Intersecting effects of sex/gender and autism on structural language: A scoping review

Abstract

Despite emerging awareness of gender diversity in the autistic population, our understanding of autism remains limited to cisgender boys and men. We conducted a scoping review to better understand how structural language skills (i.e. syntax, semantics, narrative) differ across sex/gender within autism, and how gender diversity is incorporated in such research. Five research databases were searched for articles that have autistic participants who were not all male, present quantitative results separated by sex/gender, pertain to structural language, and were published between 2000 and 2021. Twenty-four articles met inclusion criteria. One article demonstrated awareness of gender diversity beyond the binary (i.e. girl, boy). Overall, autistic girls performed better than autistic boys but worse than nonautistic girls. Autistic girls are less likely to share the same quality and magnitude of structural language difficulties as autistic boys, which may contribute to their underdiagnosis. Comparing autistic girls to nonautistic girls is more likely to reveal areas of linguistic difference and potential intervention targets. This research provides further support for developing sex/gender-aware diagnostic and support measures for autism. Broader awareness of gender diversity, as both a concept and a prevalent feature of the autistic population, is essential for researchers to continue learning about sex/gender interactions in autism. Lay abstract Research about autism is mostly about boys and men, even though many autistic people are girls, women, and transgender/nonbinary. We wanted to learn more about how gender interacts with language skills in autistic people, so we reviewed existing research articles on this topic. We also wanted to know how this previous research talked about gender. Included articles had to measure language skills for autistic people of different genders. They also had to be published between 2000 and 2021. Twenty-four articles met these requirements. We found that autistic girls showed better language skills than autistic boys but worse skills than nonautistic girls. This may be one reason that autistic girls are underdiagnosed compared to autistic boys. If we compare autistic girls to nonautistic girls instead, we can see more language differences and possible areas to target in interventions. This study supports the need to create diagnostic and support measures for autism that take gender into account. Also, only one article mentioned autistic people who are transgender or nonbinary. Researchers who want to learn more about gender and autism need to understand gender diversity and recognize that many autistic people are transgender or nonbinary.

Special considerations for assessing and caring for autism in girls and women

“…Currently, findings have gained strength as they rely on studies with larger samples, gradually incorporating more autistic women [6], as well as on reviews, metaanalyses and research presented as follows. These show that autistic women have better language skills [7], more social camouflaging [8][9][10][11][12], different and more social interests than autistic men [13,14], but also that they are more likely to develop associated comorbidities, especially psychiatric conditions [15,16]. These behavioral results are also supported by neuroimaging [18,19].…”