Sex Differences in Social Adaptive Function in Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder

Abstract

Background: Social-communication difficulties, a hallmark of ASD, autism spectrum disorder (ASD) are often observed in attention – deficit/ hyperactivity disorder (ADHD), although are not part of its diagnostic criteria. Despite sex differences in the prevalence of ASD and ADHD, research examining how sex differences manifest in social and communication functions in these disorders remains limited, and findings are mixed. This study investigated potential sex differences with age in social adaptive function across these disorders, relative to controls. Method: One hundred fifteen youth with ASD, 172 youth with ADHD, and 63 typically developing controls (age range 7–13 years, 75% males) were recruited from the Province of Ontario Neurodevelopmental Disorder (POND) Network. Social adaptive function was assessed using the Adaptive Behavior Assessment System-Second Edition (ABAS-II). The proportions of adaptive behaviors present in each skill area were analyzed as a binomial outcome using logistic regression, controlling for age, and testing for an age-by-sex interaction. In an exploratory analysis, we examined the impact of controlling for core symptom severity on the sex effect. Results: Significant sex-by-age interactions were seen within ASD in the communication (p = 0.005), leisure (p = 0.003), and social skill areas (p < 0.0001). In all three areas, lower scores (indicating poorer function) were found in females compared to males at older ages despite females performing better at younger ages. There were significant differences in the sex-by-age interactions in the social and leisure domains between those with ASD and typically developing controls, with typically developing females showing better scores at older, compared to younger, ages. There were also significant differences in the sex-by-age interactions between ASD and ADHD on the social and leisure domains, as females with ADHD consistently scored higher on social skills than males across all ages, unlike those with ASD. Sex differences across age in the social domains for ADHD were similar to those in the typically developing group. Conclusion: Sex differences in social and communication skill areas were observed between ASD and ADHD, and typically developing controls, with females with ASD performing worse than males at older ages, despite an earlier advantage. These findings reinforce the need to take a developmental approach to understanding sex differences which may have diagnostic, prognostic, and treatment implications.

Short report: Social communication difficulties and restricted repetitive behaviors as predictors of anxiety in adults with autism spectrum disorder

“…While sex was not determined as a significant moderator between autistic traits and anxiety, females, on average, scored significantly higher on social communication difficulties, RRBs, and anxiety symptoms. This is consistent with previous findings showing that autistic adolescent females, on average, have poorer social skills (Mahendiran et al, 2019), engage in more RRBs (Antezana et al, 2019), and have more anxiety symptoms when compared to males (Wijnhoven et al, 2018). Our findings show that this is true for autistic adult females as well.…”

Trajectories of Autism Symptom Severity Change During Early Childhood

“…Yet, our results are consistent with many recent studies that suggest that girls might actually demonstrate better developmental outcomes than boys in the areas of cognition (Lai et al 2012 ) sociability (Head et al 2014 ), and pragmatic communication skills (Conlon et al 2019 ). Mahendiran et al ( 2019 ) showed that young girls diagnosed with ASD tend to show better social adaptive function compared to boys and Mandy et al ( 2018 ) demonstrated that during early childhood girls show lower autistic social traits compared to boys. Infant sibling studies (6–12 months) have demonstrated that at-risk females show enhanced attention to social stimuli compared to both high-risk males and low risk males and females (Chawarska et al 2016 ).…”

“…Another possibility relates to the increasingly accepted notion that girls and boys with autism might be characterized with different clinical presentations of symptoms (Frazier et al 2014 ) which also develop differently across life (Mandy et al 2018 ; Mahendiran et al 2019 ). This presents a real challenge for current measurement instruments, as these sex-based behavioral differences might not be sufficiently captured by standard measures (Lai and Szatmari 2019 ).…”

Sex Differences in Autism Spectrum Disorder: Repetitive Behaviors and Adaptive Functioning

“…Furthermore, there is evidence that the presence of RRBs during preschool years predicts poorer adaptive abilities in later childhood [ 48 ]. To our knowledge, most of the studies investigating sex differences in this clinical population have not specifically focused on the relationship between adaptive skills and RRBs, but they have generally investigated the relation between adaptive functioning and ASD core symptoms (i.e., social communication and social skill deficits, restricted interests, and repetitive behaviors), including RRBs in this broad category of symptoms [ 15 , 49 ].…”