Ruby Hobbs-Leffler experienced the world with an intensity that her sharp intellect and extensive vocabulary could never quite capture. Life was a relentless barrage of glaring lights, deafening sounds, and intolerable textures and tastes. Emotions surfaced with a force she could not control: inconsolable cries during infancy, disruptive classroom meltdowns throughout childhood, and intense rages as she entered adolescence.
Most children failed to understand her, and many adults proved equally unequipped. Because she was articulate and insightful in numerous ways, observers frequently asked why she could not simply control her behavior. No one seemed to grasp that the world was often overwhelmingly intense for Ruby. Instead, her mother, Jessica Leffler, explained that Ruby internalized a devastating message: that she was simply "too much"—too dramatic, too difficult, and too strange.
When Ruby was finally diagnosed with autism at the age of 14, it brought an immense sense of relief. Suddenly, there were tangible reasons for the way she perceived her surroundings, and proper terminology to describe the sensory experiences that set her apart from her peers.
For Leffler, however, the diagnosis triggered profound anger. Why had Ruby been forced to endure so many years without the vital support she desperately required? Why had none of the professionals consulted by the family correctly identified her needs? Why did she spend her formative years being treated by teachers and peers like a failure, rather than a young person navigating a world built for a fundamentally different way of thinking?
Following Ruby’s tragic death by suicide in 2024 at the age of 15, Leffler is left demanding answers to a broader, more urgent question: Why are so many gifted and complex girls with autism continuing to be overlooked by parents, educators, and medical professionals?
Children diagnosed 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. Yet, for girls, an additional layer of complexity obscures these struggles.
Autistic girls without co-occurring intellectual disabilities tend to be diagnosed significantly later than boys, frequently not receiving identification until adolescence or later in life. Consequently, they miss out on crucial early interventions that help neurodivergent children navigate challenging environments. They are also far more likely to be diagnosed with standard psychiatric disorders, such as depression or anxiety, long before their underlying autism is recognized. As a result, interventions designed for neurotypical individuals often fail to provide any meaningful relief.
To cope, many girls resort to masking or camouflaging—suppressing core autistic traits in a desperate bid to fit in. Without proper support, what begins during childhood as an unconscious mimicry of peer behavior exacts a profoundly painful psychological toll over time.
While experts emphasize that there is no single cause for suicide and no way to know whether alternative steps would have altered a specific outcome, Leffler remains convinced that being understood sooner might have sustained Ruby through her darkest moments.
"It is so incredibly hard to live life the way that Ruby lived life," Leffler said recently from her dining table in Princeton, Kansas. The table was strewn with photographs of Ruby cuddling cats and smiling broadly at the camera, alongside notebooks filled with her artwork and meticulously color-coded homework assignments.
"She masked, she masked, she masked," Leffler said. "And that’s exhausting."
Statistics illustrate a stark demographic shift in diagnostic trends. Boys and girls are diagnosed with autism at roughly equal rates until approximately age three, a period when children typically exhibit major language or developmental delays that are easily recognized by parents and physicians.
During the elementary school years, however, diagnostic trajectories diverge sharply. 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. Electronic health record data from a 2024 review indicates that boys are most likely to be diagnosed between the ages of 3 and 11, whereas girls are typically identified either before age 3 or after age 11.
Researchers note that this skewed ratio can become self-perpetuating. Because prevailing medical assumptions dictate that more boys have autism, standard diagnostic tools have naturally developed a heavy bias toward male autism traits.
"Girl autism really does not check the behavioral boxes that we, as clinicians and researchers, have been taught to look for," said 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 than girls to display classic autism traits, such as a lack of eye contact and repetitive motions like rocking or hand-flapping. They also tend to play independently more often than their female peers.
In contrast, girls frequently demonstrate a higher aptitude for mimicking social responses, including maintaining eye contact and engaging in reciprocal play. Like boys with autism, they often develop deep, all-consuming special interests, but their preferred subjects are usually socially mainstream, such as unicorns or specific types of dolls. When they experience intense reactions to unexpected changes in routine, uncomfortable situations, or overwhelming sensory stimuli—a phenomenon known as an autistic meltdown—parents, teachers, and professionals often misinterpret the episodes as the behavior of an unusually emotional neurotypical child.
Ruby began seeing therapists for sleep and behavioral difficulties 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 daily routines, and difficulties navigating social nuances—none of the professionals suggested she might have autism.
"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 advanced 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, adults and children alike often struggle to understand why a student who excels academically simultaneously stumbles over seemingly simple tasks.
The coping strategies employed by girls often function effectively until early adolescence. At that critical juncture, when female social relationships grow exponentially more complex and masking becomes increasingly difficult, their mental health outcomes diverge 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. The data revealed higher baseline rates of anxiety, depression, and executive functioning challenges among both boys and girls with autism throughout childhood compared to neurotypical peers. However, upon reaching their teenage years, the anxiety levels among girls increased significantly relative to boys, and those elevated levels persisted into adulthood.
For girls who remain unidentified, negative feedback from adults and peers can severely erode 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 medical records at Duke University hospital similarly revealed that girls who received a late autism diagnosis were also highly likely to have been diagnosed with 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 study author Dr. Matthew Engelhard, a biostatistician at Duke.
These obstacles frequently persist well into adulthood. While autistic individuals of all genders often struggle with social communication nuances—such as decoding nonverbal cues, identifying shifts in tone, or asking reciprocal questions—women often face much harsher social penalties for failing to meet these 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 note that masking is not unique to autism and is not inherently harmful in every context—such as adopting a formal demeanor during a job interview—the relentless pressure to mask is strongly associated with long-term suicidal behavior among many autistic women.
In the general population, men die by suicide at significantly higher rates than women. However, women with autism die by suicide at rates comparable to men with autism, and at drastically higher rates than women without autism.
Similar heartbreak prompted Samia McCall to seek answers after her 13-year-old daughter, Maisa, attempted suicide in May 2023. As McCall began reading about neurodiversity, she was stunned by how closely the clinical descriptions of autism mirrored her creative and sensitive daughter, noting Maisa’s strong need for routine, social anxiety, communication challenges, and sensory processing differences.
When she presented her findings to Maisa’s doctor and therapist in Boise, McCall said her concerns were summarily dismissed. Providers pointed to Maisa’s good grades, verbal sophistication, and empathy as definitive proof that she could not be autistic.
Maisa was placed on a six-month waitlist for a formal evaluation before she died by suicide in November 2023 at the age of 14. Although it is impossible to predict the exact impact an evaluation might have had, McCall remains convinced that an earlier diagnosis would have benefited her daughter profoundly.
"I think it could have made a huge difference in her self-esteem. I think she was internalizing a lot of things as a personal failure when just her brain was working differently," McCall said.
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 crisis.
"By the time you get to where someone’s suicidal, it’s like Stage IV cancer. You need an intervention early," McCall said. "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 eliminate the risk of depression, self-doubt, or suicidal thoughts, mounting evidence suggests that the earlier a girl understands her own neurology, the sooner she can shape a life aligned with her unique strengths and needs.
Anne Kirby, an assistant professor at Trinity College Dublin who has conducted extensive qualitative research on autism and suicide, noted that multiple women diagnosed later in life reported that the diagnosis helped alleviate the shame and confusion they felt regarding their differences. Understanding why certain environments presented obstacles allowed them to grant themselves permission to seek rest and take necessary breaks from sensory stimulation.
"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 marked by notable growth. She thrived in an online learning environment set up quietly in a corner of her mother’s office, and she earned praise from coworkers at the grocery store and doughnut shop where she was employed. She spoke of pursuing a career in finance and envisioned a future that included marrying a partner willing to live at her mother’s home indefinitely, Leffler recalled with a smile.
However, a complex convergence of medical, mental, and personal challenges struck in early 2024. As family and friends rallied around her, Ruby experienced escalating mood swings, disordered eating, and recurring suicidal thoughts. According to her family, mental health professionals dismissed her autism diagnosis as an irrelevant detail. She died on July 11, 2024, following a sudden, impulsive moment on an otherwise ordinary day.
In the months that followed, Leffler sought out a tattoo artist sharing her daughter’s dimples, inside a studio painted in Ruby’s favorite shade of pink. Today, Leffler’s arms are as colorful as Ruby’s notebooks: a collage celebrating her daughter’s favorite animals and objects, reproductions of her artwork, and floral designs shaped from her handprint.
Ruby was perfect precisely as she was, Leffler emphasized, adding that she hopes no other girl resembling her daughter ever doubts her own inherent worth.
"She was a bright, cuddly, sparkly person," Leffler said. "She deserves to be loved and missed."
