Gender differences in autism spectrum disorders: Divergence among specific core symptoms

Abstract

Community-based studies have consistently shown a sex ratio heavily skewed towards males in autism spectrum disorders (ASD). The factors underlying this predominance of males are largely unknown, but the way girls score on standardized categorical diagnostic tools might account for the underrecognition of ASD in girls. Despite the existence of different norms for boys and girls with ASD on several major screening tests, the algorithm of the Autism Diagnosis Interview-Revised (ADI-R) has not been reformulated. The aim of our study was to investigate which ADI-R items discriminate between males and females, and to evaluate their weighting in the final diagnosis of autism. We then conducted discriminant analysis (DA) on a sample of 594 probands including 129 females with ASD, recruited by the Paris Autism Research International Sibpair (PARIS) Study. A replication analysis was run on an independent sample of 1716 probands including 338 females with ASD, recruited through the Autism Genetics Resource Exchange (AGRE) program. Entering the raw scores for all ADI-R items as independent variables, the DA correctly classified 78.9% of males and 72.9% of females (P < 0.001) in the PARIS cohort, and 72.2% of males and 68.3% of females (P < 0.0001) in the AGRE cohort. Among the items extracted by the stepwise DA, four belonged to the ADI-R algorithm used for the final diagnosis of ASD. In conclusion, several items of the ADI-R that are taken into account in the diagnosis of autism significantly differentiates between males and females. The potential gender bias thus induced may participate in the underestimation of the prevalence of ASD in females. Autism Res 2016,. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 680-689. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Gender differences in restricted and repetitive behaviors and interests in youth with autism

“…Therefore although the severity of this item may be present in girls, parents and clinicians may miss or overlook this symptom [Anthony et al, ; Attwood & Grandin, ]. This finding of increased circumscribed interests in boys is consistent with previous literature using both clinician‐ and parent‐ratings [Beggiato et al, ; Hiller et al, ; Mandy et al, ], which together suggest that RRBI gender differences may not be due solely to language used on measures, but may also be representative of female camouflage, as circumscribed interests may be overlooked by reporters and clinicians due to the nature rather than intensity.…”

“…Findings of elevated scores in pulling hair (11) and rubbing and scratching self (12) may indicate greater self‐injurious behaviors for girls. Together, these results converge with previous literature of higher self‐injury in girls with ASD [Beggiato et al, ; Maddox et al, ]. It will be important for parent‐ and self‐report measures to differentiate between self‐injurious behavior and non‐suicidal self‐injury.…”

“…Although gender differences have not been found for self‐injurious behaviors for preschoolers [Baghdadli, Pascal, Grisi, & Aussilloux, ; Schroeder et al, ] or school‐age children with ASD [Duerden et al, ; Murphy, Healy, & Leader, ; Solomon, Miller, Taylor, Hinshaw, & Carter, ], one recent study found increased rates of self‐injurious behavior in girls with ASD (Beggiato et al, ). Concurrent with this finding, higher self‐injurious behavior has been found in adult women with co‐occurring ASD and intellectual disability [Cohen et al, ].…”

Identifying the clinical needs and patterns of health service use of adolescent girls and women with autism spectrum disorder

“…Overall, few sex/gender differences emerged, although significant differences were found with respect to psychiatry and emergency department services. There is increasing interest related to the female profile of ASD [Beggiato et al, 2016;Lai et al, 2015] and results from the current exploratory study highlight important areas for future health service research. Women and girls with ASD in the current sample demonstrated equally high individual clinical needs as their male counterparts.…”

Autism Heterogeneity in a Densely Sampled U.S. Population: Results From the First 1,000 Participants in the RI‐CART Study

“…It is recognized that heterogeneity in clinical presentation is influenced by genetic variability, comorbidity, and sex [Beggiato et al, ; Bishop et al, ; Havdahl et al, ; Masi, DeMayo, Glozier, & Guastella, ], and small studies will sample unevenly across these dimensions, limiting both the reproducibility and generalizability of findings. In addition, the importance of demographic factors such as socioeconomic status (SES) is particularly important to address, given the strong link between demographic factors (e.g., SES, minority status) and presentation and outcomes in ASD [Dickerson et al, ; Zamora, Williams, Higareda, Wheeler, & Levitt, ].…”