What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills.
Allison B Ratto, Lauren Kenworthy, Benjamin E Yerys and 12 others
PMID 29204929WHAT IT FOUND
Boys and girls with autism and no intellectual disability scored similarly on observed diagnostic tests, but parents rated girls as having stronger autistic traits and lower daily living skills.
Key findings
01In the matched sample of 228 children, boys and girls had similar overall ADOS severity scores.
02Parents rated girls as having stronger autistic traits across all five SRS domains and lower daily living skills on the Vineland-II.
03After accounting for ADI-R domain scores, girls were less likely to meet ADI-R criteria, and girls with higher IQ were least likely.
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
All participants had IQ above 70 and had to meet criteria on at least one gold-standard measure, so girls who do not meet these tools were not included. The main comparison was cross-sectional and did not follow participants over time, so it cannot show how diagnostic pathways or adaptive skills changed. Complete ADI-R, SRS and Vineland-II data were not available for every child, and children missing a measure were excluded from that analysis, so some analyses were not matched. Raw scores were not available for all participants, so the study could not statistically compare raw differences behind the normed parent-report scores. Very few participants met criteria on the ADI-R only, so comparisons between one measure and two measures were limited. The study used biological sex assigned at birth and did not examine gender identity. Parent-report differences could reflect parental expectations or greater sensitivity of sex-normed continuous measures, not only true trait differences.
The easy way to misread this
Do not read similar ADOS scores as evidence that current diagnostic tools identify autistic girls and boys equally well. Girls were less likely to meet ADI-R criteria as IQ increased, and the sample included only girls who already met at least one gold-standard measure, so girls who do not meet these measures were not represented.