This blog was written for MQ by Dr Miriam Martini who works alongside MQ Fellow Dr Mark Taylor at the Karolinska Institutet in Sweden.
Autism is a lifelong neurodevelopmental condition that shapes how people communicate, interact, and perceive the world. While autism has long been stereotyped as a “male condition,” we now know that autistic women and girls have often been overlooked or misdiagnosed.
So what happens during that time when autism goes unnoticed? Many autistic people, especially females, find themselves navigating psychiatric care for mental health difficulties long before autism is considered.
In our new study, funded by MQ, we wanted to better understand this journey. We looked at 11 different psychiatric diagnoses—like depression, anxiety, eating disorders, ADHD, and self-harm—and tracked whether they appeared before someone was eventually diagnosed with autism.
Our findings revealed clear differences between autistic females and males.
More than half of autistic females (54%) had been diagnosed with at least one psychiatric condition before their autism diagnosis. In comparison, this was true for 41% of autistic males. Two or more psychiatric diagnoses prior to an autism diagnosis were recorded for 28% of females and 13% of males.
The most common preceding diagnoses were ADHD, anxiety, and depression. Interestingly, while females were more likely to receive most of the psychiatric diagnoses we studied, they were actually less likely to be diagnosed with ADHD compared to autistic males. These sex differences weren’t limited to a particular age or time period—they were consistent from 2010 to 2020 and across different ages at autism diagnosis.
We also looked at what happened after individuals received an autism diagnosis. In many cases, psychiatric diagnoses continued beyond the point of autism identification. Between 23% and 88% of those with a prior mental health diagnosis continued to receive care for the same condition in the five years following their autism diagnosis.
For autistic females in particular, anxiety, sleep problems, and self-harm were more likely to persist over time compared to autistic males.
These findings may point towards an early onset and increased continuity of mental health problems in autistic females—consistent with our previous MQ-funded research on mental health problems and psychiatric hospitalizations in young adulthood.
However, not all psychiatric symptoms may stem from a separate mental health condition. In some cases, these symptoms might be better understood in the context of autism. Our findings suggest that contact with psychiatric services does not necessarily facilitate an autism diagnosis.
This emphasizes the importance of careful assessment of difficulties in psychiatric care to ensure that underlying neurodevelopmental conditions are not overlooked, especially when individuals present with complex or multiple mental health difficulties. Getting the right diagnosis is crucial—it can lead to a better understanding of one’s challenges and tailored support.