Influencia de las comorbilidades en el diagnóstico tardío del Trastorno del Espectro Autista (TEA) en mujeres adultas: una revisión sistemática PRISMA

Abstract

Autism Spectrum Disorder (ASD) has a long history of study, in which it has mostly been examined through diagnostic models primarily in the male population. This has caused the diagnosis to be late and has led to underdiagnosis. This research aimed to analyze the influence of psychiatric comorbidities on the late diagnosis of ASD in adult women through a systematic review of the scientific literature. Following the guidelines of the PRISMA 2020 method, we conducted a systematic review. To obtain the information, we used the search engines PubMed, SciELO, and SCOPUS and used descriptors related to ASD, adult women, late diagnosis, and psychiatric comorbidities. At the end of the identification, screening, and eligibility assessment process, 11 studies were included that met the established criteria for qualitative analysis. It was evidenced, after the investigation, that the majority of women receive a diagnosis in adulthood, mostly after going through a long clinical trajectory of previous diagnoses such as anxiety, eating behavior disorders, and personality disorders. These comorbidities are the main cause of masking and often make it difficult to identify the underlying ASD, delaying access to appropriate support. Other factors were also identified, such as social camouflaging, the presentation of internalized symptoms, and gender biases in diagnostic criteria. As a conclusion, we can say that late diagnosis in adult women is a multifactorial and structural phenomenon, which highlights the need to incorporate a gender perspective in the diagnostic process and to strengthen research and clinical training regarding this female phenotype of ASD.