The Invisible Struggle: Improving Diagnosis for Women and Girls

For decades, the “standard” model of neurodivergence was a hyperactive boy disrupting class or a non-verbal boy lining up trains.

Because of this stereotype, generations of women and girls have been left behind—diagnosed with anxiety, depression, bipolar disorder, or simply labeled “dramatic” or “shy,” while their underlying neurodivergence went unnoticed.

Improving diagnosis isn’t just about changing medical textbooks (though we need that too). It is about changing what we look for. If we keep looking for the “naughty boy,” we will keep missing the “quiet girl.”

Here is how we close the gap.

1. The “Coke Bottle” Effect (The After-School Collapse)

One of the biggest reasons girls are missed is that they are often “model students.” They are quiet, helpful, and academically capable. Teachers rarely flag them because they aren’t causing trouble.

But the cost of that performance is high.

  • The Sign: A girl who is an angel at school but has explosive meltdowns the second she gets into the car or walks through the front door.
  • The Reality: She has been shaking the “Coke bottle” of her emotions all day—masking her sensory overwhelm and confusion to fit in. Home is the only place safe enough to take the lid off.
  • The Fix: We must stop judging a child’s struggles solely by their school report card. If the parents say she is struggling, believe them, even if the teacher says she is “fine.”

2. Move from “Observation” to “Inquiry”

Traditional diagnosis relies on observation: “Does she make eye contact?” “Does she sit still?”

Women and girls are socially conditioned to force these behaviors. They can often do them, but it costs them energy.

To diagnose women, we need to stop looking at the behavior and start asking about the internal cost.

  • Instead of checking: “Is she making eye contact?”
  • Ask: “Does making eye contact make you feel physically tired or anxious?”
  • Instead of checking: “Is she playing with other kids?”
  • Ask: “Is she intellectually analyzing the social interaction to figure out the ‘rules’ rather than just naturally participating?”

3. Recognizing “Socially Acceptable” Obsessions

We know to look for a boy obsessed with train schedules or spinning wheels.

But when a girl becomes obsessed with horses, a boy band, or makeup, we dismiss it as “typical girl stuff.”

  • The Difference: It is the intensity, not the topic.
  • The Sign: Does she collect facts about the boy band like data? Does she get genuinely distressed if she can’t engage with her interest? Is it a “comfort blanket” she retreats to when stressed?
  • The Fix: Validate these interests as potential “special interests” (Autism) or “hyper-fixations” (ADHD), rather than just hobbies.

4. The “Chameleon” Trait (Masking)

Many neurodivergent women are unconscious experts at mimicking others to survive. They study popular peers, copy their mannerisms, and adopt their phrases to avoid rejection.

  • The Consequence: This often leads to a diagnosis of Borderline Personality Disorder (BPD) or severe social anxiety because their sense of “self” feels unstable.
  • The Fix: Professionals need to be trained to spot Camouflaging. High social skills shouldn’t rule out Autism; often, in women, high social performance is actually a symptom of the anxiety required to hide it.

5. Trusting the “Self-Diagnosis”

Because the medical system has historically failed women, many are figuring it out themselves through social media or reading articles like this one.

  • The Reaction: Instead of rolling our eyes at “TikTok diagnoses,” we should listen.
  • The Truth: If a woman relates deeply to the neurodivergent experience, she has likely spent years feeling “wrong” and is finally finding language that fits. That self-insight is valid data.

We improve diagnosis by widening our lens. We need to stop looking for the deficit and start listening to the experience.