A startling revelation: Autistic girls are slipping through the diagnostic net, with a groundbreaking study shedding light on a gender bias that has long been overlooked.
According to the research, published in the BMJ (https://www.bmj.com/content/392/bmj-2025-084164), boys are up to four times more likely to receive an autism diagnosis during childhood, despite females potentially being just as likely to be on the spectrum. But here's where it gets controversial: this disparity isn't due to a higher prevalence in males, but rather a systematic failure to identify autism in girls.
The study, conducted by the Karolinska Institutet in Sweden, analyzed autism diagnosis rates for 2.7 million people born between 1985 and 2020. The results were eye-opening. By age 20, diagnosis rates between men and women were nearly equal, debunking the long-held belief that autism predominantly affects males.
"The gender difference in autism prevalence is much lower than we thought," said Dr. Caroline Fyfe, the lead author. "Women and girls are being underdiagnosed or diagnosed late." The study found that boys were diagnosed nearly three years earlier than girls on average, with a median age of 15.9 for girls and 13.1 for boys. This means boys are three to four times more likely to be diagnosed with autism before age 10, but girls catch up by age 20 due to a surge in diagnoses during adolescence.
And this is the part most people miss: the study suggests that the gender gap in autism diagnosis is not a static issue. While the disparity remained consistent for children under 10 over the last three decades, it decreased rapidly for older age groups. This indicates that the male-to-female ratio for autism spectrum disorder has been decreasing over time and with later diagnoses.
Patient advocate Anne Cary, in a linked editorial, pointed out that systemic biases in diagnosis are to blame, rather than a genuine difference in incidence. She emphasized that girls are more likely to 'mask' traditional autism signs, leading to misdiagnosis. "A girl who will eventually be diagnosed with autism has less than a third of a chance of receiving that diagnosis before age 10," Cary noted.
The consequences of this oversight are profound. Misdiagnosed autistic girls and women often face incorrect psychiatric diagnoses, such as mood and personality disorders, and must advocate for themselves to receive appropriate treatment. This can lead to co-existing mental health issues, such as anxiety and depression, due to a lack of support and the strain of masking.
Autism charities and experts agree that tackling gender stereotypes is crucial. Dr. Judith Brown, from the National Autistic Society, stated, "Gender should never hinder an autism diagnosis and access to support." She highlighted the need to move beyond outdated assumptions, as women and girls often 'mask' their challenges, making identification more difficult.
Jolanta Lasota, CEO of Ambitious about Autism, emphasized the unique experiences of autistic girls, which have been overlooked for too long. She stressed the importance of understanding these differences to ensure they receive the support they need.
Dr. Conor Davidson, a former autism champion, revealed that autism in girls often goes unnoticed until adolescence or early adulthood. He called for increased awareness among psychiatrists to identify autism in women, especially those with mental health issues, who may have slipped through the diagnostic net in childhood.
So, what's the solution? The study's authors and experts agree that it's time to challenge gender stereotypes and biases in autism diagnosis. By doing so, we can ensure that girls and women on the spectrum receive the understanding and support they deserve, putting an end to the era of overlooked and misdiagnosed autism in females.
