Why girls are missed

• Present as more socially motivated, masking demand avoidance behind cooperation in public
• Use indirect avoidance strategies (negotiating, distracting, procrastinating) rather than overt refusal
• Internalise distress — presenting with anxiety and depression rather than externalised behaviour
• Perform compliance at school but experience severe meltdowns at home
• Use social mimicry effectively enough to confuse clinicians

Common misdiagnoses

• Anxiety disorder (GAD, social anxiety, school refusal)
• ODD (Oppositional Defiant Disorder)
• ADHD — often inattentive type
• Borderline Personality Disorder (particularly in late adolescence)
• Eating disorders (often linked to demand avoidance around food)
• Selective Mutism

The cost of masking

Masking — suppressing autistic and PDA traits to fit in — has a significant mental health cost. Research links heavy masking to burnout, depression, suicidality, and loss of identity. Recognition of masking is now a critical part of comprehensive PDA assessment.

What assessment should look like for girls

• Use female-normed or female-informed assessment tools
• Gather reports from multiple contexts — home, school, and peer relationships
• Explicitly ask about masking and the gap between school/home behaviour
• Assess for co-occurring conditions including anxiety, eating disorders, and trauma
• Do not dismiss PDA because the child “presented well” during assessment

Community & peer connection

Peer community — with others who truly understand — is one of the most powerful support tools. Visit our Support hub to find groups, forums, and networks.