Sexual and Reproductive Healthcare Among Youth With Autism and ADHD: A Population-Based Study From Sweden

Youth with autism spectrum disorder or attention-deficit/hyperactivity disorder (ADHD) may face barriers to sexual and reproductive health (SRH) services. Yet, data on preventive SRH service use remain limited, especially digital care. This population-based registry study investigated whether patterns of SRH service use differed by digital versus in-person care among 12-22-year-olds in Stockholm County (2018-2022). Among 454,405 youth (48.6% female; mean age 16 years), 11,850 were autistic, 31,144 had ADHD, and 9126 had both conditions; the majority of SRH contacts were in-person visits. ADHD youth had higher adjusted Odds Ratios [aOR] of in-person (females: 2.02 [95% CI, 1.93-2.11]; males, 1.46 [1.39-1.54]) and digital visits (females, 1.21 [1.14-1.29]; males, 1.26 [1.05-1.52]) than control peers. Autistic youth had lower aOR of in-person (females, 0.67 [0.63-0.72]; males, 0.45 [0.40-0.51]) and digital visits (females, 0.79 [0.71-0.89]; males, 0.79 [0.54-1.15]). Intensity of use (incidence rate ratios) was higher among ADHD youth but similar among autistic females compared with control peers. Autistic females were more likely to consult physicians but less likely to see midwives or use short-acting contraception. ADHD was associated with higher odds of all provider types, contraceptive methods, and abortion. In conclusion, ADHD youth engaged more and autistic youth less-particularly males-with SRH services than controls. Smaller relative digital than in-person differences suggest digital options might reduce access disparities. Similar intensity of use between autistic and control females suggests barriers may be entry to care, whereas high SRH use among ADHD youth challenges assumptions that low engagement drives risk outcomes.