A recent study has brought to light a startling revelation: autistic girls are significantly less likely to receive an autism diagnosis compared to their male counterparts. This research suggests that while girls may be just as prone to autism as boys, they are diagnosed up to four times less frequently during childhood.
Conducted by the Karolinska Institutet in Sweden, this extensive study examined the diagnosis rates of autism among individuals born in Sweden from 1985 to 2020, tracking over 2.7 million people. Of those studied, approximately 2.8% were diagnosed with autism between the ages of two and thirty-seven.
A fascinating finding emerged from the data: by the age of twenty, the rates of diagnosis between men and women were nearly equal, which challenges long-held beliefs that autism predominantly affects males. According to Dr. Caroline Fyfe, the lead author of the study, "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."
The research highlighted that boys received their diagnoses an average of nearly three years earlier than girls. Specifically, the median age for girls’ diagnosis was 15.9 years, while boys were diagnosed at a median age of 13.1 years. Alarmingly, boys were three to four times more likely to be diagnosed before turning ten years old. However, the gap narrows considerably as girls tend to be diagnosed at a later stage during adolescence.
The authors emphasized the importance of investigating the reasons behind the delayed diagnosis for females, stating, "These observations highlight the need to investigate why female individuals receive diagnoses later than male individuals."
This study, published in the BMJ, also noted that while the gender gap in diagnosis rates for children under ten has remained relatively stable over the past thirty years, it has decreased significantly across other age groups. The authors remarked, "Findings indicate that the male to female ratio for autism spectrum disorder has decreased over time and with increasing age at diagnosis." In fact, they suggest that this ratio might be considerably lower than previously believed, potentially becoming indistinguishable by adulthood in Sweden.
In a related editorial, patient advocate Anne Cary pointed out that the discrepancies in diagnosis rates reflect systemic biases rather than a true difference in incidence. She noted that delays in symptom onset and the tendency for females to mask their symptoms contribute to this issue. "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 ten years," Cary explained.
As many autistic girls and women wait for proper diagnoses, they often face misdiagnoses related to psychiatric issues like mood and personality disorders. This situation forces them to advocate for themselves in order to receive appropriate treatment as autistic individuals, just like their male peers.
In response to these revelations, autism charities have called for urgent action to address gender stereotypes that hinder accurate diagnoses. Dr. Judith Brown, head of evidence and research at the National Autistic Society, asserted, "Gender should never be a barrier to receiving an autism diagnosis and access to the right support." Historically, there has been a misguided belief that autism primarily affects males. However, the reality is that many women and girls tend to conceal their autism traits, making it more difficult to identify their specific challenges.
Misdiagnosed autistic women often develop coexisting mental health issues such as anxiety and depression due to insufficient support and the fatigue associated with masking their symptoms. Therefore, it is crucial to ensure that the experiences of autistic women and girls are acknowledged, and that outdated stereotypes are dispelled.
Jolanta Lasota, CEO of Ambitious about Autism, added that autistic girls have unique experiences compared to boys and have gone unnoticed for far too long. Misunderstanding their needs can result in a lack of essential support, leading some to reach a mental health crisis point.
"It is vital for researchers and diagnostic services to deepen their understanding of how autism presents differently in girls and women, and for our support systems to adjust to meet the increasing demand for assistance that we now recognize is necessary," she emphasized.
Dr. Conor Davidson, a former autism champion at the Royal College of Psychiatrists, noted that autism in girls often goes undetected during childhood, with signs appearing later in life—sometimes only during adolescence or early adulthood. Recently, adult neurodevelopmental clinics in the UK have reported seeing a higher number of women seeking assessments compared to men. However, the waiting lists for both child and adult autism evaluations remain unacceptably long.
Many autistic women have yet to receive a diagnosis, and it is essential for them to access timely evaluations and appropriate care when needed. Psychiatrists must also consider the possibility of autism when assessing patients with mental health challenges, especially for women whose autism may have gone unnoticed in their childhood.
