In brief
In childhood, clearly more boys than girls receive an autism diagnosis. A large Swedish study of 2,756,779 people found: as age at diagnosis rises, the ratio of male to female diagnoses narrows; up to the age of 20 it was about 1.2 in 2022. [1] This suggests that many girls and women are not diagnosed less often, but later. The study did not examine why this is so; the authors discuss possible explanations. Research on this is still young.
This English translation was produced with AI assistance and has not yet been independently reviewed.
What the study found
A research team linked the data of all children born alive in Sweden between 1985 and 2020 (2,756,779) with the diagnoses in the health register and followed them until 2022. By then, 78,522 (2.8 per cent) had been diagnosed with an autism spectrum disorder. [1] Males were more often diagnosed in childhood. The diagnosis rate in 2020 to 2022 was highest in males aged 10 to 14 years (645.5 per 100,000 person-years), and in females aged 15 to 19 years (602.6). [1] The ratio of male to female diagnoses fell with rising age at diagnosis and, for people over 10 years, over the course of the calendar years. The authors conclude that in Sweden it may no longer differ in adulthood. [1] Context in our news item: Girls and women: why the sex ratio in autism falls with age.
Which explanations are discussed
The authors name several possible reasons without testing them in the study: differences in how features appear and how diagnostic criteria are applied; masking (camouflaging), through which features might only become visible in adolescence, when social demands become more complex; earlier other psychiatric diagnoses in women before the autism diagnosis (“diagnostic overshadowing”); and more frequent use of general health services by women. [1]
Masking refers to strategies by which people on the autism spectrum adapt to an environment shaped mainly by people without autism, such as deliberately making eye contact or preparing topics of conversation. [2] More on this: Masking: when adapting is exhausting.
What do we know – what is still open?
- Well established for Sweden: The ratio of male to female diagnoses falls with age at diagnosis. [1]
- Open: Why this is so. The explanations named are hypotheses of the authors and were not tested in this study. [1]
- Limits of the study: Register data only allow classification by ICD-10 categories, co-occurring conditions were not taken into account, and because outpatient data before 2001 were missing, diagnoses in earlier birth cohorts were recorded later. The study counts diagnoses, not actual occurrence, and looks at the ratio of male to female diagnoses. [1]
- Transferability: The data come from Sweden. Whether the results apply to Germany has not been checked.
What this can mean for you
If you recognise yourself, as a girl or woman, in descriptions of autism, an assessment can make sense even in adulthood: Assessment in adulthood. Where you can find exchange and advice is listed in the directory of contact points and in the entry point I suspect autism in myself. This article makes no diagnosis and does not replace a professional examination.
Note: This article offers general information. It does not replace personal advice or treatment by professionals.
Sources and literature
- Fyfe C, Winell H, Dougherty J, Gutmann DH, Kolevzon A, Marrus N, Tedroff K, Turner TN, Weiss LA, Yip BHK, Yin W, Sandin S: Time trends in the male to female ratio for autism incidence: population based, prospectively collected, birth cohort study. BMJ 2026;392. https://doi.org/10.1136/bmj-2025-084164 – Observational study
- Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai M-C, Mandy W: “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders 2017;47(8):2519–2534. https://doi.org/10.1007/s10803-017-3166-5 – Qualitative study
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