Why is anxiety so often the first stop for autistic girls?

They are offered parenting courses, their daughter is offered six sessions of Cognitive Behavioural Therapy (CBT), and they are told to encourage her to be ‘more resilient’. Yet, nothing changes. In fact, things often get worse. The school refusal becomes more entrenched, the meltdowns at home more explosive, the quiet withdrawal from life more profound. The family is left feeling blamed and misunderstood, and the child is left without the support she so desperately needs. 

This is a story that is reaching epidemic proportions. It’s a systemic failure to understand the female autistic profile, and it is causing untold damage to a generation of girls. 

Let me tell you about ‘Alice’. To her teachers, Alice, aged ten, is a model pupil. She is quiet, conscientious, and always hands her homework in on time, completed to an incredibly high standard. She never disrupts the class. She is, in their words, “a delight to have”. They notice she can be a little tearful sometimes, and seems to worry a great deal about getting things ‘perfectly right’. They see her hovering on the edge of the playground, watching the other children play, but rarely joining in. When they gently encourage her, she might manage a few minutes before making an excuse to go and sit by herself with a book. They see a shy, sweet, anxious little girl. They recommend a lunchtime ‘worry club’. 

But Alice’s parents see a completely different child. The moment Alice gets in the car after school, the careful composure she has maintained for six solid hours begins to crumble. The journey home is often silent and tense. As soon as she walks through the front door, the explosion happens. It can be triggered by anything – the wrong kind of snack, a question about her day, the sound of her younger brother’s television programme. The screaming, crying, and lashing out can last for an hour or more, after which she collapses into a heap, utterly spent. 

Her parents know she struggles with the scratchy labels in her uniform, the overwhelming noise of the dining hall, and the unpredictability of social interactions. They know she spends her evenings meticulously arranging her pencils and rewriting her homework until it’s flawless, long after her peers are relaxing. They know that her ‘tummy aches’ every Sunday night are a manifestation of the sheer dread of facing another week of pretending to be someone she is not. 

Alice is masking.

Masking, or camouflaging, is a survival strategy that is particularly common in autistic girls and women. From a very young age, they learn to observe the neurotypical people around them and to mimic their behaviour. They learn to force eye contact even when it’s painful, to suppress the urge to stim (rock, flap, or fidget), to smile and nod in conversations they don’t understand, and to push through crippling sensory overload. It is an exhausting, full-time performance, a constant act of social translation in a world where they don’t speak the native language. 

The ‘model pupil’ at school is the result of this exhausting performance. The meltdown at home is the inevitable release of all that pent-up stress and sensory overwhelm in the one place she feels safe enough to be her authentic self. She isn’t being ‘naughty’ or ‘defiant’; she is dysregulated and completely overwhelmed. Her battery is not just empty; it is in severe deficit. 

So why are so many professionals only seeing the anxiety? Why are we so quick to place a label on the symptom, rather than asking what is causing it? An anxiety diagnosis is often the path of least resistance. It fits neatly into the boxes on a referral form. But treating the anxiety without understanding its root cause is like constantly mopping a flooded floor without ever turning off the overflowing tap. The anxiety is not the problem itself; it is the entirely predictable, logical consequence of being an autistic person forced to navigate a neurotypical world without the right support or understanding. 

Of course she is anxious. She is anxious about getting social cues wrong, about saying the wrong thing, about the fire alarm going off, about the change in routine because of a substitute teacher, about the smell of the school lunches. Her anxiety is a rational response to a world that constantly bombards and confuses her.

But as we’ve seen, an autistic girl’s anxiety is often far from irrational; it’s a direct result of her environment and neurology. In some cases, these therapies can even be harmful, inadvertently teaching girls to mask more effectively, to better suppress their authentic selves, which only serves to increase their internal stress and alienation. 

Secondly, it leads to a catastrophic erosion of mental health. Years of being misunderstood, of feeling like a failure for not being able to cope with things others find easy, takes a heavy toll. The constant internal pressure cooker of masking, without any valve for release or understanding, is a direct pathway to autistic burnout, depression, eating disorders, and self-harm in adolescence and adulthood. We are seeing a tragedy unfold where girls are reaching crisis point before their underlying neurotype is even considered. 

Finally, and perhaps most tragically, it fundamentally damages a girl’s sense of self. When you are constantly told, implicitly or explicitly, that your natural responses are wrong, you learn to hate and distrust yourself. You believe you are broken, too sensitive, too much. You miss the opportunity to understand how your brain works, to embrace your autistic identity, to

find your community, and to learn strategies that actually work for you. You are denied the chance to thrive as the person you truly are. 

If you are a parent reading this, and it resonates with your own experience, please listen to your instincts. You are the expert on your child. If you have been told it’s ‘just anxiety’ but you feel in your gut that there is something more going on, you are probably right. 

Start documenting everything. Create a diary that details the stark differences between your daughter’s behaviour at home versus at school. Note down her sensory sensitivities, her social difficulties, her need for routine, her intense interests, and the pattern of her meltdowns. This evidence is crucial. 

Challenge the professionals. Ask them directly: “Have you considered autism? Are you familiar with the female presentation?” Seek out a diagnostic assessment from a clinician or a team who explicitly state their experience with autistic girls and women. Do not be fobbed off. 

For too long, our understanding of autism has been based on a male-centric model. We have been looking for boys who are obsessed with trains and who don’t make eye contact, while completely missing the quiet girls who are obsessed with novels and are making too much eye contact because they’ve taught themselves to. 

These girls are not anxious. They are autistic. And they deserve to be seen, understood, and supported for who they are.