Factors associated with age at autism diagnosis in a community sample of Australian adults.
Australian women and non-English-speaking adults get an autism diagnosis years later, largely because they hide traits and pass male-tuned screens.
01Research in Context
What this study did
Huang et al. (2021) looked at 657 Australian adults who received an autism diagnosis. They used a math model to see which traits predicted a later age of diagnosis.
The team checked age, gender, language spoken at home, and self-reported autism traits. All data came from one point in time.
What they found
Women were diagnosed later than men, even when their autism traits were high. Speaking a language other than English also pushed diagnosis back.
Older adults today were diagnosed later than younger adults. In short, being female, non-English speaking, or already mid-life predicted delay.
How this fits with other research
Milner et al. (2024) extends this finding. They show that high camouflaging scores explain part of the female delay. Women who mask their traits get missed longer.
Lineberry et al. (2023) and Diemer et al. (2023) add depth. Australian women and parents tell the same story: providers dismiss concerns and use male-based checklists, so girls and women are overlooked.
Parikh et al. (2018) saw the mirror image in kids. Higher family income and known language delays sped diagnosis. Yunhe’s adult data now show the flip side: social factors still steer who gets noticed.
Why it matters
If you assess adults, know that women and non-English speakers are easy to miss. Add sex-specific questions and use an interpreter when needed. Ask about camouflaging. A quick screen for social masking can cut years of wait and open the door to support.
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02At a glance
03Original abstract
Autism diagnosis in adulthood has become increasingly common due to a range of factors including changes in awareness, diagnostic criteria, and professional practices. Past research identified a range of demographic and autism-related factors associated with autism diagnosis age in children. However, it is unclear whether these apply to autistic adults. This study aimed to examine predictors of autism diagnosis age in adults while controlling for current age and autistic traits. We used a cross-sectional sample of 657 adults aged 15-80 from three self and carer-report studies: the Australian Longitudinal Study of Autism in Adulthood (ALSAA), Study of Australian School-Leavers with Autism (SASLA) and Pathways, Predictors and Impact of Receiving an Autism Spectrum Diagnosis in Adulthood (Pathways). Using hierarchical multiplicative heteroscedastic regression, we found that older current age and higher self-reported autistic traits predicted older diagnosis age, and that female gender, lack of intellectual disability, language other than English, family history of autism, lifetime depression, and no obsessive-compulsive disorder predicted older diagnosis age beyond current age and autistic traits. The paradoxical relationship between high autistic traits and older diagnosis age requires further investigation. Based on these findings, we recommended strategies to improve autism recognition in women and people from non-English-speaking backgrounds. Future studies could extend the findings by examining the effects of childhood and adulthood socioeconomic status on adult diagnosis age. LAY SUMMARY: We studied the relationship between age at autism diagnosis and other characteristics in adults. We found that both older current age and higher autistic traits, female gender, language other than English, family history of autism, and history of depression were related to older age at diagnosis, while intellectual disability and history of obsessive-compulsive disorder were related to younger age at diagnosis. Our findings suggest more work is needed to help recognize autism in women and people from non-English-speaking backgrounds.
Autism research : official journal of the International Society for Autism Research, 2021 · doi:10.1002/aur.2610