Autism In Women May Be As Common As In Men, Study Finds

Why It Matters

Recognizing that autism prevalence is similar across sexes highlights systemic gaps in diagnostic practices, prompting reforms that can reduce delayed care and improve outcomes for autistic women.

Key Takeaways

• Swedish study finds adult autism rates near gender parity
• Diagnostic tools biased toward male presentation miss many girls
• Late diagnoses increase mental‑health comorbidities in females
• Revised screening needed to capture camouflaging behaviors
• Early intervention improves outcomes regardless of gender

Pulse Analysis

The new BMJ‑published Swedish analysis reshapes a long‑standing narrative that autism is four times more common in boys. By leveraging national registers and following 2.7 million children for three decades, researchers observed a steady convergence of diagnosis rates, with the male‑to‑female ratio dropping to 1.2 by age 20 and projections pointing toward parity in adulthood. This epidemiological shift underscores that the apparent gender gap is largely an artifact of how autism has been identified, rather than a biological disparity.

Clinicians increasingly recognize that traditional diagnostic instruments—such as the ADOS‑2 and early‑screening questionnaires—were calibrated on predominantly male cohorts. Autistic girls often mask their traits through social mimicry, intense but socially acceptable interests, and high compliance, which can conceal underlying sensory and communication challenges. Consequently, many girls receive a diagnosis only after adolescence, after accumulating anxiety, depression, or eating disorders. The delayed identification not only inflates comorbidity statistics but also deprives these individuals of early therapeutic support that can improve adaptive functioning and reduce secondary mental‑health burdens.

The study’s implications extend beyond academia to healthcare policy, insurance reimbursement, and the burgeoning market for gender‑responsive assessment tools. Stakeholders are urged to revise screening protocols, incorporate camouflaging metrics, and train clinicians to recognize subtler presentations. Early, tailored interventions—speech therapy, occupational therapy, and social‑communication programs—have demonstrated measurable gains in academic performance and quality of life. As the gender gap narrows, a coordinated effort to update diagnostic standards will be essential for equitable care and for unlocking the full economic and social potential of a previously underserved population.

Autism In Women May Be As Common As In Men, Study Finds

Image: Little friends reacting with joy playing on the tablet

Autism is four times more common in boys than in girls. It’s a statistic repeated with confidence for years but, it turns out, it may not be true.

A sweeping new Swedish population study published in The BMJ followed more than 2.7 million children over 35 years. The paper suggests that by adulthood, the male‑to‑female ratio in autism diagnoses may approach parity. While boys are still diagnosed more frequently in early childhood, girls steadily “catch up” through adolescence. By age 20, the cumulative ratio had fallen to 1.2 in 2022, with projections suggesting it may reach 1:1.

This is much more than a statistical update. It’s a wake‑up call that validates what the autism community has been saying for years. As poet Jessica Jocelyn writes in the 2023 collection Girl (Remastered), “Behind every late diagnosed woman is a little girl who knew this world was never made for her but could never explain why.”

Because if autism rates are similar by adulthood, then the earlier gap reflects not biology but blind spots in how we identify children.

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As a pediatrician, I don’t experience this as an abstract epidemiological shift

I see it in exam rooms: girls (often high‑achieving) with chronic anxiety, social exhaustion and perfectionism so intense it borders on collapse. They are often labeled as sensitive, dramatic, intense or gifted but anxious. Autism is rarely the first thought.

And that’s the problem.

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We Built Autism Diagnostic Tools Around Boys

Most of our screening tools and diagnostic frameworks were developed using predominantly male research samples. The behavioral patterns that triggered referrals—like restricted interests in mechanical systems, overt social withdrawal and visible repetitive behaviors—map more cleanly onto how autism often presents in boys.

Autistic girls frequently present differently. They may have intense interests that are more socially acceptable, such as animals, books, celebrities or social justice. They may study social rules and rehearse conversations. They camouflage. They comply. They observe before they engage.

In early childhood, this can mask underlying social processing differences.

The Swedish data mirror what clinicians who follow the issue have long suspected. Boys’ diagnoses peak around ages 10 to 14, while girls peak later, around 15 to 19. The male‑to‑female ratio declines steadily with age and in more recent cohorts. That pattern suggests not that girls “develop” autism later, but that we recognize it later.

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Why Girls With Autism Are Diagnosed Later

If our tools were designed around a male prototype, they will systematically miss girls.

This is precisely the issue psychologists Donna Henderson and Sarah Wayland addressed in their influential 2023 book Is This Autism? A Guide For Clinicians And Everyone Else. The book sets out the DSM‑5‑TR diagnostic criteria and shows how they present in women, or in anyone who is adept at camouflaging their autistic traits. Like so many clinicians I know, the book changed everything about how I understand autism.

Perspectives like these move the conversation forward, but they do nothing to solve the systemic problem: that the diagnostic instruments insurance companies often require in order to pay for services, such as the ADOS‑2, were built for boys.

We need revised screening and diagnostic instruments that account for camouflaging, relational fatigue, sensory overwhelm masked by compliance and the internalizing patterns of anxiety, depression and eating disorders, which often precede diagnosis in girls.

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Delayed Autism Diagnosis in Girls Takes A Toll

Because autism is a neurodevelopmental condition present from early childhood, the earlier we identify it, the earlier we can intervene with supports that improve long‑term outcomes.

Early interventions like speech therapy, social communication support, occupational therapy for sensory regulation and parent coaching make a big difference. Such supports are associated with better adaptive functioning, stronger communication skills and reduced secondary mental health complications.

When we miss autism diagnoses in girls until adolescence, we delay the support they need. By the time many girls receive a diagnosis, they have already accumulated years of anxiety, social trauma, self‑doubt and internalized shame. They know they are different from the other kids, and those kids make sure to point it out. Some have been treated for depression or obsessive‑compulsive disorder without anyone asking the deeper neurodevelopmental questions. Research cited in the Swedish study shows high rates of co‑occurring psychiatric diagnoses, particularly in females, before autism is identified.

Earlier identification of autism doesn’t change who the child is. Instead, it changes the environment around the child to one that provides context for their experiences and supports to help them thrive. It changes the narrative from “What’s wrong with me?” to “This is how my brain works.”

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It’s Time To Revise Autism Screening Tools

This conversation extends beyond pediatrics. The Swedish study disentangled age, period and cohort effects with sophisticated modeling and concluded that lifetime diagnosis rates may now be similar between sexes. That finding demands a systemic response.

The gender gap in autism diagnosis may be closing. Now our diagnostic tools, our understanding of autism and our institutions need to catch up.