Parent experiences of obtaining an autism diagnosis for their daughter: An interpretative phenomenological analysis

Are the diagnostic rates of autistic females increasing? An examination of state-wide trends

BACKGROUND

Autism has been considered a 'male-dominant' condition. However, recent research suggests that autistic females are underdiagnosed, misdiagnosed, and later diagnosed. Females may also have different and more nuanced behavioral profiles. To examine diagnosis rates of females, we used 20 years of state-wide data to characterize historical trends in the diagnosis of autism in females to determine whether the proportion of females diagnosed with autism has changed over time.

METHODS

Data were drawn from 10,247 participants (males = 8,319, females = 1928) who received an autism diagnosis between 2000 and 2021 from state-wide autism centers associated with the University of North Carolina TEACCH Autism Program.

RESULTS

The rates of females diagnosed with autism increased at a greater rate compared with males. Age of diagnosis remained consistently higher for females. Late diagnosis (defined as 13+) increased over time across both males and females, however, was more commonly associated with females, particularly those with co-occurring intellectual disability.

CONCLUSIONS

Our results indicate that the proportion of females diagnosed with autism has increased steadily over a 20-year period, which likely reflects greater societal knowledge of how autism may manifest differentially in females.

Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology

LAY ABSTRACT

Previous research has shown that girls/women are diagnosed later than boys/men with autism. Individuals who are diagnosed later in life, especially girls/women, have greater anxious and depressive symptoms. Previous research has been limited due to narrow inclusionary criteria for enrollment in studies. The present study uses two samples-one clinic-based, large "real-world" sample and another research-based sample with strict criteria for autism diagnosis-to understand the relationships between diagnostic age, sex assigned at birth, and symptoms of anxiety/depression. In both samples, those who were diagnosed later had greater anxious/depressive symptoms, and anxiety was not predicted by sex. In the clinic-based but not research-based sample, those assigned female at birth were diagnosed later than those assigned male at birth. In the clinic-based sample only, individuals assigned female at birth and who were later diagnosed experienced greater symptoms of anxiety/depression compared to those assigned male who benefited from earlier diagnostic timing. Within the research-based sample, those assigned female at birth had greater depressive symptoms than those assigned male. These findings highlight the importance of timely identification of autism, especially for girls/women who are often diagnosed later. Community-based samples are needed to better understand real-world sex-based and diagnostic age-based disparities in mental health.

A survey of assessment practices among health professionals diagnosing females with autism

BACKGROUND

Emerging research suggests there may be a distinct female autism phenotype, although females are still diagnosed at a much lower rate than males. To date, no research has examined the assessment practices of health professionals when assessing females for autism.

AIMS

This study aimed to identify the training received, level of confidence, and assessment practices specific to assessing females for autism.

METHODS AND PROCEDURE

An online survey was completed by 126 health professionals (34 paediatricians, 40 psychologists and 52 speech pathologists) working across Australia.

OUTCOMES AND RESULTS

The majority of health professionals received no training that addressed gender differences when assessing for autism, even when controlling for number of years since they completed their studies. Most health professionals reported using similar assessment practices when assessing and diagnosing males and females for autism; only 18.2 % reported using female-specific assessment measures.

CONCLUSIONS AND IMPLICATIONS

Suggestions for the lack of difference in assessment measures used across genders are discussed. Potential for including measures that may be more sensitive to the presentation of autism in females in health professional's assessment practices is identified. The high proportion of health professionals engaging in professional development following their clinical training highlights the importance of training opportunities to enhance practitioner understanding and confidence when undertaking assessments for autism in females.