Sex differences in the timing of identification among children and adults with autism spectrum disorders.
Girls and women with ASD are identified later than males—adjust your screening radar and referral questions accordingly.
01Research in Context
What this study did
Sander and colleagues looked at medical records to see when girls and boys got their autism label.
They compared kids with Asperger’s and kids with autistic disorder.
They also checked if women got the same label later than men.
What they found
Girls with Asperger’s were spotted later than boys in childhood.
Women with autistic disorder were spotted later than men in adulthood.
The gap was not just a kid problem—it carried into grown-up life.
How this fits with other research
Zidane Burgess et al. (2026) widen the picture: gender-diverse autistic adults wait even longer than cis girls.
Lundin et al. (2021) explain why—experts say girls hide symptoms by copying peers and looking “less autistic.”
Germani et al. (2014) seems to clash: they found no sex gap in core symptoms. But they studied only high-functioning kids, so the masking effect may already be in place.
Sutton et al. (2022) show the tools we use add to the problem—girls score lower on repetitive items, so CARS-2 and GARS-3 can miss them.
Why it matters
Late ID means late help. If you screen with boy-tuned eyes, girls slip by. Add questions about camouflaging, social anxiety, and peer copying. Lower your cut-score bar for fear/nervousness items. Ask every client, “Have you ever been told you’re just shy or moody?” The earlier you catch the mask, the sooner you can teach real coping skills.
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02At a glance
03Original abstract
To examine differences by sex in the timing of identification of individuals with autism spectrum disorders (ASD), survey data were collected in the Netherlands from 2,275 males and females with autistic disorder, Asperger's syndrome and PDD-NOS. Among participants < 18 years of age, females with Asperger's syndrome were identified later than males. Among participants ≥ 18 years of age, females with autistic disorder were identified later than males. In more recent years, girls with Asperger's syndrome are diagnosed later than boys, confirming earlier findings. In adults, the delayed timing of diagnosis in females with autistic disorder may be related to changing practices in diagnosis over time. Strategies for changing clinician behaviour to improve recognition of ASD in females are needed.
Journal of autism and developmental disorders, 2013 · doi:10.1007/s10803-012-1656-z