Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 31;10(2):272.
doi: 10.3390/children10020272.

Finding the Proportion of Females with Autistic Spectrum Disorder Who Develop Anorexia Nervosa, the True Prevalence of Female ASD and Its Clinical Significance

Robert McCrossin  1   2
Affiliations

Finding the Proportion of Females with Autistic Spectrum Disorder Who Develop Anorexia Nervosa, the True Prevalence of Female ASD and Its Clinical Significance

Robert McCrossin. Children (Basel). .

Abstract

It appears that up to 80% of females with autistic spectrum disorder (ASD) have not been diagnosed by the age of 18. This translates to a prevalence of about 5-6%, and if true, has serious implications for female mental health. One way of finding the true value is to use Bayes' Theorem with a comorbid condition as a more easily recognizable flag. An obvious choice is anorexia nervosa (AN), but it transpires that the proportion of women with ASD who develop AN is unknown. This study uses published data in novel ways to provide two methods of estimating a range for this variable, and gives a median value of 8.3% for AN in ASD and, with four other methods, a median prevalence of 6% for female ASD. The clinical implications of the diagnosis and management of ASD and its comorbidities are discussed and, as an example, a solution is provided for the rate of ASD in symptomatic generalized joint hypermobility. It is probable that one in six women with a mental health condition is autistic.

Keywords: Bayes’ theorem; anorexia nervosa; autistic spectrum disorder; diagnosis; female; generalized joint hypermobility; hazard ratio; likelihood ratio; management; prevalence.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Bayesian 2 × 2 table for female model two as probabilities.
Figure A2
Figure A2
Bayesian 2 × 2 table for female population ASD/S-GJH as probabilities.
Figure 1
Figure 1
Female singletons diagnosed per year of age.
Figure 2
Figure 2
Singleton distribution by referral question. ?ASD and behaviour/learning now referenced in text twice, before and after figure.
Figure 3
Figure 3
Singletons and siblings for each 6 months of age.
Figure 4
Figure 4
Venn diagram of Bayes’ theorem.
Figure 5
Figure 5
Bayesian 2 × 2 table.
Figure 6
Figure 6
P(AN|ASD) distributed as percentages.
Figure 7
Figure 7
Bayesian matrix and hazard ratio ranges of P(AN|ASD).
Figure 8
Figure 8
Bayesian 2 × 2 table.
Figure 9
Figure 9
Bayesian 2 × 2 table for female model one as probabilities.
Figure 10
Figure 10
Bayesian 2 × 2 table for female population model two as probabilities.
Figure 11
Figure 11
Bayesian matrix median and hazard ratio value and ranges of P(AN|ASD).
Figure 12
Figure 12
Pathways to the true female ASD prevalence.
Figure 13
Figure 13
Percentage prevalence estimates of female ASD.
Figure 14
Figure 14
P(AN|ASD) revised Bayes’ matrix range.
Figure 15
Figure 15
Bayesian 2 × 2 table with ASD as a test for AN.
Figure 16
Figure 16
Bayesian matrix range of P(AN|ASD).
Figure 17
Figure 17
Therapeutic dynamic: the key is to listen.
See this image and copyright information in PMC

References

    1. McCrossin R. Finding the True Number of Females with Autistic Spectrum Disorder by Estimating the Biases in Initial Recognition and Clinical Diagnosis. Children. 2022;9:272. doi: 10.3390/children9020272. - DOI - PMC - PubMed
    1. Westwood H., Tchanturia K. Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review. Curr. Psychiatry Rep. 2017;19:41. doi: 10.1007/s11920-017-0791-9. - DOI - PMC - PubMed
    1. Maenner M.J., Shaw K.A., Baio J., Washington A., Patrick M., DiRienzo M., Christensen D.L., Wiggins L.D., Pettygrove S., Andrews J.G., et al. Prevalence of Autistic Spectrum Disorder among Children Aged 8 Years–Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016. MMWR Surveill. Summ. 2020;69:1–12. doi: 10.15585/mmwr.ss6904a1. - DOI - PMC - PubMed
    1. Kentrou V., de Veld D.M.J., Mataw K.J.K., Begeers S. Delayed Autism Spectrum Disorder Recognition in Children and Adolescents Previously Diagnosed with Attention-Deficit/Hyperactivity Disorder. Autism. 2019;23:1065–1072. doi: 10.1177/1362361318785171. - DOI - PMC - PubMed
    1. Hours C., Recasens C., Baleyte J.-M. ASD and ADHD Comorbidity: What Are We Talking about? Front. Psychiatry. 2022;13:837424. doi: 10.3389/fpsyt.2022.837424. - DOI - PMC - PubMed

LinkOut - more resources