Comparative Analysis of Autistic Women Across the Lifespan: Childhood vs. Adulthood Diagnosis

Abstract

This study investigates the experiences of autistic adult women, a group understudied in autism research due to a predominant focus on early identification/intervention, restrictive research participation criteria, and differing rates of diagnosis by sex. This study characterizes a cohort of autistic adult women (n = 1424) across various dimensions including demographics, relationships, education, employment, income, well-being, and co-occurring psychiatric conditions. It also explores differences among those diagnosed with autism as children versus those diagnosed as adults. The sample was limited to women able to read and provide independent consent to participate. Results indicated that the average age of diagnosis for those diagnosed before age 18 was 9.6 years old, whereas for those diagnosed in adulthood it was 31.8. Over 80% of the sample had completed some college or post-secondary education, with more than a third of those diagnosed as adults having attained a 4-year college degree or higher. More than half were employed, with those diagnosed as adults more likely to be employed full time (31.74%). Additionally, more than half were married or identified a romantic partner. Significant rates of psychiatric comorbidity were reported, with those diagnosed with autism as adults more likely to have co-occurring anxiety (69.87%), depression (61.79%), eating disorders (17.28%), and substance use diagnoses (8.85%) than those diagnosed as children. High rates of suicidal ideation (34%) and self-harm (21%) were endorsed in the full sample. Regression analyses indicated that being diagnosed with autism at a later age was associated with higher internalizing, externalizing, and substance use as well as a lower report of personal strengths, even when accounting for demographic factors. Despite these challenges, our findings highlight that many autistic women have positive outcomes and meet common adult developmental milestones. The authors advocate for the development of more tailored treatment options that address the specific needs of autistic women.