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Improving autism identification and support for individuals assigned female at birth: clinical suggestions and

Meng-Chuan Lai1, Anouck Amestoy2, Somer Bishop3

  • 1Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health and The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.

The Lancet. Child & Adolescent Health
|November 16, 2023
PubMed

Insights

Autism is more often diagnosed in males due to biological factors and biases. This review highlights challenges in identifying autism in females assigned female at birth (AFAB) and proposes solutions for equitable care.

Area of Science:

  • Neurodevelopmental disorders
  • Autism Spectrum Disorder (ASD) research
  • Gender and health disparities

Background:

  • Autism Spectrum Disorder (ASD) is diagnosed more frequently in males than females.
  • Individuals assigned female at birth (AFAB) who are autistic face significant health disparities, including delayed diagnosis and insufficient support.
  • These disparities are linked to identification biases and varied presentations of ASD in AFAB individuals.

Purpose of the Study:

  • To review the challenges in identifying autism in AFAB individuals.
  • To propose clinical and research directions for improving the health and well-being of autistic AFAB individuals.
  • To address health inequities and clinical challenges faced by autistic AFAB individuals.

Main Methods:

  • A viewpoint article based on a review by an international panel.
  • Panel comprised clinicians, scientists, and individuals with lived experience of autism.
  • Discussion focused on recognition challenges and proposed future directions.

Main Results:

  • Recognition challenges arise from cognitive differences, varied ASD presentations in AFAB individuals, clinician biases (expectancy, gender, autism-related), and social determinants.
  • Autistic AFAB individuals often experience late or missed diagnoses.
  • Inadequate support systems exacerbate health disparities.

Conclusions:

  • Professional development is crucial for clinicians to improve equitable autism assessment and early identification in AFAB individuals.
  • Health-care systems, professional societies, and governing bodies must support this training.
  • Tailored support in education, healthcare, and social integration is essential for autistic AFAB individuals' well-being.

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