Recent research suggests that autism may be as prevalent in females as in males, challenging long-held assumptions about the condition. However, a significant disparity remains in diagnosis rates, with boys consistently diagnosed at younger ages and more frequently than girls.
A large-scale study, analyzing data from to in Sweden, tracked nearly individuals. The study, published in the BMJ, found that by age , diagnosis rates between men and women were nearly equal, with % of the cohort receiving an autism diagnosis between the ages of two and .
“Our findings suggest that the gender difference in autism prevalence is much lower than previously thought, due to women and girls being underdiagnosed or diagnosed late,” explained Dr. Caroline Fyfe, lead author of the study.
Diagnostic Delays and Disparities
Despite the comparable prevalence by age , a substantial gap exists in the timing of diagnosis. Boys receive an autism diagnosis, on average, nearly three years earlier than girls. The median age of diagnosis is years for boys, compared to years for girls. Under the age of , boys are three to four times more likely to be diagnosed with autism than girls, although this difference diminishes as individuals age.
This delay in diagnosis for girls is a critical concern, as it can lead to missed opportunities for early intervention and support. The study authors emphasize the need to understand the reasons behind these disparities, noting that “These observations highlight the need to investigate why female individuals receive diagnoses later than male individuals.”
Systemic Biases and Masking
Experts suggest that systemic biases in diagnostic practices, rather than a true difference in incidence, contribute significantly to the gender gap. Anne Cary, a patient and patient advocate, argues that current diagnostic methods and tools may be biased and require refinement. “These biases have meant that a girl who would ultimately have a diagnosis of autism would have less than a third of a chance of receiving a diagnosis before the age of years,” Cary stated.
A key factor contributing to underdiagnosis in girls is “masking,” where individuals consciously or unconsciously suppress autistic traits to fit in socially. Historically, diagnostic criteria and societal expectations have been based on how autism presents in boys, potentially overlooking the more subtle or internalized presentations often seen in girls. This can lead to misdiagnosis with other conditions, such as mood or personality disorders.
The Impact of Late Diagnosis
The consequences of a delayed or missed autism diagnosis can be significant. Without appropriate support and understanding, autistic women may experience increased anxiety, depression, and difficulty navigating social situations. They may also struggle to access the resources and accommodations they need to thrive.
As Dr. Judith Brown, head of evidence and research at the National Autistic Society, points out, “Gender should never be a barrier to receiving an autism diagnosis and access to the right support.” She highlights that historically, the assumption that autism primarily affects men and boys has hindered recognition of the condition in females.
Evolving Understanding and Future Directions
The research indicates that the male-to-female ratio in autism diagnoses has been decreasing over time, particularly with increasing age at diagnosis. This suggests a growing awareness and improved identification of autism in females. However, challenges remain.
Jolanta Lasota, chief executive of Ambitious about Autism, emphasizes that autistic girls have distinct experiences that have long been overlooked. “Autistic girls have different experiences to autistic boys and have slipped under the radar for far too long.” By having their needs misunderstood, they may miss out on vital support and experience mental health crises.
Dr. Conor Davidson, former Royal College of Psychiatrists’ autism champion, notes a recent trend of increasing numbers of women seeking autism assessments in adult neurodevelopmental clinics in the UK. He also points to the unacceptably long waiting lists for both child and adult assessments, highlighting the urgent need for improved access to timely diagnosis and care.
The findings underscore the importance of ongoing research to better understand the diverse presentations of autism in girls and women, and to adapt support services to meet their specific needs. Psychiatrists are also encouraged to consider the possibility of autism when assessing patients with mental health problems, particularly women, to ensure accurate diagnosis and appropriate care.
