Does sex influence the diagnostic evaluation of autism spectrum disorder in adults?

Wilson, C. Ellie; Murphy, Clodagh; McAlonan, Gráinne; Robertson, Dene; Spain, Debbie; Hayward, Hannah; Woodhouse, Emma; Deeley, Quinton; Gillan, Nicola; Ohlsen, J. Chris; Zinkstok, Janneke; Stoencheva, Vladimira; Faulkner, Jessica; Yildiran, Hatice; Bell, Vaughan; Hammond, Neil; Craig, Michael C.; Murphy, Declan

doi:10.1177/1362361315611381

Cited by 89 publications

(79 citation statements)

References 45 publications

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“…A major finding of ours was that females with ASD were far more likely to receive psychotropic medications than males, even when controlling for specific comorbidities. This could be additional support to the growing evidence that ASD is underdiagnosed in females [Begeer et al, ; Gould & Ashton‐Smith, ; Wilson et al, ]. In a recent meta‐analysis, Loomes, Hull, and Mandy [] concluded that the true male to female ratio in ASD is closer to 3:1, rather than 4:1, which we observed in this study.…”

Section: Discussionsupporting

confidence: 88%

Psychiatric Comorbidities and Psychotropic Medication Use in Autism: A Matched Cohort Study with ADHD and General Population Comparator Groups in the United Kingdom

2018

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Psychiatric comorbidities and use of psychotropic medications are common among patients with autism spectrum disorder (ASD). However, most previous research used data from the United States (US) and few studies have compared medication use in ASD to control groups, making contextualization of results difficult. In the United Kingdom (UK), general practitioners play a key role in the management of ASD. We conducted a retrospective, cross-sectional study over calendar year 2015, using primary care data from the UK. We identified a prevalent cohort of ASD cases (n = 10,856) and matched control groups of (a) general population (n = 21,712) and (b) attention deficit hyperactivity disorder (ADHD; n = 7,058) on age, sex and region. We described psychiatric comorbidities, psychotropic medications, and healthcare utilization in all three cohorts. Within the ASD cohort, we used multivariable logistic regression models to explore associations between patient characteristics and the outcomes of: any psychotropic medication, polypharmacy, and number of primary care visits. We used conditional logistic regression to compare the ASD and control groups. Psychiatric comorbidities were recorded for 41.5% of ASD patients; 32.3% received psychotropic medication and 9.8% received polypharmacy. Increased age and all psychiatric comorbidities (except conduct disorder) were associated with treatment use. Males were less likely to receive a treatment than females [Odds ratio (OR) 0.74 (0.66-0.83)]. ASD patients were more likely to take psychotropic medications than the general population ], but less likely compared to ADHD patients ]. Overall, rates of medication use in the UK were lower than those previously reported in the US.Lay Summary: We used electronic medical records from the UK, to describe the amount of psychiatric comorbidities, psychotropic medication use and healthcare resource use in ASD. Around one in three people with ASD were prescribed a psychotropic medication, which was more than the general population, but less than for those with ADHD. Increased age, psychiatric comorbidities and female gender were all independently associated with psychotropic medication use. Rates of medication use in the UK were lower than those previously reported in the US.

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Section: Discussionsupporting

confidence: 88%

Psychiatric Comorbidities and Psychotropic Medication Use in Autism: A Matched Cohort Study with ADHD and General Population Comparator Groups in the United Kingdom

2018

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“…Other reports (Brereton et al, 2006;Dworzynski et al, 2012) similarly noted that females with ASD are just as likely as males with ASD to demonstrate disruptive behavior and attentional deficit and hyperactivity, a pattern different from that found in typically developing boys and girls. A recent study of adults reported that in a large clinic referred sample of adults, women were significantly less likely to receive a diagnosis of ASD after being referred for an evaluation (Wilson et al, 2016). The sum of these findings also mirrors conclusions from research on attention deficit hyperactivity disorder (ADHD).…”

Section: Role Of Implicit Biassupporting

confidence: 57%

The clinician perspective on sex differences in autism spectrum disorders

Jamison

Bishop²,

Huerta

et al. 2017

Autism

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Research studies using existing samples of individuals with autism spectrum disorders have identified differences in symptoms between males and females. Differences are typically reported in school age and adolescence, with similarities in symptom presentation at earlier ages. However, existing studies on sex differences are significantly limited, making it challenging to discern if, how, and at what point in development females with autism spectrum disorder actually exhibit a different behavioral presentation than males. The purpose of this study was to gather impressions from a large group of clinicians to isolate specific areas for future study of sex differences. Clinicians were surveyed about their opinions and perceptions of symptom severity in females, as compared to males, at different points during development. They were also asked to provide open-ended responses about female symptom presentation. Consistent with previous literature, clinicians noted more sex-related differences in restricted and repetitive behaviors and fewer differences for social communication features. Differences were most commonly observed in school age and adolescence, suggesting this time period as a critical and particularly vulnerable window for females with autism spectrum disorder. The results are discussed in the context of other male/female differences across development so that more targeted investigations of autism spectrum disorder sex differences across development.

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“…This study was cross‐sectional, specific to high functioning males with ASD, lacked pubertal developmental measures [Urosevic et al, ] and did not include a semi‐structured clinical interview of possible psychiatric comorbidity such as the SCID‐5‐RV. Hence, our findings describe age‐related differences that may not generalize to others within the autism spectrum, including females [Craig et al, ; Ecker et al, ; Wilson et al, ]. However, study strengths include the relatively large sample of physically healthy, medication naive, clearly diagnosed males with ASD without confounding psychiatric diagnoses and matched controls, and the 25 year age span from childhood to adulthood.…”

Section: Limitationsmentioning

confidence: 86%

Abnormal functional activation and maturation of ventromedial prefrontal cortex and cerebellum during temporal discounting in autism spectrum disorder

Murphy

Christakou

Giampietro

et al. 2017

Human Brain Mapping

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People with autism spectrum disorder (ASD) have poor decision-making and temporal foresight. This may adversely impact on their everyday life, mental health, and productivity. However, the neural substrates underlying poor choice behavior in people with ASD, or its' neurofunctional development from childhood to adulthood, are unknown. Despite evidence of atypical structural brain development in ASD, investigation of functional brain maturation in people with ASD is lacking. This cross-sectional developmental fMRI study investigated the neural substrates underlying performance on a temporal discounting (TD) task in 38 healthy (11-35 years old) male adolescents and adults with ASD and 40 age, sex, and IQ-matched typically developing healthy controls. Most importantly, we assessed group differences in the neurofunctional maturation of TD across childhood and adulthood. Males with ASD had significantly poorer task performance and significantly lower brain activation in typical regions that mediate TD for delayed choices, in predominantly right hemispheric regions of ventrolateral/dorsolateral prefrontal cortices, ventromedial prefrontal cortex, striatolimbic regions, and cerebellum. Importantly, differential activation in ventromedial frontal cortex and cerebellum was associated with abnormal functional brain maturation; controls, in contrast to people with ASD, showed progressively increasing activation with increasing age in these regions; which furthermore was associated with performance measures and clinical ASD measures (stereotyped/restricted interests). Findings provide first cross-sectional evidence that reduced activation of TD mediating brain regions in people with ASD during TD is associated with abnormal functional brain development in these regions between childhood and adulthood, and this is related to poor task performance and clinical measures of ASD. Hum Brain Mapp 38:5343-5355, 2017. © 2017 Wiley Periodicals, Inc.

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Does sex influence the diagnostic evaluation of autism spectrum disorder in adults?

Cited by 89 publications

References 45 publications

Psychiatric Comorbidities and Psychotropic Medication Use in Autism: A Matched Cohort Study with ADHD and General Population Comparator Groups in the United Kingdom

Psychiatric Comorbidities and Psychotropic Medication Use in Autism: A Matched Cohort Study with ADHD and General Population Comparator Groups in the United Kingdom

The clinician perspective on sex differences in autism spectrum disorders

Abnormal functional activation and maturation of ventromedial prefrontal cortex and cerebellum during temporal discounting in autism spectrum disorder

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