Article

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

ABSTRACT

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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    • "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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    • "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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    • "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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