Epidemiology of autism in adults across age groups and ability levels
Open accessAbstract
Background: The epidemiology of autism in adults has relied on untested projections using childhood research. Aims: To derive representative estimates of the prevalence of autism and key associations in adults of all ages and ability levels. Method: Comparable clinical diagnostic assessments of 7274 Adult Psychiatric Morbidity Survey participants combined with a population case-register survey of 290 adults with intellectual disability. Results: The combined prevalence of autism in adults of all ages in England was 11/1000 (95% CI 3–19/1000). It was higher in those with moderate to profound intellectual disability (odds ratio (OR) = 63.5, 95% CI 27.4–147.2). Male gender was a strong predictor of autism only in those with no or mild intellectual disability (adjusted OR = 8.5, 95% CI 2.0–34.9; interaction with gender, P = 0.03). Conclusions: Few adults with autism have intellectual disability; however, autism is more prevalent in this population. Autism measures may miss more women with autism.
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Epidemiological studies indicate that ASD is more common among males than females, with a ratio estimate from the 2010 Global Burden of Disease study revealing a ratio of 4:1.
“Epidemiological studies indicate that ASD is more common among males than females, with a ratio estimate from the 2010 Global Burden of Disease study revealing a ratio of 4:1 (Brugha et al. 2016; Loomes et al. 2017).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Brugha et al. 2016
The Discussion reports a male excess in the Global Burden of Disease estimate, but not a single 4:1 ratio for ASD overall: it says autistic disorders were three times as common in males and other forms of autism were over four times as common. It also notes that the male excess was not evident among adults with moderate or profound intellectual disability. (LLM, conf=0.88)
Experimental — accuracy not yet measuredASD is more common in males than in females, with reported ratios ranging from 2.1 to 5.1, and an estimate of 4.1 in the 2010 Global Burden of Disease study.
“Epidemiological administrative and community-based [Au:OK?YES] studies have suggested that ASD is more common in males than in females, with reported ratios [Au:OK to add 'with reported ratios' here?] ranging from 2.1 -5. 1, with an estimate of 4.1 in the 2010 [Au:OK?] Global Burden of Disease study 3,4 .”
From Autism spectrum disorder (2020) · cites this paper as [4]
The Discussion (page unavailable in our copy) reports male excess in childhood autism and a male:female ratio of 2.1:1 for children with lower IQ. It does not report a ratio of 5.1 or a precise 4.1 estimate from the Global Burden of Disease project; it says the latter estimated about three males per female for autistic disorders and over four for other forms of autism. The paper also found no clear male excess among adults with moderate to profound intellectual disability. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMost people in the world who are autistic are adults, and many of these individuals have not received a diagnosis of autism.
“Given that most people in the world who are autistic are adults , and as many of these individuals have not received a diagnosis of autism 4,15”
From Autism spectrum disorder (2020) · cites this paper as [4]
The ‘Interpretation of our findings’ section says that research-identified autistic adults in a household sample had not been recognised or diagnosed by health services, and describes a large population of unrecognised adults. The paper estimates autism prevalence among adults in England, but does not establish that most autistic people worldwide are adults. Page numbers were not provided in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe large increase in estimated prevalence of the autism spectrum reflects necessary improvements in its epidemiological modelling and aligns global estimates with estimates derived from high-quality epidemiological surveys.
“The large increase in the estimated prevalence of the autism spectrum reflects necessary improvements in its epidemiological modelling and aligns global estimates with estimates derived from high-quality epidemiological surveys.11, 12, 13”
From The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021. (2025) · cites this paper as [11]
The Abstract reports a population-survey estimate of 11 per 1,000 adults in England, supporting the reference to an epidemiological survey estimate. Neither the Abstract nor the Interpretation of our findings says that a large increase in global estimated prevalence resulted from improved modelling or that global estimates were brought into alignment with survey estimates. The paper's statement that prevalence did not appear to increase rapidly concerns underlying rates, not the claimed change in estimates. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA large UK epidemiological study estimated autism prevalence among adults living in the community to be 9.8 per 1000, adjusted to 11 per 1000 following inclusion of a sample with intellectual disability.
“A large UK epidemiological study estimated autism prevalence among adults living in the community to be 9.8 per 1000 (Brugha et al., 2011), adjusted to 11 per 1000 following inclusion of a sample with intellectual disability (Brugha et al., 2016).”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Brugha et al., 2016
Gender ratio (1.2:1) was close to equal in studies assessing autism in adults with intellectual disability.
“Gender ratio (1.2:1) was close to equal in studies assessing autism in adults with intellectual disability (Brugha et al., 2016; Rutherford, McKenzie, Johnson, et al., 2016).”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Brugha et al., 2016
Prevalence of autism in populations with moderate to profound intellectual disability was high (21% to 42.3%), including some cases of first diagnosis in adulthood.
“Prevalence of autism in populations with moderate to profound intellectual disability was high (21% to 42.3%) (Brugha et al., 2016; Saemundsen et al., 2010), including some cases of first diagnosis in adulthood (Saemundsen et al., 2010).”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Brugha et al., 2016
Despite the frequent co-occurrence of autism and intellectual disability in adults, only a small proportion of studies intentionally included these individuals.
“Despite the frequent co-occurrence of autism and intellectual disability in adults (Brugha et al., 2016; Saemundsen et al., 2010), only a small proportion of studies intentionally included these individuals.”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Brugha et al., 2016
Lower sex ratios have also been noted among community-identified individuals with moderate to profound intellectual disability.
“Lower sex ratios have also been noted among community-identified individuals with moderate to profound intellectual disability (Brugha et al. 2016).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Brugha et al. 2016
Active case-finding that does not rely on administrative records has demonstrated an equivalent community rate of ASD in men and women with moderate to profound intellectual disability.
“Active case-finding that does not rely on administrative records has demonstrated an equivalent community rate of ASD in men and women with moderate to profound .”
From Autism spectrum disorder (2020) · cites this paper as [4]
The GBD 2019 global age-standardised prevalence of the autism spectrum was relatively low compared with prevalence from active case-finding methods.
“which was relatively low compared with the prevalence of autism spectrum disorder from active case-finding methods (in which prevalence is estimated using a diagnostic instrument in a general population survey supplemented by a search in case registries or special education facilities).11, 12, 13”
From The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021. (2025) · cites this paper as [11]
Prevalence of autism in the combined sample of adults with all intellectual abilities in England was 1.1%.
“Prevalence of autism in the combined sample was 1.1%”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Brugha et al. (2016)
Gender difference in autism prevalence was found only in the mild/no ID group.
“Gender difference was found only in the mild/no ID group.”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Brugha et al. (2016)
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Adult Outcomes After Newborn Respiratory Failure Treated With Extracorporeal Membrane Oxygenation*
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Aging Well on the Autism Spectrum: An Examination of the Dominant Model of Successful Aging
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Autism Spectrum Disorder May Be Highly Prevalent in People with Functional Neurological Disorders
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Autistic Traits, Empathizing–Systemizing, and Gender Diversity
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“…impair the ability to cope with daily hassles and reach long-term goals (Bednarz et al., 2020; Uddin, 2021; Wallace et al., 2016) and affect essential life areas, such as social relationships, work, and independent living (Bishop-Fitzpatrick et al., 2017; Brugha et al., 2016; Lai et al., 2020).”
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- Authors
- Brugha, T. S., Spiers, N., Bankart, J., Cooper, S.-A., McManus, S., Scott, F. J., Smith, J., & Tyrer, F.
- Affiliations
- University of Leicester (GB)
- Corresponding author
- Brugha, Traolach S.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2016-12
- Volume
- 209
- Issue
- 6
- Pages
- 498-503
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2400322275
- Cited by
- 299
- References
- 44
- Citations by year
- 2026: 19 · 2025: 28 · 2024: 54 · 2023: 33 · 2022: 45 · 2021: 32 · 2020: 31 · 2019: 28 · 2018: 18 · 2017: 7 · 2016: 3 · 2012: 1
- FWCI
- 12.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institute for Health and Care Research
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
- Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
- Keywords
- autism spectrum disorder, adults, prevalence, intellectual disability, gender differences, underdiagnosis in women, age groups, Adult Psychiatric Morbidity Survey, England
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Adult, Aged, Autistic Disorder, England, Female, Humans, Male, Intellectual Disability, Middle Aged, Registries, Comorbidity, Prevalence, Young Adult
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