Gesi Camilla, Migliarese Giovanni, Torriero Sara, Capellazzi Martina, Omboni Anna Caterina, Cerveri Giancarlo, Mencacci Claudio
Department of Psychiatry and Addiction, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy.
Department of Psychiatry and Addiction, ASST Pavia, 27100 Pavia, Italy.
Brain Sci. 2021 Jul 9;11(7):912. doi: 10.3390/brainsci11070912.
Autism Spectrum Disorder (ASD) is often unrecognized, especially in mild forms and in women. Studies evaluating features associated with missed/misdiagnosis in men and women with ASD are warranted. 61 subjects (22 females, 39 males, age 28.5 ± 10.8 years) with ASD with no language/intellectual deficit were enrolled in the service for the treatment of psychiatric comorbidities in adults with ASD of the ASST Fatebenefratelli-Sacco in Milan (Italy). A detailed clinical history was gathered, and two self-report questionnaires (Autism Spectrum Quotient-AQ and Adult Autism Subthreshold Spectrum-AdAS Spectrum) were administered. 75.4% received their ASD diagnosis average eight years later than the first evaluation by mental health services. Compared to males, females showed a significantly greater delay in referral to mental health services and a significantly higher age at diagnosis of ASD. Among men, diagnostic delay inversely correlated with scores on the AdAS Spectrum total, Verbal communication, Empathy and Inflexibility and adherence to routine domains. Among women, diagnostic delay positively correlated with the Attention to detail score while the age at diagnosis of ASD positively correlated with the AdAS Spectrum Verbal communication and Restricted interests and rumination domain scores. Females were less likely to be correctly diagnosed and more likely to be misdiagnosed at first evaluation than men. Females reported significantly higher scores than men in the Hyper/Hyporeactivity to sensory input domain only among subjects who were misdiagnosed. Our findings provide gender-specific information about ASD patients seeking help for comorbid conditions and might be a primary ground for future research.
自闭症谱系障碍（ASD）常常未被识别，尤其是症状较轻的形式以及女性患者。有必要开展研究评估与ASD男性和女性患者漏诊/误诊相关的特征。61名无语言/智力缺陷的ASD患者（22名女性，39名男性，年龄28.5±10.8岁）被纳入意大利米兰ASST Fatebenefratelli-Sacco成人ASD合并精神疾病治疗服务项目。收集了详细的临床病史，并进行了两份自我报告问卷（自闭症谱系商数 - AQ和成人亚阈自闭症谱系 - AdAS Spectrum）测试。75.4%的患者获得ASD诊断的时间比心理健康服务机构首次评估的时间平均晚了八年。与男性相比，女性患者转诊至心理健康服务机构的延迟时间显著更长，ASD诊断时的年龄也显著更高。在男性中，诊断延迟与AdAS Spectrum总分、言语交流、共情、刻板及坚持常规领域的得分呈负相关。在女性中，诊断延迟与细节关注度得分呈正相关，而ASD诊断时的年龄与AdAS Spectrum言语交流、受限兴趣及反复思考领域得分呈正相关。在首次评估时，女性比男性更不容易被正确诊断，更容易被误诊。仅在被误诊的受试者中，女性在感觉输入的过度/低反应性领域的得分显著高于男性。我们的研究结果提供了关于因合并症寻求帮助的ASD患者的性别特异性信息，可能是未来研究的主要依据。
