Abstract
The sex difference in the prevalence of autism spectrum disorder (ASD) may be magnified by sex differences on diagnostic measures. The current study compared autistic males and females on items on the gold-standard diagnostic measure, the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). In a sample of 8-to-17-year old autistic individuals from research (n = 229) and clinical settings (n = 238), females were less likely to show atypicalities on most items related to social-communication behaviors and on total and subscale scores. When controlling for overall intensity of symptomatology, no sex differences survived statistical corrections. Diagnostic criteria and/or gold-standard assessments may be less sensitive to female presentations of ASD and/or autistic females may exhibit fewer or less intense behaviors characteristic of ASD.
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Notes
Sex is defined as biological and physiological characteristics related to being male, female, or intersex. Gender refers to the socially constructed characteristics associated with sex (World Health Organization, 2002). As gendered social constructs begin early in development, and gender identity is rarely assessed to appropriately distinguish between the effect of sex or gender on presentation, the term sex/gender will be used in reviews of extant literature (e.g., Lai et al., 2015). Additionally, while we recognize the increased prevalence of gender diversity (e.g., transgender, nonbinary, etc.) among autistic individuals who may not conform to “traditional” gender norms (Janssen et al., 2016; Øien et al., 2018a, b; Strang et al., 2014), the present study focuses on ASD diagnostic assessments based on sex as data was not collected on gender identity.
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Acknowledgments
We wish to thank the families, parents and children, who participated in the GENDAAR study at the four data collection sites, as well as those who participated through Children’s National Hospital. Funding was provided by the NIMH R01 MH10028 ACE Network (Pelphrey). This publication was also supported by Award Number 1U54HD090257 from the NIH, District of Columbia Intellectual and Developmental Disabilities Research Center Award (DC-IDDRC) program, and by a private grant to Children’s National through the Isadore and Bertha Gudelsky Family Foundation.
The ACE GENDAAR Consortium includes contributions from: Kevin Pelphrey PhD (PI), Katy Ankeman MSW, Elizabeth Aylward PhD, Raphael Bernier PhD, Susan Bookheimer PhD, Sarah Corrigan MA, Mirella Dapretto PhD, Daniel Geschwind MD, Abha Gupta PhD, Allison Jack PhD, Zack Jacokes, Erin Libsack, Jennifer Lowe PhD, Desiree Lussier PhD, Shafali Jeste MD, Anna Kresse MPH, James McPartland PhD, Adam Naples PhD, Charles Nelson PhD, Emily Neuhaus PhD, Megha Santhosh MHE, Matthew State MD, Catherine Sullivan, Carina Torgenson, Jack Van Horn PhD, Pamela Ventola PhD, Julie Wolf PhD.
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HR conceived of the study, finalized its design, completed analyses, and coordinated and drafted the manuscript; RO complete analyses and drafted the manuscript, FS designed and complete analyses and drafted the manuscript, SJW oversaw data collection and drafted the manuscript, AR contributed to data collection, study design, and drafted the manuscript.
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Hannah M. Rea, Roald A. Øien, Sara Jane Webb, and Allison Ratto report no affiliations with or involvement in any organization or entity with any financial interest in the outcome of this project. Frederick Shic is a paid consultant for Roche and Janssen pharmaceutical companies.
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Rea, H.M., Øien, R.A., Shic, F. et al. Sex Differences on the ADOS-2. J Autism Dev Disord 53, 2878–2890 (2023). https://doi.org/10.1007/s10803-022-05566-3
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DOI: https://doi.org/10.1007/s10803-022-05566-3