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
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    • "However, A-TAC is thoroughly validated and the cutoffs reliably mirror current estimates of the prevalence of ADHD and ASD, respectively[48], in the Swedish population. Another limitation is that the DSM-IV criteria for ASD, on which A-TAC is based, mainly reflect the symptomatology displayed by males and that the presentation of ASD may be different in girls[49], hence making the A-TAC assessment of autistic traits in girls less certain. The major strengths of this study are that it is based on a large sample of twins and the use of a well-established and fairly comprehensive rating scale. "
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    ABSTRACT: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders thought to have both genetic and environmental causes. It has been hypothesized that exposure to elevated levels of prenatal testosterone is associated with elevated traits of ASD and ADHD. Assuming that testosterone levels from a dizygotic male twin fetus may lead to enhanced testosterone exposure of its co-twins, we aimed to test the prenatal testosterone hypothesis by comparing same-sex with opposite-sex dizygotic twins with respect to neurodevelopmental symptoms. Neuropsychiatric traits were assessed in a population-based twin cohort from the Child and Adolescent Twin Study in Sweden (CATSS). Parental interviews were conducted for 16,312 dizygotic twins, 9 and 12 years old, with the Autism—Tics, ADHD, and other Comorbidities inventory (A-TAC). Girls with a female co-twin had an increased risk of reaching the cut-off score for ADHD compared with girls with a male co-twin. Both boys and girls with a female co-twin displayed a larger number of traits related to attention deficit and repetitive and stereotyped behaviors than those with a male twin. In girls, this also extended to social interaction and the combined measures for ASD and ADHD, however, with small effect sizes. Our results are reverse to what would have been expected from the prenatal testosterone hypothesis but consistent with a previous study of ASD and ADHD traits in dizygotic twins. The seemingly protective effect for girls of having a twin brother may be an effect of parent report bias, but may also be an unexpected effect of sharing the intrauterine environment with a male co-twin.
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    • "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.
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    • "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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