Post‑COVID Rise In Autism Diagnoses Driven By Improved Recognition In Girls and Women, Study Finds

Autism diagnoses recorded in a large US healthcare system fell through 2020 and then rose — largely because clinicians are identifying more girls and women, not because autism suddenly became more common.

Researchers at Saint Louis University analyzed electronic health records for 171,134 people who received care every year from 2016 through 2024 within one large US health system. Across the full cohort, the annual rate of newly recorded autism diagnoses declined until 2020 and then increased. But when the investigators examined the data by sex, two very different trends emerged.

The biggest increase was among teenage girls, with new diagnoses rising by about 22 percent each year from 2020 to 2024. (Maskot/Maskot/Getty Images)

Newly recorded diagnoses among males were stable or declined across the study period, while diagnoses among females rose substantially. From 2020 to 2024 the annual rate of newly recorded autism diagnoses among females increased by about 19% per year on average, and the largest gains were seen in teenage girls (about 22% annual growth during 2020–2024). The absolute number of females with a newly recorded diagnosis nearly doubled, from 284 in 2016 to 513 in 2024.

What Might Explain the Pattern?

The investigators and related research suggest several non‑biological explanations. Autism has historically been diagnosed more often in boys and men, and many screening tools and clinical descriptions were developed from male‑predominant research samples. Some autistic girls and women may present differently — for example, showing greater social motivation or "camouflaging" social difficulties — and so have been harder to detect using conventional approaches.

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Practical factors after the COVID‑19 disruption may also have contributed. Early pandemic restrictions interrupted routine pediatric visits, developmental screening, and in‑person schooling, so some assessments were delayed and could have rebounded as services resumed. The wider adoption of telehealth, greater public awareness, and peer sharing of lived experiences (especially online) may have increased access to assessment and encouraged more people to seek diagnoses.

Evidence Against A Purely Pandemic‑Driven Effect

The authors reanalyzed the data excluding the anomalous 2020 values and found the broad pattern persisted: diagnoses rose among females while remaining flat or declining among males. In that sensitivity analysis, the inflection point for female diagnoses shifted back to around 2018, indicating that pandemic disruptions alone cannot explain the trend.

Limitations

Key limitations temper the conclusions: the study measured the first autism diagnosis recorded within a single healthcare system (which may not be each person’s first lifetime diagnosis); diagnoses were identified via billing codes rather than standardized confirmatory assessments or detailed chart review; and the cohort was predominantly White and limited to patients who consistently used the same system. These factors limit generalizability to the broader US population.

Bottom line: The study, published in JAMA Network Open, suggests that much of the post‑COVID rebound in recorded autism diagnoses reflects improved recognition and diagnosis of girls and women who were previously missed, rather than a sudden rise in the underlying biological prevalence of autism. Later diagnosis can delay access to supports, accommodations, and community resources, so improving identification across sexes remains an important clinical and public‑health priority.