For decades, autism has been considered primarily a disorder that affects boys. But experts say that idea is being seriously questioned, as new research suggests that girls may be affected just as often as boys — they're just diagnosed later.
The prevalence of autism has increased significantly over the past 30 years, and traditionally reports show about four times as many boys as girls being diagnosed. However, a large study involving over 2.5 million children, followed for decades, found that while boys are diagnosed more often in childhood, girls “catch up” on this difference during adolescence. By the age of 20, diagnosis rates between the sexes are almost equal.
Experts have called the study “important and timely,” as it supports the long-held belief that autism in women and girls remains largely undiagnosed. Publishing the findings in The BMJ, the authors highlight the need to understand why women receive a diagnosis later than men.
The study was led by the Karolinska Institute in Sweden and included about 2.7 million people born between 1985 and 2022, followed for about 35 years. During this period, over 78 cases were diagnosed, usually around the age of 14. Diagnosis was most common in boys aged 10–14 and in girls aged 15–19, while after the age of 20, no significant difference was observed between the sexes.
Autism is a neurodevelopmental disorder present from birth, but because it occurs on a spectrum, some people are diagnosed early, while others much later. It is associated with differences in social communication and repetitive or rigid behaviors, which can lead to social isolation and a higher risk of mental and physical health problems.
Researchers cite several explanations for why autism has been viewed as a “male disorder,” including the so-called “female protective effect,” which suggests that girls need a higher genetic load for signs of autism to become apparent. Girls also often manage to “mask” autistic traits by imitating the social behaviors of their peers, while diagnostic criteria are built largely on male models.
As a result, signs of autism in girls may not be apparent until adolescence, when social interactions become more complex. The researchers conclude that the male-to-female ratio shows a “strong equalization effect over time,” suggesting that autism is not actually more common in boys, but simply appears earlier and is diagnosed more quickly.
However, the authors acknowledge limitations of the study, as it did not take into account common genetic, environmental factors, or comorbid disorders such as ADHD or intellectual disability.
Independent experts warn that despite the debate over diagnosis, the under-diagnosis of autism, especially in girls and women, is worrying. Studies show that undiagnosed autistic people often face serious difficulties, including serious mental health problems and an increased risk of suicide.
The findings come at a time when demand for mental health, ADHD and autism services is increasing significantly, creating long waiting lists – particularly for girls and women who have been overlooked by the diagnostic system in the past. /GazetaExpress/
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