Sex Differences in Co-occurring Conditions Among Autistic Children and Youth in Florida: A Retrospective Cohort Study (2012-2019).
Amber M Angell, Alexis Deavenport-Saman, Larry Yin and 4 others
PMID 33394250WHAT IT FOUND
In 83,500 autistic children, girls had significantly higher odds of anxiety, mood disorders, intellectual disability, epilepsy, sleep, and GI issues than boys.
Boys had higher odds of ADHD. This suggests clinicians should screen girls more aggressively for these co-occurring conditions.
Key findings
01After adjusting for age, race, ethnicity, urbanicity, and insurance, autistic girls had significantly higher odds of all co-occurring conditions except ADHD, including anxiety, mood disorders, epilepsy, GI disorders, metabolic disorders, developmental disorders, intellectual disability, and sleep disorders.
02Autistic girls had significantly lower odds of ADHD compared to boys.
03The top three co-occurring conditions for both girls and boys were developmental disorders, ADHD, and gastrointestinal disorders, though prevalence rates differed slightly by sex.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study relied on healthcare claims data, so diagnoses were not confirmed using gold standard clinical measures. The dataset did not include information on socioeconomic status, household income, IQ, or other clinical measures that might influence the findings. There was a large number of unknown racial and ethnic categories in the data. The study did not examine the time of onset for co-occurring conditions. Insurance type was used as a proxy for socioeconomic status, but this is imperfect because some children qualify for Medicaid based on their autism diagnosis rather than income.
Declared interests
The study used data from the OneFlorida Data Trust, which is supported by the Patient-Centered Outcomes Research Institute (PCORI). No other conflicts of interest were reported.
The easy way to misread this
Do not assume that higher odds of co-occurring conditions in girls mean they are more severely affected by autism itself. These findings reflect diagnostic patterns in healthcare claims, which may be influenced by how girls present with symptoms and how clinicians diagnose them, rather than the core severity of autism.