Are we getting better at identifying and diagnosing neurodivergent girls and women? Insights into sex ratios and age of diagnosis from clinical population data in Scotland.
Donald Maciver, Anusua Singh Roy, Lorna Johnston and 4 others
PMID 41157911WHAT IT FOUND
Autism and ADHD sex ratios in Scotland have balanced since 2014, with more females diagnosed in adults.
However, girls are still referred and diagnosed years later than boys. The delay begins before referral, suggesting parents and schools are missing early signs in females.
Key findings
01Male-to-female ratios for autism diagnosis have dropped significantly since 2014, with adults now showing more females than males diagnosed.
02Females are referred and diagnosed for autism and ADHD at a median age several years later than males, a gap that persists across the lifespan.
03In younger children, the male-to-female ratio for ADHD diagnosis remains extremely high at 6.67, indicating significant under-identification in girls at this stage.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study used voluntary participation from diagnosing teams, which may have selected for better-performing services with more efficient processes. Sex was recorded as assigned at birth, excluding non-binary and transgender individuals who are disproportionately represented in neurodivergent populations. The sample size for intellectual disability was very small, limiting conclusions for that group. Data on co-occurring mental health conditions were not collected, so the study could not analyse how psychiatric diagnoses might mask or delay neurodevelopmental identification.
Declared interests
The National Autism Implementation Team (NAIT) completed the work and is funded by the Scottish Government. The authors declared no other conflicts of interest.
The easy way to misread this
Do not interpret the balanced adult sex ratios as evidence that girls are being identified early. The data shows that while more women are now being diagnosed, they are still reaching services years later than men, often after significant distress or masking has occurred.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →