How Different Are Girls and Boys Above and Below the Diagnostic Threshold for Autism Spectrum Disorders?

National Clinical Guideline Centre, Royal College of Physicians, UK.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 08/2012; 51(8):788-97. DOI: 10.1016/j.jaac.2012.05.018
Source: PubMed


This study aimed to explore sex differences in autistic traits in relation to diagnosis, to elucidate factors that might differentially impact whether girls versus boys meet diagnostic criteria for autism or a related autism spectrum disorder (ASD).
Data from a large population-based sample of children were examined. Girls and boys (aged 10-12 years) meeting diagnostic criteria for an ASD were compared with those failing to meet diagnostic criteria despite very high scores on a trait measure of ASD, the Childhood Autism Spectrum Test (CAST). Information about behavioral difficulties as reported by teachers, and early estimates of intellectual functioning, were compared.
Girls, but not boys, meeting diagnostic criteria for ASD showed significantly more additional problems (low intellectual level, behavioral difficulties) than peers with similarly high CAST scores who did not meet diagnostic criteria.
These data suggest that, in the absence of additional intellectual or behavioral problems, girls are less likely than boys to meet diagnostic criteria for ASD at equivalently high levels of autistic-like traits. This might reflect gender bias in diagnosis or genuinely better adaptation/compensation in girls.

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Available from: Angelica Ronald, Dec 21, 2013
    • "Recent genetic research has begun to shed light on potential genderspecific mutations and female protective factors that may lead to the differential diagnosis rate between sexes (see Jeste and Geschwind 2014; Werling and Geschwind 2013 for recent reviews). Research has also indicated that in order for girls to receive a diagnosis of ASD they require a greater symptom threshold, as well as accompanying behavioral problems or intellectual disability (ID) (Banach et al. 2009; Dworzynski et al. 2012) potentially leading to later detection and diagnosis (Kopp and Gillberg 1992). As a result, the behavioral phenotype and symptom presentation of girls with ASD, especially toddlers and preschoolers, is still widely unknown (Van Wijngaarden-Cremers et al. 2013). "
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    ABSTRACT: Due to the uneven gender ratio of autism spectrum disorders (ASD), girls are rarely studied independently from boys. Research focusing on restricted and repetitive behaviors (RRBs) indicates that above the age of six girls have fewer and/or different RRBs than boys with ASD. In this study we investigated whether girls and boys with ASD demonstrated similar rates and types of RRBs in early childhood, using discrete observational coding from a video-taped play interaction. Twenty-nine girls with ASD were matched to 29 boys based on ASD severity. While boys in our sample demonstrated a greater frequency of RRBs, this was not significant and our findings indicate that girls and boys under five are more similar than dissimilar on this core deficit. However our data also revealed a trend toward gender-differential growth trajectories—a finding worthy of further investigation in larger samples.
    Journal of Autism and Developmental Disorders 06/2015; 45(11). DOI:10.1007/s10803-015-2511-9
    • "The lower proportion of females among those with ASD without intellectual disability might indicate that females with higher cognitive ability have symptoms that are either different or more subtle than in males, and could therefore lead to under-recognition and delay in diagnosis (Goldman 2013; Lai et al. 2015). One study of ASD traits among children in a general school population found that at similar levels of ASD-related symptoms, girls were less likely than boys to meet diagnostic criteria for ASD (Dworzynski et al. 2012), supporting this suggestion. Early studies into sex differences in ASD examined primarily participants with intellectual disability. "
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    ABSTRACT: This study investigated the differences in clinical symptoms between females and males with autism spectrum disorder (ASD) across three verbal ability groups (nonverbal, phrase and fluent speech), based on which Autism Diagnostic Observation Schedule module was administered to 5723 individuals in four research datasets. In the Simons Simplex Collection and Autism Treatment Network, females with ASD and phrase or fluent speech had lower cognitive, adaptive, and social abilities than males. In the Autism Genetics Resource Exchange and the Autism Consortium, females with phrase or fluent speech had similar or better adaptive and social abilities than males. Females who were nonverbal had similar cognitive, adaptive, and social abilities as males. Population-based longitudinal studies of verbally fluent females with ASD are needed.
    Journal of Autism and Developmental Disorders 06/2015; 45(11). DOI:10.1007/s10803-015-2501-y · 3.06 Impact Factor
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    • "In order to account for this marked discrepancy between estimated versus observed gender ratios, as well as why girls are formally diagnosed with HFA later and less often than boys, two hypotheses have been suggested. The first hypothesis suggests that current diagnostic criteria and assessment tools for HFA are biased towards the male presentation of HFA, which may differ from the female presentation of HFA (Dworzynski, et al., 2012; Kopp & Gillberg, 2011; Nydén, Hjelmquist, & Gillberg, 2000). For instance, girls with HFA have been suggested to show a number of phenotypical differences relative to their male counterparts including fewer special interests, better superficial social skills, better communication skills and subtler forms of aggression (Gillberg & Coleman, 2000; Kirkovski, et al., 2013). "
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    ABSTRACT: This study evaluated the effects of an eight-session female higher-functioning autism anti-stigma program on the knowledge, attitudes and behavioural intentions of adolescent girls. Participants were seventh-, eighth- and ninth-grade students (N = 273) in a mainstream school. Two-eighth-grade classes were randomly allocated to the intervention condition. The remaining students were either allocated to the no-intervention peer or no-intervention non-peer condition. The anti-stigma program positively influenced knowledge, attitudes and to a lesser extent behavioural intentions towards peers with higher-functioning autism within the intervention condition. Some degree of attitudinal improvement occurred across all conditions following the program suggesting some spill over effects. Overall, findings provide preliminary evidence supporting the efficacy of an anti-stigma program tailored to support females with higher-functioning autism.
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