In the global landscape of neurodiversity, a profound silence often surrounds the experiences of women and girls. While awareness of Autism Spectrum Disorder (ASD) is growing, the data in India reveals a troubling disparity.
According to the Centers for Disease Control and Prevention (CDC), the global prevalence of autism is approximately 1 in 36 children. However, in India, the diagnostic gap remains stark. Research published in the Journal of Autism and Developmental Disorders indicates that for every four boys diagnosed with autism in India, only one girl is identified.
Medical experts are now sounding a critical alarm: this 4:1 ratio is not a biological certainty—it is a diagnostic blind spot. While young boys may express their neurodivergence through outward disruption, young Indian girls are socialised to do the exact opposite: to mask, to mimic, and to disappear into the background.
As World Autism Acceptance Month is observed in April, there is a need to dismantle the mimicry trap and provide a clear service-oriented roadmap for women and families navigating a system that wasn`t originally built to see them.
The masking mandate: Why Indian girls disappear
In the context of traditional Indian upbringing, social expectations act as a powerful catalyst for masking. Bernice Mariya Rani G, consultant in psychology and child life therapy at Manipal Hospital, explains, “From a young age, girls are frequently taught to be polite, to adjust, and to prioritise the needs of others. While these are often viewed as positive cultural values, for a neurodivergent girl, they become a blueprint for hiding her true self. Masking is not merely acting; it is an exhaustive, high-stakes performance.”
She outlines what masking entails:
1. Forcing eye contact even when it feels physically painful, invasive, or distracting.
2. Suppression of stims or repetitive movements (like hand-flapping or rocking) that help regulate the nervous system.
3. Constant self-monitoring of tone, posture, and facial expressions to match the expected social vibe of the room.
4. Mentally scripting conversations hours in advance to avoid social errors.
“When a child hides who they really are to fit in, this, if it goes on for a long time, can lead to anxiety, tiredness, and feeling lost about who they are,” explains Bernice.
The shutdown versus meltdown
A primary reason for the delayed diagnosis in India is the way distress is expressed. In a typical Indian setting—such as a crowded wedding or a family dinner with overlapping conversations, bright lights, and strong smells—the sensory demand is immense.
Unlike the stereotypical meltdown often associated with autistic boys (which might involve shouting or physical movement), girls may experience a shutdown. According to Bernice, “This is a neurobiological protective freeze response. To an observer, she might just seem moody, quiet, or well-behaved, but internally, her nervous system is in a state of collapse. This internal freeze is frequently mistaken for compliance, which is why many girls reach adulthood without support.”
The mimicry trap and normal interests
One of the greatest hurdles to identification is that autistic girls often gravitate toward interests that are culturally celebrated or expected in India. While older diagnostic criteria looked for atypical obsessions like train schedules or mechanical data, girls often focus intensely on:
1. Creative arts: Deep, technical immersion in classical dance, music, or painting.
2. Literature: Reading the same stories repeatedly for predictability and emotional comfort.
3. Nurturing: An intense, almost hyper-focused attachment to animals, pets, or specific people.
Bernice points out, “The red flag isn`t what they like, but how they like it. The intensity of the focus is a regulatory tool used to feel safe and calm. Just because these interests look normal or even talented, people often don`t recognise that they could be a sign of autism,” she notes. For these girls, the hobby isn`t just a pastime—it is a sanctuary.
Seeking a nuanced evaluation: The clinical path in India
If a parent suspects their daughter is neurodivergent despite her coping well academically, Radhika Gad, clinical psychologist at Kokilaben Dhirubhai Ambani Hospital, emphasises the need to look beneath the surface. “High intelligence often allows autistic girls to intellectualise social rules, making their struggles invisible in a classroom setting,” she reveals.
The recommended clinical roadmap:
1. Consult a specialised professional: Seek a developmental paediatrician, a licensed clinical psychologist, or a psychiatrist who specifically cites experience with female presentation or high-masking individuals.
2. The multidisciplinary approach: A nuanced evaluation must include a detailed developmental history (looking back at early childhood signs like light sensitivity or social fatigue), behavioural observations, and standardised assessments.
3. The aftermath report: When speaking to doctors, focus on the child`s behaviour after the social performance is over. Is she having emotional outbursts at home? Does she need three hours of silent solitude after school? This social hangover is a primary indicator of the energy cost of masking.
“Children, particularly girls, may engage in masking behaviour to fit into and meet societal expectations. This behaviour could lead to exhaustion, overwhelm, emotional outbursts, or anxiety,” notes Radhika.
The adult experience: Unmasking after decades
For adult women in India, the path to self-discovery often starts with a history of misdiagnosis. Many spend years being treated for mood swings, borderline traits, or chronic anxiety without the underlying cause—a neurodivergent brain—ever being addressed.
The unmasking exercise
For those who have hidden their traits for so long that being yourself feels like a foreign concept, Gad suggests a daily exercise in building awareness through self-check-ins:
1. The sensory audit: Throughout the day, stop and notice physical sensations. Are the tags on your clothes scratching you? Is the hum of the AC making your head throb?
2. Energy tracking: Ask, “Which situations today made me feel like I was performing?” and “When did I feel truly at ease?”
3. Identifying triggers: Note which environments lead to a shutdown or a feeling of being disconnected (zoning out).
By identifying what a performed personality is versus an authentic need, a woman can begin to advocate for her own well-being.
Practical support: The home sensory audit
You do not need an expensive clinic or high-tech gear to make an Indian home neuro-friendly.
Based on recommendations by Gad, here are five immediate, low-cost sensory fixes to reduce the daily mental load:
1. Lighting: Harsh overhead tube lights can be physically painful for those with light sensitivity. Swap them for warm-toned lamps, LED strips, or even simple fairy lights to create a softer visual environment.
2. Auditory management: During loud Indian festivals or even daily traffic noise, use noise-cancelling headphones or loop earplugs. These allow for focus during tasks like studying or working.
3. Tactile grounding: Introduce weighted blankets, soft-textured rugs, or small fidget toys. These provide proprioceptive input, which helps the brain feel where the body is in space, reducing anxiety.
4. Olfactory control: Switch to mild, natural essential oils and avoid strong chemical cleaners or heavy incense if strong scents cause nausea or headaches.
5. The recovery zone: Designate a specific corner of the house as a ‘no-social zone.’ This is a place where the person can go to unmask—no eye contact required, no talking necessary, just a space to reset the nervous system.
Communicating with family: Navigating cultural scepticism
In a culture where fitting in is a primary virtue and adjusting is expected, explaining a need for boundaries to sceptical elders can be a major hurdle. The experts suggest moving away from clinical terms like sensory processing or spectrum and focusing on relatable, functional outcomes.
Radhika’s strategy for communication:
1. Avoid labels initially: If family members are resistant to the word autism, describe the need instead. Try: “My brain processes sound very intensely, and I need 15 minutes of quiet to be a better guest at dinner.”
2. Highlight the engaged benefit: Explain that these boundaries aren`t about leaving the family, but about staying well enough to participate. “If I take this break now, I won`t get a headache and can enjoy the celebration later.”
3. Consistency is key: Calmly and consistently applying these boundaries helps family members see them as a routine rather than a mood. Over time, they are more likely to adapt when they see the positive change in your energy.
4. Clinical inclusion: If an elder is particularly sceptical, inviting them to a session with a neuro-affirming professional can provide the external authority they may need to take the condition seriously.
Finding neuro-affirming care in India
The fear of being dismissed by a traditional doctor—told you are too smart or too social to be autistic—is a valid concern for many women. To find a professional who understands the nuance of the female spectrum, Radhika recommends looking for these green flags:
1. The masking question: Does the professional ask about how you feel internally during social situations, or only how you look to others?
2. Modernised tools: Ask if they use updated assessment tools that account for high-masking individuals.
3. The difference versus deficit language: Look for professionals who describe neurodivergence as a difference in functioning rather than a disorder that needs fixing
4. Keywords: Search for terms like neuro-affirming, trauma-informed, and strength-based when looking for psychologists or psychiatrists in major Indian hubs.
The path forward: Acceptance over perfection
The goal for the Indian neurodivergent community is not to fix the person to fit an overwhelming environment, but to adjust the environment to support the person`s unique brain. When we stop viewing autism through a narrow lens of disruption and start looking at the internal cost of fitting in, we begin to see the millions of women who have been hiding in plain sight.
As Bernice beautifully concludes, “When a child feels safe at home, they don`t have to pretend. They can just be themselves, and that alone is enough.” By shifting the focus from outward behaviour to internal experience, we can ensure that no girl or woman in India has to disappear into the background ever again. Acceptance begins with seeing the person behind the mask.
