Autism diagnoses increased after the COVID-19 pandemic, but new research suggests the trend is driven less by a sudden rise in autism itself than by changing recognition of who has the condition. A study published in JAMA Network Open found that newly recorded autism diagnoses have risen sharply among girls and women, while rates among males have remained largely stable or declined.
The findings suggest that clinicians are becoming better at recognizing autism in females, a group that has historically been underdiagnosed because diagnostic criteria and screening tools were largely developed using data from boys.
Inside the study
Researchers analyzed electronic health records from 171,134 patients who received continuous care within a large U.S. health system between 2016 and 2024.
Rather than estimating autism prevalence, the researchers tracked when autism was first recorded in the medical system, allowing them to examine changes in diagnosis patterns over time.
Overall, newly recorded autism diagnoses declined in the years leading up to 2020 before increasing after the COVID-19 pandemic began.
However, once the researchers analyzed males and females separately, a very different picture emerged.
Diagnoses among females rose rapidly
Between 2020 and 2024, newly recorded autism diagnoses among females increased by approximately 19 percent each year.
The number of girls and women receiving a first recorded autism diagnosis almost doubled, rising from 284 in 2016 to 513 in 2024.
By comparison, diagnosis rates among males remained relatively stable or showed slight declines during the same period.
The most pronounced increase occurred among teenage girls, whose diagnosis rates rose by roughly 22 percent annually after the pandemic.
Researchers suggest many of these adolescents likely showed autistic traits earlier in childhood but were only identified later, when increasing academic demands, more complex friendships, and greater social expectations made those differences more apparent.
Why girls have often been overlooked
For many years, autism research focused primarily on boys.
As a result, many screening questionnaires and diagnostic approaches were built around patterns that are more commonly observed in males.
Researchers now recognize that autism often presents differently in girls and women.
Many autistic girls appear more socially engaged, consciously imitate their peers, memorize social rules, or develop interests that seem more socially acceptable, making their autistic traits less obvious to teachers, parents, and healthcare professionals.
Because of these differences, girls have frequently been misdiagnosed with conditions such as anxiety or depression instead of autism.
The study found that females received an autism diagnosis, on average, about three and a half years later than males.
Even during childhood, girls were typically diagnosed approximately one and a half years later than boys, potentially delaying access to educational support, therapy, and accommodations during important developmental years.
The pandemic may have accelerated an existing trend
The timing of the increase has raised questions about whether COVID-19 itself influenced autism diagnoses.
Early in the pandemic, routine developmental screenings, school observations, and in-person medical appointments were disrupted, likely delaying many evaluations during 2020.
As healthcare services resumed, assessment backlogs may have contributed to a surge in later diagnoses.
The rapid expansion of telehealth also made autism assessments more accessible for many families by reducing travel barriers and long waiting times.
At the same time, growing awareness on social media introduced many women to descriptions of autism that closely matched their own lifelong experiences.
For some families, these personal accounts encouraged them to seek professional evaluations for themselves or their children.
The trend began before COVID-19
To determine whether the findings simply reflected pandemic-related disruptions, the researchers repeated their analysis after excluding data from 2020.
The overall pattern remained nearly identical.
Without the unusual pandemic year, the increase in female diagnoses could be traced back to approximately 2018, suggesting that greater recognition of autism in girls and women had already begun before COVID-19.
The pandemic may therefore have accelerated or highlighted an existing shift rather than creating an entirely new one.
These findings also help explain why autism prevalence statistics continue to rise.
At least part of the increase likely reflects improved recognition among groups that were previously overlooked rather than a sudden biological increase in autism itself.
Limitations and clinical implications
The researchers acknowledge several limitations.
The study measured the first autism diagnosis recorded within a single healthcare system, which may not always represent an individual’s first diagnosis elsewhere.
The analysis also relied on medical billing codes rather than detailed standardized diagnostic assessments.
In addition, the study population consisted primarily of White patients receiving long-term care within one health system, limiting how broadly the findings can be generalized to more diverse populations.
Even so, the results highlight a continuing diagnostic gap.
Delayed recognition can postpone access to educational services, workplace accommodations, mental health support, and autistic peer communities that often play an important role in improving quality of life.
The researchers suggest clinicians should move beyond traditional, male-centered assumptions about autism and recognize that the condition can present differently across individuals.
As scientific understanding of autism continues to evolve, improving screening tools and increasing awareness of female autism may help more girls and women receive earlier diagnosis, appropriate support, and better long-term outcomes.
