Sex Differences in Psychiatric Diagnoses Preceding Autism Diagnosis and Their Stability Post Autism Diagnosis.

Miriam I Martini,Ralf Kuja-Halkola,Agnieszka Butwicka,Ebba Du Rietz,Aleksandra Kanina,Isabell Brikell,Zheng Chang,Henrik Larsson,Paul Lichtenstein,Sven Bölte,Francesca Happé,Mark J Taylor

Journal of child psychology and psychiatry, and allied disciplines（2025）

Department of Medical Epidemiology and Biostatistics

Cited 0|Views4

Abstract

BACKGROUND:Autistic individuals often receive psychiatric diagnoses prior to their autism diagnosis. It remains unclear to what extent autistic females and males differ in their likelihood of receiving psychiatric diagnoses prior to their autism diagnosis and continue seeking care for them after an autism diagnosis. METHODS:In a nationwide cohort of all individuals born in Sweden 1990-2015 with a clinical autism diagnosis (N = 72,331, nfemales = 24,110), we used linear and logistic regression to estimate the association between sex and (a) psychiatric diagnoses before autism diagnosis, including time trends by autism diagnosis year (2010-2020), (b) autism diagnosis age in those with preceding diagnoses, (c) stability of preceding diagnoses (defined as continued care utilization indicated through diagnosis or medication in the 5 years following autism diagnosis). RESULTS:In total 54.2% of autistic females and 40.9% of autistic males received at least one preceding psychiatric diagnosis (most common: ADHD, anxiety, depression). Autistic females showed higher odds than males for most preceding psychiatric diagnoses (ORrange = 1.29 [1.18, 1.41]-10.69 [8.06, 14.17]), except psychotic disorders (OR = 0.91 [0.78, 1.06]) and ADHD (OR = 0.69 [0.66, 0.71]). Sex differences in preceding diagnoses were persistent across different autism diagnosis years (2010-2020). For most conditions, females with a preceding diagnosis were diagnosed with autism later than males with the same condition. For both sexes, the stability of preceding diagnoses varied considerably (23.1%-88.9%) and was less than 50% for most diagnoses. Females showed a higher stability for anxiety, sleep disorders and self-harm (ORrange = 1.45 [1.30, 1.62]-2.37 [1.93, 2.90]), and males for psychotic disorders (OR = 0.60 [0.44, 0.81]). CONCLUSIONS:Autistic females are more likely to be diagnosed with psychiatric conditions prior to an autism diagnosis and receive care for them post autism diagnosis. Our findings emphasize the variability of clinical presentation and importance of disentangling persistent support needs from overlapping diagnostic presentations, particularly in autistic females, to provide appropriate and timely care.

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【要点】：本研究发现自闭症女性在自闭症诊断之前更可能接受精神疾病诊断，且在自闭症诊断之后继续寻求相关治疗的可能性也更高，表明自闭症患者的临床表现存在性别差异。

【方法】：通过对1990-2015年在瑞典出生的所有临床诊断为自闭症的个体（N=72,331，女性24,110人）进行线性回归和逻辑回归分析，评估性别与自闭症诊断前精神疾病诊断的关联。

【实验】：研究利用瑞典全国队列数据，发现54.2%的自闭症女性和40.9%的自闭症男性在自闭症诊断之前至少接受过一次精神疾病诊断（最常见的是ADHD、焦虑和抑郁），并在2010-2020年自闭症诊断年份中性别差异在先前诊断中持续存在。大多数情况下，有先前诊断的女性比男性晚被诊断为自闭症。先前诊断的稳定性（定义为在自闭症诊断后5年内继续治疗）在男性和女性中差异较大（23.1%-88.9%），且大多数诊断的稳定性低于50%。