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

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Lai, M. C., Amestoy, A., Bishop, S., Brown, H. M., Giwa Onaiwu, M., Halladay, A., Harrop, C., Hotez, E., Huerta, M., Kelly, A., Miller, D., Nordahl, C. W., Ratto, A. B., Saulnier, C. A., Siper, P. M., Sohl, K., Zwaigenbaum, L., & Goldman, S. (2023). Improving autism identification and support for individuals assigned female at birth: clinical suggestions and research priorities. The Lancet Child & Adolescent Health, 7(12), 897-908. https://doi.org/10.1016/s2352-4642(23)00221-3

Publication date: 14 Nov 2023 Added to AutiHub: 5 Jul 2026 Type: Article Article language: English
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Authors

Publication authors
18
Publication authors identified as autistic
2 / 18 (11.1%)
  1. Meng-Chuan Lai
  2. Anouck Amestoy
  3. Somer Bishop
  4. Heather M. Brown *
  5. Morénike Giwa Onaiwu *
  6. Alycia Halladay
  1. Clare Harrop
  2. Emily Hotez
  3. Marisela Huerta
  4. Amy Kelly
  5. Dylan Miller
  6. Christine Wu Nordahl
  1. Allison B. Ratto
  2. Celine A. Saulnier
  3. Paige M. Siper
  4. Kristin Sohl
  5. Lonnie Zwaigenbaum
  6. Sylvie Goldman

Abstract

Emerging evidence suggests that the higher prevalence of autism in individuals who are assigned male than assigned female at birth results from both biological factors and identification biases. Autistic individuals who are assigned female at birth (AFAB) and those who are gender diverse experience health disparities and clinical inequity, including late or missed diagnosis and inadequate support. In this Viewpoint, an international panel of clinicians, scientists, and community members with lived experiences of autism reviewed the challenges in identifying autism in individuals who are AFAB and proposed clinical and research directions to promote the health, development, and wellbeing of autistic AFAB individuals. The recognition challenges stem from the interplay between cognitive differences and nuanced or different presentations of autism in some AFAB individuals; expectancy, gender-related, and autism-related biases held by clinicians; and social determinants. We recommend that professional development for clinicians be supported by health-care systems, professional societies, and governing bodies to improve equitable access to assessment and earlier identification of autism in AFAB individuals. Autistic AFAB individuals should receive tailored support in education, identity development, health care, and social and professional sense of belonging.

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100
Total cited references integrated for this publication.
Cited references with an identified autistic author
9 / 100 (9.0%)
Cited author occurrences identified as autistic
13 / 687 (1.9%)
Among occurrences linked to AutiHub author records: 13 / 258 (5.0%). Distinct cited authors identified as autistic: 10 / 570 (1.8%).
Cited author occurrences linked to AutiHub author records
258 / 687 (37.6%)
Distinct linked cited authors: 169 / 570 (29.6%)
Linked cited-author occurrences not identified as autistic
245 / 258 (95.0%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 245 / 687 (35.7%). Distinct linked cited authors not identified as autistic: 159 / 169 (94.1%).
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