A persistent diagnostic gap
Autism and ADHD are both diagnosed considerably more often in boys and men than in girls and women, historically at ratios of around 4:1 for autism. Extensive research now suggests this gap reflects diagnostic bias far more than any true difference in how common these conditions actually are.
Where the bias comes from
Diagnostic criteria for both autism and ADHD were developed primarily through research on boys, meaning the "typical" presentation used in clinical assessments reflects male patterns of behaviour. Traits that present differently in girls and women — quieter hyperactivity, more socially camouflaged autistic traits, internalised rather than externalised difficulties — have historically been under-recognised or misread as something else entirely, such as anxiety or a personality trait.
Masking and its cost
Many girls and women learn to mask neurodivergent traits from a young age, consciously or unconsciously mimicking neurotypical social behaviour to fit in. Masking can be so effective that it delays or entirely prevents diagnosis, often at real cost to mental health and self-understanding, with many women only receiving a diagnosis in adulthood — frequently after a child's own assessment prompts them to recognise their own traits.
Why this matters for employers
A workforce shaped by this diagnostic gap will include many women with undiagnosed or late-diagnosed neurodivergent conditions, whose difficulties may never have been named, let alone supported. Relying on formal diagnosis as the sole gateway to adjustments risks excluding exactly the group most affected by historical bias.
What helps
- Needs-based, not diagnosis-based, access to adjustments and support.
- Manager training that includes how neurodivergent traits can present differently across genders.
- Genuine psychological safety to disclose without needing a formal label to be believed.
- Awareness that a late-diagnosed employee may be processing a significant personal shift alongside their working life.
Frequently asked questions
Are autism and ADHD actually less common in women? Current evidence suggests true prevalence is much closer across genders than diagnostic rates suggest — the gap is largely a reflection of how conditions were studied and diagnosed, not how common they are.
What is masking? The conscious or unconscious suppression of neurodivergent traits to appear more neurotypical, often learned as a survival strategy from childhood and sustained at significant personal cost.
Should workplace adjustments require a formal diagnosis? Best practice increasingly supports needs-based adjustments rather than requiring formal diagnosis, precisely because of the barriers described here.