For much of her short life, Ruby Hobbs-Leffler experienced the world with an intensity that defied easy categorization. She was a bright, articulate girl with an expansive vocabulary, yet she found herself utterly unable to translate the overwhelming sensory onslaught of her daily existence into words. Bright lights, loud noises, and intolerable textures and tastes hit her all at once. Feelings bubbled up uncontrollably, manifesting as inconsolable howls in infancy, classroom meltdowns during her childhood years, and sudden rages in adolescence.
Most children could not understand her, and neither could many adults. Because she was articulate and insightful in so many ways, teachers, peers, and authority figures often wondered why she simply could not just behave. No one seemed to grasp that the world was sometimes entirely too much for Ruby. Instead of receiving accommodation or understanding, she absorbed a devastating message, as her mother, Jessica Leffler, recalled: she was told she was "too much"—too dramatic, too difficult, and too strange.
When Ruby was finally diagnosed with autism at the age of 14, the news came as an overwhelming relief. Suddenly, there were valid reasons for the way she perceived her environment, and there were concrete words for the sensory experiences that had alienated her from her peers throughout her formative years.
For Leffler, however, that relief was instantly eclipsed by profound anger. Why did Ruby have to go so many years without the support she desperately needed? Why did none of the professionals the family asked for help during her childhood manage to identify her needs? Why did she have to spend the most vulnerable years of her life being treated by teachers and peers like a failure, rather than a young person simply trying to navigate a world engineered for a completely different way of thinking?
Today, following Ruby’s tragic death from suicide in 2024 at the age of 15, Leffler wants answers to a much larger question: Why are so many girls with autism who possess gifts and face challenges similar to Ruby’s being routinely overlooked by the medical, educational, and mental health systems meant to protect them?
Children with autism are significantly more likely than their neurotypical peers to experience co-occurring mental health conditions such as depression and anxiety, and they face a heightened risk of suicidal ideation and mortality. For girls, however, an additional, highly complex layer obscures diagnosis and delays vital intervention.
Girls with autism who do not have co-occurring intellectual disabilities tend to be diagnosed significantly later than their male counterparts—frequently not until adolescence or even later in life. Consequently, they miss out on crucial early interventions that can help neurodivergent children successfully navigate challenging social and sensory environments. Instead, they are frequently diagnosed with standard psychiatric disorders like depression or generalized anxiety long before anyone identifies their autism, leaving them to cycle through treatments designed for neurotypical individuals that offer little to no relief.
To cope with the dissonance, many girls resort to masking or camouflaging—the conscious or unconscious suppression of autistic traits in a desperate bid to fit in. Without proper guidance or support, what begins in childhood as an automatic mimicry of peers eventually exacts a painful, compounding psychological toll over time.
While experts note there is no single reason why any individual dies by suicide, and no way of knowing whether an alternative timeline would have changed the outcome, Leffler remains convinced that being understood sooner might have sustained Ruby during her darkest moments.
"It is so incredibly hard to live life the way that Ruby lived life," Leffler said recently from her dining room table in Princeton, Kansas, which was strewn with photographs of Ruby cuddling cats and grinning widely at the camera, alongside notebooks filled with her intricate drawings and color-coded homework assignments.
"She masked, she masked, she masked," Leffler added. "And that’s exhausting."
Statistically, boys and girls are diagnosed with autism at roughly equal rates until approximately age three. These youngest children typically exhibit major language or developmental delays that are relatively straightforward for parents and pediatricians to spot. During the elementary school years, however, the trajectories diverge dramatically. Boys are diagnosed with the neurodevelopmental condition at more than three times the rate of girls, and they receive those diagnoses at much younger ages.
A 2024 review of electronic health records found that boys are most likely to receive an autism diagnosis between the ages of 3 and 11, whereas girls are typically identified either before age 3 or after age 11. Researchers suggest this skewed ratio is self-perpetuating because diagnostic tools themselves have historically been calibrated around male autism traits.
"Girl autism really does not check the behavioral boxes that we, as clinicians and researchers, have been taught to look for," explained Dr. Lauren Kenworthy, chief of neuropsychology and director of the Center for Autism Spectrum Disorders at Children’s National in Washington, D.C.
Boys are statistically more likely to display classic autism traits, such as a lack of eye contact, repetitive motions like rocking or hand-flapping, and a tendency to play alone more frequently than their female peers. Girls, by contrast, tend to be far more adept at mimicking social responses, such as maintaining eye contact and engaging in reciprocal play. While they possess deep, all-consuming special interests just like autistic boys, their preferred subjects are often socially mainstream, such as unicorns or specific types of dolls.
When girls experience intense, visceral reactions to changes in routine, uncomfortable situations, or overwhelming sensory stimuli—a phenomenon known as an autism meltdown—parents, educators, and professionals frequently write them off as simply being unusually emotional neurotypical children.
Ruby began seeing therapists for sleep and behavioral issues when she was just nine years old. Although she exhibited numerous classic early childhood indicators—including extreme sensitivity to noise, severely limited food preferences, a rigid adherence to routine, and difficulties understanding social nuances—no clinician ever suggested she might be autistic.
"I assumed, very incorrectly, that they would tell me what I needed to know," Leffler said.
Children with autism frequently present "spiky" cognitive profiles, meaning that exceptional ability or intellectual maturity in specific domains, such as verbal skills or reasoning, coexists alongside significant delays in areas like executive functioning and impulse control. Without an accurate diagnosis to explain this discrepancy, adults and peers alike often struggle to understand why a child who excels academically can simultaneously stumble over seemingly simple, everyday tasks.
The coping strategies that girls develop often manage to function well enough until early adolescence. At that critical juncture, when female social relationships grow exponentially more complicated and masking becomes vastly more difficult, their mental health outcomes split sharply from those of their male peers.
In a study led by Kenworthy earlier this year, researchers tracked 313 youth with autism ranging in age from 2 to 25. They documented higher baseline rates of anxiety, depression, and executive functioning challenges compared to neurotypical peers in both boys and girls throughout childhood. However, upon reaching their teenage years, the girls’ anxiety spiked significantly higher than the boys’ and remained elevated well into adulthood.
For girls who remain completely unidentified, the constant stream of negative feedback from adults and peers inflicts severe, compounding damage on their self-esteem.
"Often, the longer a girl goes without knowing she has autism, the more deeply entrenched are her own negative attributions about her failings," Kenworthy noted.
A 2024 review of hospital records at Duke University found that girls who received a late autism diagnosis were also highly likely to have first received a diagnosis of depression or anxiety within the preceding two years.
"When you are receiving these anxiety and mood diagnoses… that’s going to delay your autism diagnosis," said the study’s author, Dr. Matthew Engelhard, a biostatistician at Duke.
These obstacles regularly persist into adulthood. Individuals with autism across all genders frequently struggle with the subtle nuances of social communication, such as decoding nonverbal cues, identifying sudden shifts in tone, or asking reciprocal questions. However, women face disproportionately harsher social penalties if they fail to meet these behavioral expectations.
"There are different social standards for women, and this is why women mask harder," said Storee Powell, a 38-year-old disability advocate based in Smithfield, Utah.
While experts point out that masking is not unique to autism and is not inherently harmful—pointing to how anyone might naturally act more formally during a job interview than they would with close friends—for many autistic women, relentless masking creates a crushing pressure cooker directly associated with long-term suicidal behavior.
In the general population, men die by suicide at significantly higher rates than women. Among autistic individuals, however, women die by suicide at roughly the same rates as autistic men, representing a vastly elevated risk compared to neurotypical women.
Similar tragedies have upended other families. After her 13-year-old daughter, Maisa, survived a suicide attempt in May 2023, Samia McCall began reading extensively about neurodiversity. She was stunned to discover how closely the descriptions of autism aligned with her creative, sensitive daughter—particularly her strong need for routine, social anxiety, communication hurdles, and sensory processing differences.
When McCall brought her findings to Maisa’s doctor and therapist in Boise, Idaho, she recalled that they brushed off her concerns, pointing to Maisa’s good grades, verbal sophistication, and empathy as definitive proof that she could not possibly be autistic.
Maisa was trapped on a six-month waitlist for a formal evaluation when she died by suicide in November 2023 at the age of 14. While it is impossible to predict the exact outcome of an earlier evaluation, McCall remains convinced her daughter would have benefited immensely from timely recognition.
"I think it could have made a huge difference in her self-esteem," McCall said. "I think she was internalizing a lot of things as a personal failure when just her brain was working differently."
After connecting online last year, McCall, Leffler, and a third grieving mother named Deborah Royal established the Seen Movement, a suicide prevention organization dedicated to advocating for systemic reform in how institutions respond to individuals in acute crisis.
"By the time you get to where someone’s suicidal, it’s like Stage IV cancer. You need an intervention early," McCall emphasized. "Because if you identify and support someone who’s autistic or neurodivergent early in life, then they’re never going to develop this idea that something’s wrong with them."
While a childhood diagnosis does not serve as an absolute guarantee that an autistic person will never grapple with depression, self-doubt, or suicidal thoughts, emerging evidence suggests that the earlier a girl achieves self-awareness, the sooner she can design a life that accommodates her unique strengths and needs.
Anne Kirby, an assistant professor at Trinity College Dublin who has conducted extensive qualitative interviews with autistic adults for her research on autism and suicide, noted that multiple women diagnosed later in life reported that the label successfully lifted a profound burden of shame and confusion. Once they understood the root causes of their struggles, granting themselves permission to rest and take sensory breaks became far easier.
"A common experience of late-diagnosed people is that they generally feel that they hadn’t received support for things that they were struggling with throughout their lives," Kirby said. "After diagnosis, they often were able to give themselves more freedom to live life differently."
For Ruby, the period following her diagnosis was one of genuine thriving. She excelled at online learning, which she completed quietly from a dedicated corner in Leffler’s office, and she became a beloved presence at the grocery store and doughnut shop where she worked. She harbored plans to pursue a career in finance and joked about marrying a man who would agree to live at her mother’s house forever, Leffler recalled with a soft laugh.
Then, a complex convergence of medical, mental, and personal crises struck in early 2024. Even as loved ones rallied to support her, Ruby began experiencing increasingly severe mood swings, disordered eating, and suicidal ideation. Mental health providers she encountered during this period dismissed her autism diagnosis as an irrelevant detail. On July 11, 2024, following a sudden, impulsive moment on an otherwise ordinary day, Ruby died.
In the aftermath of the loss, Leffler sought out a tattoo artist who shared dimples similar to her daughter’s, operating out of a studio painted in Ruby’s favorite shade of pink. Today, Leffler’s arms are as colorful as Ruby’s old notebooks—a rich collage featuring her favorite animals and objects, reproductions of her original drawings, and flowers arranged in the exact shape of her handprint.
Ruby was perfect precisely the way she was, Leffler insists, adding that she does not want any other young girl facing similar neurodivergent hurdles to ever doubt her own inherent worth.
"She was a bright, cuddly, sparkly person," Leffler said. "She deserves to be loved and missed."
