Sex differences in the course of autistic and co-occurring psychopathological symptoms in adolescents with and without autism spectrum disorder.
Ernst Horwitz, Melissa Vos, Annelies De Bildt and 4 others
PMID 36680498WHAT IT FOUND
In adolescents with autism, social communication difficulties were similar for males and females.
However, autistic males showed more repetitive behaviors and resistance to change than females. Anxiety and depression increased in females but decreased in males, a pattern identical to those without autism.
Key findings
01There were no sex differences in social communication symptoms for individuals with autism, contradicting the idea of a distinct female social phenotype.
02Autistic males had higher scores for repetitive behaviors and resistance to change than autistic females, but this gap narrowed over adolescence as female scores increased.
03Anxiety and depressive symptoms increased in females and decreased in males during adolescence, but this sex difference was not specific to autism and was seen in the control group too.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
Diagnoses were based on clinical records from a specific time period using DSM-IV criteria, which may differ from current DSM-5 standards. The study focused on individuals with average IQ and milder forms of autism, so findings may not apply to those with intellectual disability or more severe presentations. Potential diagnostic bias against girls may mean that females with autism in the sample had a more 'male-like' presentation, possibly underestimating true sex differences. Attrition and missing data across five time points in a long-term study can affect the stability of trajectory estimates.
Declared interests
The authors declared no conflicts of interest. The study was funded by the Netherlands Organisation for Health Research and Development (ZonMw) and other public health grants.
The easy way to misread this
Do not interpret the lack of sex differences in social communication as evidence that autism presents identically in boys and girls in all contexts. The study used standardized parent-report measures which may not capture subtle social difficulties or camouflaging behaviors that are clinically relevant for females.