Abstract
Historically, diagnostic criteria for autism have been shaped by male-centric childhood presentations, leading to reduced diagnostic accuracy for non-male autistic individuals. We investigated disparities between gender-diverse and cisgender autistic individuals in the age at formal diagnosis, delays between initial suspicion and diagnosis, and the frequency of prior perceived misdiagnoses. We analyzed 2,722 participants predominately late-diagnosed with autism, including 402 gender-diverse individuals. The analysis, controlling for age at participation, revealed that cisgender females were diagnosed at the oldest age, followed by gender-diverse individuals and cisgender males. Autistic gender-diverse individuals received the highest number of co-occurring psychiatric diagnoses and had the highest rates of prior perceived misdiagnosis, followed by cisgender females and cisgender males. These findings highlight the pressing need for diagnostic frameworks that account for gender diversity and actively mitigate biases in clinical practice.
Lay abstract
Autism is often thought of as a condition that mainly affects boys in childhood. However, research shows that this view can delay or complicate diagnosis for non-male autistic individuals. For instance, research has demonstrated that autistic females are diagnosed later than males. In this study, we examined when and how autism is diagnosed in gender-diverse individuals (people whose gender identity does not align with the sex they were assigned at birth or who identify outside the male/female binary) compared to cisgender men and women (whose gender aligns with their birth sex). We analyzed data from 2,722 Dutch adults with autism, including 402 gender-diverse participants, mostly diagnosed in adulthood. We looked at the age at which participants were diagnosed and how long it took from first suspecting autism to receiving a formal diagnosis. We also examined whether participants had been diagnosed with another psychiatric condition and whether they perceived that diagnosis to be a misdiagnosis. Our results showed that gender-diverse people and cisgender women tend to be diagnosed later than cisgender men. Gender-diverse individuals and women reported being previously diagnosed with other conditions such as personality disorders, which they later believed were incorrect. These results suggest that gender biases still affect autism diagnosis, especially for gender-diverse people and women. Understanding these challenges is important to improve diagnostic practices and ensure more accurate and timely support for everyone on the autism spectrum.
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