Phenotypic differences between female and male individuals with suspicion of autism spectrum disorder.
Sanna Stroth, Johannes Tauscher, Nicole Wolff and 6 others
PMID 35255969WHAT IT FOUND
Females with autism were diagnosed later and showed fewer restricted/repetitive behaviors than males.
The ADOS algorithm worked equally well for both sexes, but females required fewer observed social features to reach a diagnosis. Clinicians must actively rule out anxiety and depression when assessing females.
Key findings
01Females with an autism diagnosis were significantly older at assessment than males in both the child and adult samples.
02The ADOS diagnostic algorithm performed similarly for females and males, but the optimal model for females required fewer behavioral features.
03More females were diagnosed with autism despite scoring below the ADOS cut-off, while more males were not diagnosed despite exceeding it.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was retrospective and relied on existing medical records. The female sample was significantly smaller than the male sample, limiting statistical power to detect small differences. There is a degree of circularity because ADOS scores were part of the diagnostic process used to define the groups. The ADOS instrument itself may be biased toward male presentations, as it was validated on predominantly male samples. The study did not include non-verbal individuals or those with profound intellectual disabilities, limiting generalizability to those populations.
Declared interests
Funded by the German Federal Ministry of Education and Research (BMBF) and Philipps-Universität Marburg. The authors coordinated the research consortium (ASD-Net) from which data was drawn.
The easy way to misread this
Do not interpret the finding that females require fewer ADOS features for classification as evidence that the ADOS is easier to use or more sensitive for females. The data shows that many females were diagnosed despite failing to meet the standard ADOS cut-off, indicating the tool may miss autism in females unless clinical judgment overrides the algorithm.