New Research Challenges Long-Held Assumptions About Autism and Gender
A comprehensive international study has delivered findings that fundamentally challenge conventional understanding about autism diagnosis patterns between genders. The research, led by experts at Sweden's Karolinska Institutet, suggests that autism spectrum disorder diagnosis rates may become "more or less equal for men and women" by adulthood, contradicting previous assumptions about significant gender disparities.
Unprecedented Scale of Research
The research team meticulously tracked over 2.7 million individuals born in Sweden between 1985 and 2000, following their diagnostic journeys up to 2022. During this extensive observation period, approximately 2.8 per cent of the population received an autism spectrum disorder diagnosis. The sheer scale of this longitudinal study provides unprecedented insight into how diagnostic patterns evolve across different age groups and genders.
The Changing Gender Ratio Over Time
The study revealed a significant shift in the male-to-female diagnosis ratio as individuals aged. While traditional understanding often cited a four-to-one or three-to-one ratio of men or boys to women or girls, this research indicates that ratio decreases substantially over time. Lead author Dr Caroline Fyfe, now at the University of Edinburgh, explained the crucial findings to the Press Association.
"Our study found that whilst this sex difference was still visible amongst children under 10 years – with roughly three to four boys diagnosed for each girl diagnosed, there was a rapid increase in diagnoses of ASD among girls during adolescence," Dr Fyfe stated. "This produced a female catch-up effect, such that by the age of 20 years – rates of ASD were more or less equal for men and women."
Implications for Diagnosis and Understanding
The research team believes these findings indicate late or underdiagnosis of ASD in females rather than there being an actual sex difference. This revelation has profound implications for clinical practice and public understanding of autism spectrum disorders.
Dr Judith Brown from the National Autistic Society commented on the study's significance: "The results of this study highlight the fact that gender should never be a barrier to receiving an autism diagnosis and access to the right support."
The Challenge of Masking and Misdiagnosis
Experts explain that autistic women and girls have often been missed in diagnostic processes due to several factors. Dr Steven Kapp, senior lecturer in psychology at the University of Portsmouth, noted: "Autistic women and girls have often been missed because of subtler behaviours from trends towards more imitation and masking, including more eye contact than male counterparts."
The study itself notes that as autistic girls and women await proper diagnosis, they are "likely to be (mis)diagnosed with psychiatric conditions, especially mood and personality disorders". This misdiagnosis can lead to significant consequences, including the development of co-existing mental health difficulties such as anxiety and depression.
Clinical Biases and Community Perspectives
Dr Kapp further explained: "Research has revealed that clinical biases contribute to under-recognition of women and girls, which we in the autistic community have long critiqued." These biases have meant that many autistic women and girls have been forced to self-advocate to receive appropriate recognition and support.
A linked editorial accompanying the study, written by a patient and patient advocate, emphasises: "Studies like (this) are essential to changing the assumption that autism is more prevalent in the male sex than in the female sex."
Broader Implications for Mental Health
The research highlights how lack of proper diagnosis can have cascading effects on mental health and wellbeing. Dr Brown from the National Autistic Society explained: "Misdiagnosed autistic women can develop co-existing mental health difficulties, such as anxiety and depression, as a result of a lack of support and the exhaustion of masking."
Dr Kapp added important context about specific vulnerabilities: "Lack of self-understanding may amplify lack of self-acceptance, such as the over-representation of autistic females among anorexic people."
Moving Forward with New Understanding
The study's authors conclude that the male-to-female ratio for autism spectrum disorder "may no longer be distinguishable by adulthood" in Sweden. This represents a significant shift from previous understanding and has important implications for diagnostic practices worldwide.
Dr Brown emphasised the importance of this new understanding: "This is why it's so vital that the experiences of autistic women and girls are not overlooked, and outdated stereotypes and incorrect assumptions are finally put to rest."
As Dr Kapp noted, achieving greater gender parity in autism diagnosis "promotes more safety, wellbeing and positive relationships for autistic women and girls", highlighting the real-world benefits of this improved understanding and diagnostic practice.
