actually has that quality piece that’s a little less engaged than maybe another person...”
  — Dr. Maya Gittleson [13:27]

8. Identity & Self-Understanding

• Impact of Proper Diagnosis: For many girls and women, receiving an autism diagnosis is life-changing, providing an explanation for lifelong struggles and ending self-blame (16:27, 21:49).

• Seeking Belonging: Adolescent and adult women often seek diagnoses for self-understanding or to find communities they genuinely belong to (21:49).

  “Finding where they fit in...They want to go to that support or they want to be in that grouping that they found on campus, but they don’t want to be an imposter.”
  — Dr. Maya Gittleson [21:49]

9. IEPs and School Challenges

• Invisible Struggles at School: Girls may "function" well at school but experience distress at home. Schools often deny support because the obvious struggles aren’t seen in class (23:06).

  “They sit there...saying, we don't see this at school. I'm like, but you’re not going to. But let me tell you, because she’s asking. You’re causing emotional distress with this child.”
  — Dr. Maya Gittleson [23:06]

  “Pay attention to the effort. Is she studying other kids to figure out how to act? Is she exhausted after social time even if she says it went fine?...Does she say things like, 'I'm just bad at people.'”
  — Dr. Wendy Hunter [24:53]

10. Common Signs for Parents to Watch For

• Intense, sometimes unusual interests that are gender-normative (like makeup), so they are missed as red flags (14:12).
• Rigid behaviors around routines or preferences (food, movies).
• Extreme exhaustion or distress after social interactions.
• A strong tendency to mimic social behaviors rather than genuinely engage.
• Alternating maturity: appearing older than peers in some ways, younger in others.

11. Intergenerational Recognition

• Some mothers realize their own undiagnosed autism only after seeing the evaluation process for their daughters (28:21).

  “As I was filling out the forms for my daughter, I thought, wait, this is me.”
  — Dr. Wendy Hunter [28:21]

Notable Quotes & Moments

• On Masking and Fatigue:
  "She laughs when everyone else laughs, even when she doesn’t get the joke...when she finally gets home where it’s safe, she falls apart. Not because she's being dramatic, because she’s tired."
  — Dr. Wendy Hunter [07:23]

• On Misdiagnosis:
  “That diagnosis...carries with them. So then they go somewhere else and then they use the diagnosis, oh, you have bipolar. Okay, bipolar. And then...it just perpetuates and that’s a really upsetting thing for me because what’s the underlining issue that's going on? It’s never touched.”
  — Dr. Maya Gittleson [15:14]

• On Special Interests in Girls:
  “For girls, that’s easy. Makeup. So a lot of the girls are obsessed about makeup...A parent would never come to me and say, I’m concerned, my child's obsessed with makeup, she's a girl...”
  — Dr. Maya Gittleson [14:12]

• On Food Rigidity vs. Eating Disorder:
  “She just was wanting to eat the same thing every day for periods of time....It wasn’t trains, it wasn’t makeup. It was the food.”
  — Dr. Maya Gittleson [25:32]

Timestamps for Key Segments

• [02:20] When Dr. Wendy introduces the gender gap in autism diagnosis and the myth of autism as a “boys’ condition”
• [05:30–07:45] Dr. Gittleson explains how her training failed to prepare her for diagnosing girls and why superficial cues mislead clinicians
• [07:45–09:49] Exploration of masking, meltdowns, and why girls’ symptoms are missed
• [10:03] Sensory processing differences and emotional dysregulation
• [13:09–14:50] Limitations of diagnostic tools and discussion of “special interests” in girls
• [15:14–16:27] Discussion on frequent misdiagnosis and the problem of treating the wrong condition
• [21:49] College-aged women seeking diagnosis for self-understanding
• [23:06–24:55] IEP challenges; what parents and schools often miss
• [24:55–27:12] Masking, food rigidity, and nuanced advice for parents
• [28:21] Recognition of autism in mothers through their children’s evaluation

Actionable Advice for Parents and Listeners

• Pay attention to hidden effort behind social success.
• Observe for unexplained exhaustion after socialization.
• Notice rigid preferences, especially those that seem normal for girls.
• Don’t dismiss the possibility of autism because of eye contact or verbal skills.
• Seek professional assessment if your daughter presents with intense interests, struggles with social connection, or seems perpetually exhausted by social life.
• Remember: a diagnosis can bring relief, self-understanding, and access to the right support.

Further Resources

• Dr. Maya Gittleson: Gittleson Psychology Services (link in show notes)
• Book Mentioned: Autism in Heels – a memoir capturing the adult female experience of autism
• Podcast Contact: pediatriciannextdoorpodcast.com | hellopediatriciannextdoorpodcast.com

This thoughtfully structured episode is a must-listen for parents, teachers, and anyone seeking to truly understand autism beyond old stereotypes—and especially as it appears in girls and women.