Sex/Gender Differences in Co-occurring Neurodevelopmental and Mental Health Conditions of Autistic Adults: a Systematic Review and Meta-analysis

Abstract To investigate sex/gender differences in co-occurring neurodevelopmental and mental health conditions among autistic adults, we conducted a systematic review and meta-analyses of studies reporting prevalence rates separately for autistic people referred to as female (PRF) and autistic people referred to as male (PRM). Autistic PRF exhibited higher rates of anxiety, eating disorders and trauma-related conditions. Autistic PRM showed elevated rates of certain neurodevelopmental and externalising conditions. No sex/gender differences were found for obsessive-compulsive disorder, attention deficit/hyperactive disorder, and schizophrenia/psychotic disorders. This review highlights gaps in the evidence base. Findings underscore the need for heightened clinical attention to co-occurring neurodevelopmental and mental health conditions in autistic adults, particularly PRF, and can inform more targeted screening efforts and tailoring of treatment.