Friend matters: sex differences in social language during autism diagnostic interviews

Abstract

Background Autistic individuals frequently experience social communication challenges. Girls are diagnosed with autism less often than boys even when their symptoms are equally severe, which may be due to insufficient understanding of the way autism manifests in girls. Differences in the behavioral presentation of autism, including how people talk about social topics, could contribute to these persistent problems with identification. Despite a growing body of research suggesting that autistic girls and boys present distinct symptom profiles in a variety of domains, including social attention, friendships, social motivation, and language, differences in the way that autistic boys and girls communicate verbally are not yet well understood. Closely analyzing boys’ and girls’ socially-focused language during semi-structured clinical assessments could shed light on potential sex differences in the behavioral presentation of autistic individuals that may prove useful for identifying and effectively supporting autistic girls. Here, we compare social word use in verbally fluent autistic girls and boys during the interview sections of the ADOS-2 Module 3 and measure associations with clinical phenotype. Methods School-aged girls and boys with autism (N = 101, 25 females; aged 6–15) were matched on age, IQ, and parent/clinician ratings of autism symptom severity. Our primary analysis compared the number of social words produced by autistic boys and girls (normalized to account for differences in total word production). Social words are words that make reference to other people, including friends and family. Results There was a significant main effect of sex on social word production, such that autistic girls used more social words than autistic boys. To identify the specific types of words driving this effect, additional subcategories of friend and family words were analyzed. There was a significant effect of sex on friend words, with girls using significantly more friend words than boys. However, there was no significant main effect of sex on family words, suggesting that sex differences in social word production may be driven by girls talking more about friends compared to boys, not family. To assess relationships between word use and clinical phenotype, we modeled ADOS-2 Social Affect (SA) scores as a function of social word production. In the overall sample, social word use correlated significantly with ADOS-2 SA scores, indicating that participants who used more social words were rated as less socially impaired by clinicians. However, when examined in each sex separately, this result only held for boys. Limitations This study cannot speak to the ways in which social word use may differ for younger children, adults, or individuals who are not verbally fluent; in addition, there were more autistic boys than girls in our sample, making it difficult to detect small effects. Conclusions Autistic girls used significantly more social words than boys during a diagnostic assessment—despite being matched on age, IQ, and both parent- and clinician-rated autism symptom severity. Sex differences in linguistic markers of social phenotype in autism are especially important in light of the late or missed diagnoses that disproportionately affect autistic girls. Specifically, heightened talk about social topics could complicate autism referral and diagnosis when non-clinician observers expect a male-typical pattern of reduced social focus, which autistic girls may not always exhibit.

A Bibliometric Study of Scientific Productivity on Adaptive Behavior in Children and Adolescents with Autism

“…In fact, through the publication of the 89 scientific articles, regardless of the type of paper, we highlight that during 2021 significant advances have been achieved. Not only from cross-sectional (Liu, et al 2021;Cola et al 2022;Mason et al 2021) Generally speaking, this research is relevant for people currently suffering from ASD, in whom symptoms could be prevented and treated (Thurm, & Swedo, 2012). Even the results of this research can be of use to caregivers, family members and researchers, respectively (Anagnostou et al 2015).…”

Intellectual disabilities moderate sex/gender differences in autism spectrum disorder: a systematic review and meta‐analysis

“…Girls/women with ASD are found to produce more socially focused language, and this may mask their social difficulties (Cola et al . 2022). Taken together, among individuals with ASD without ID, girls/women exhibit less symptoms than boys/men in most of the investigated areas.…”

“…High verbal abilities and pragmatic language are an essential part of social communication (Baird & Norbury 2016), and therefore, higher linguistic abilities could help girls/women with ASD without ID to manage social situations better than boys/men. Girls/women with ASD are found to produce more socially focused language, and this may mask their social difficulties ( Cola et al 2022). Taken together, among individuals with ASD without ID, girls/women exhibit less symptoms than boys/men in most of the investigated areas.…”

Sex Differences in Friendships and Loneliness in Autistic and Non-Autistic Children Across Development

“…School-aged and adolescent autistic girls are more likely than autistic boys to talk about social groups in conversations 26 and to refer to friends during semi-structured interviews. 27 When autistic children describe the quality and meaning of their friendships, both sex and age may be in uencing factors. Autistic girls may be more likely than autistic boys to prioritize intimacy in their friendships during adolescence, 6 but it remains unclear whether the quality and meaning of friendships differ across sex among school-aged children, who are less likely to conceptualize friendships in terms of affection and intimacy.…”

“…40 Two ongoing studies (P50HD055784, 2R01MH100027-11) are currently being conducted at the University of California, Los Angeles. Two completed studies 42,43 took place at UCLA, one completed study 44 took place at both the University of North Carolina, Chapel Hill and the University of Chicago, and the other two completed studies 27,45 took place at Children's Hospital of Philadelphia. The number of participants whose data was used from each study is listed in Table 1.…”