Prevalence and Predictors of Missed Appointments Within an Outpatient Behavioral Clinic for Autistic Children.
Same ASD story looks worse when the child is called a girl, proving clinician bias keeps girls from speedy diagnosis.
01Research in Context
What this study did
Bottini et al. (2025) sent the same ASD vignette to clinic staff. Half saw the child labeled male, half female. They asked, 'How severe?' and 'How sure are you?'
What they found
Staff rated the 'girl' version more severe even though the story never changed. Confidence stayed the same. Many wrote that girls are 'harder to judge.'
How this fits with other research
Kirkovski et al. (2013) warned us girls get missed because their signs are quiet. The new survey shows why: clinicians still expect boys' ASD.
Rutherford et al. (2016) saw real charts and found girls referred later. The vignette result gives the reason—bias at first glance.
Kopp et al. (2011) built extra items like 'avoids demands' to catch girls. The 2025 data say we must use them or bias wins.
Why it matters
Your intake form may hide girls. Add sex-specific prompts. Train staff on quiet ASD traits. One extra question—'Does she copy peers too well?'—can move referral earlier and shrink the gap.
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02At a glance
03Original abstract
Despite the importance of clinical judgement in autism spectrum disorder (ASD) assessment, little is currently known about challenges faced by diagnosticians when the client is female, any sex/gender biases during the assessment process, and how these issues affect diagnostic outcomes. Forty-seven ASD diagnosticians completed a questionnaire containing two hypothetical case studies (a 'male' and 'female' ASD presentation), with sex/gender randomly assigned within each. Diagnosticians reported greater ASD symptom severity when female sex/gender pseudonyms were allocated to the case studies, but their confidence in ASD diagnosis was similar regardless of condition. Diagnosticians identified a large number of challenges associated with assessing females for ASD. Many of these related to sex/gender differences in ASD presentation and limitations of diagnostic instruments.
Journal of autism and developmental disorders, 2025 · doi:10.1016/j.arcped.2018.06.008