Barriers and facilitators towards an autism diagnosis for females within healthcare: A thematic analysis of interviews with UK healthcare professionals

There has been growing recognition that autism spectrum disorder (ASD) presents differently in females than in males, and our current understanding of autism is male-centric. This may produce barriers towards appropriate recognition of autistic characteristics in key social areas, such as healthcare, which could affect referral for assessments and accurate autism diagnosis for females. While there are many studies reporting about patient perspectives on the autism diagnostic process, there is a dearth of research investigating the perspectives of healthcare professionals about the female presentation of autism. The present study aimed to explore the perspectives of NHS healthcare professionals (HCPs) on the recognition, referral, and diagnosis of autism in female patients across the lifespan. Semi-structured interviews were conducted with eleven NHS HCPs and a reflexive thematic analysis was carried out to identify the key themes. The results revealed themes about gender biases and diagnostic overshadowing as important general barriers towards autism recognition and diagnosis for females within the NHS healthcare system. Themes involving systemic barriers were also identified as limiting the recognition of female autistic presentation, which included issues about time constraints and a lack of training. Several facilitators towards better diagnosis of autism in females were identified, which emphasised changes to current practice and diagnostic criteria to better account for the heterogeneity of female autism, and a more integrated approach to referrals with the education sector. Together, these findings have implications for healthcare service development and implementation for the classification of autism, suggesting targeted training and diagnostic adaptions to improve the experience and accuracy of the pathway of females for a diagnosis of autism.