A Mixed-Methods Investigation of Diagnostician Sex/Gender-Bias and Challenges in Assessing Females for Autism Spectrum Disorder

Despite the importance of clinical judgement in autism spectrum disorder (ASD) assessment, little is currently known about challenges faced by diagnosticians when the client is female, any sex/gender biases during the assessment process, and how these issues affect diagnostic outcomes. Forty-seven ASD diagnosticians completed a questionnaire containing two hypothetical case studies (a 'male' and 'female' ASD presentation), with sex/gender randomly assigned within each. Diagnosticians reported greater ASD symptom severity when female sex/gender pseudonyms were allocated to the case studies, but their confidence in ASD diagnosis was similar regardless of condition. Diagnosticians identified a large number of challenges associated with assessing females for ASD. Many of these related to sex/gender differences in ASD presentation and limitations of diagnostic instruments.

Automated summary

Despite the importance of clinical judgement in ASD assessment, there is little knowledge on the challenges and gender biases faced by diagnosticians when assessing females. Diagnosticians tended to perceive greater ASD symptom severity when presented with a female case study, and identified numerous challenges associated with assessing females for ASD, many of which were related to gender differences in ASD presentation and limitations of diagnostic instruments.