Physical health of autistic girls and women: a scoping review

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Physical health of autistic girls and women: a scoping review Caroline Kassee1,2†, Stephanie Babinski2,3†  , Ami Tint1,4  , Yona Lunsky4,5  , Hilary K. Brown2,6  , Stephanie H. Ameis1,4,5,7  , Peter Szatmari1,5,7, Meng‑Chuan Lai1,4,5,7,8,9,10*†  and Gillian Einstein2,8,11,12† 

Abstract  Background:  There is a growing recognition of sex and gender influences in autism. Increasingly, studies include comparisons between sexes or genders, but few have focused on clarifying the characteristics of autistic girls’/wom‑ en’s physical health. Methods:  A scoping review was conducted to determine what is currently known about the physical health of autis‑ tic girls/women. We screened 1112 unique articles, with 40 studies meeting the inclusion criteria. We used a conver‑ gent iterative process to synthesize this content into broad thematic areas. Results:  Autistic girls/women experience more overall physical health challenges compared to non-autistic girls/ women and to autistic boys/men. Emerging evidence suggests increased prevalence of epilepsy in autistic girls/ women compared to non-autistic girls/women and to autistic boys/men. The literature also suggests increased endo‑ crine and reproductive health conditions in autistic girls/women compared to non-autistic girls/women. Findings regarding gastrointestinal, metabolic, nutritional, and immune-related conditions are preliminary and inconsistent. Limitations:  The literature has substantial heterogeneity in how physical health conditions were assessed and reported. Further, our explicit focus on physical health may have constrained the ability to examine interactions between mental and physical health. The widely differing research aims and methodologies make it difficult to reach definitive conclusions. Nevertheless, in keeping with the goals of a scoping review, we were able to identify key themes to guide future research. Conclusions:  The emerging literature suggests that autistic girls/women have heightened rates of physical health challenges compared to non-autistic girls/women and to autistic boys/men. Clinicians should seek to provide holistic care that includes a focus on physical health and develop a women’s health lens when providing clinical care to autis‑ tic girls/women. Keywords:  Autism, Physical health, Sex differences, Gender, Girls, Women, Scoping review

*Correspondence: [email protected] † Caroline Kassee and Stephanie Babinski are equal contribution joint first authors † Meng-Chuan Lai and Gillian Einstein are equal contribution joint senior authors 1 The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4, Canada Full list of author information is available at the end of the article

Background Autism spectrum disorder (hereafter autism) is a neurodevelopmental condition characterized by early-onset social communication difficulties and repetitive, stereotyped behaviors. The estimated prevalence rate of autism is appro