Gender differences in restricted and repetitive behaviors and interests in youth with autism

Abstract

Previous work has found gender differences in restricted and repetitive behaviors and interests (RRBI) for autism spectrum disorder (ASD). Compared to girls, affected boys have increased stereotyped and restricted behaviors; however much less is known about gender differences in other areas of RRBI. This study aims to identify whether specific RRBI (i.e., stereotyped, self‐injurious, compulsive, insistence on sameness, ritualistic, and restricted), as measured by item‐level data on the Repetitive Behavior Scale‐Revised (RBS‐R), can distinguish girls from boys with ASD. Participants included 615 individuals with ASD (507 boys; 82.4%), ages 3–18 years of age (M = 10.26, SD = 4.20), who agreed to share data with the National Database for Autism Research (NDAR). Multivariate analysis of variance and discriminant function analysis (DFA) were used to determine whether item‐level RBS‐R data could correctly classify cases by gender. DFA results suggest that RBS‐R items significantly differentiate gender. Strongly differentiating RBS‐R items had greater success in correctly classifying affected boys (67.90%) than girls (61.00%). Items that best‐discriminated gender were heightened stereotyped behaviors and restricted interests items in boys and compulsive, sameness, restricted, and self‐injurious behavior items in girls. This study is the first to find that girls with ASD may have increased compulsive, sameness, and restricted RRBI compared to boys. Additionally, findings support heightened self‐injurious behaviors in affected girls. Future research should disentangle whether elevated rates of RRBI in girls are central to the presentation of ASD in girls or an epiphenomenon of the high rates of co‐occurring disorders (e.g., anxiety) noted in girls. Autism Res 2019, 12: 274–283 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary This study is the first to examine a comprehensive measure of repetitive behavior in children with autism, with findings of increased compulsive, insistence on sameness, and self‐injurious behavior characterizing girls and increased stereotyped and restricted behavior characterizing boys. Future research should determine whether these elevated behaviors in girls are directly part of the autism presentation in girls or symptoms of co‐occurring psychopathology. It is important for autism diagnostic measures to best capture the types of repetitive behavior girls may demonstrate.

Linking social motivation with social skill: The role of emotion dysregulation in autism spectrum disorder

“…As shown, male and female participants did not differ in mean symptom level for measures of internalizing symptoms or aggressive behavior. In contrast, female participants displayed significantly higher levels of attention problems, self-injurious behavior, and irritability than males, consistent with previous findings among a subset of other research samples (e.g., Antezana et al, 2018;Holtmann, Bolte, & Poustka, 2007).…”

The Female Autism Phenotype and Camouflaging: a Narrative Review

“…In a similar vein, some research into gender differences in restricted and repetitive interests has suggested that autistic females have lower levels of these interests than males (Hattier et al 2011;. However, some have argued that autistic females' special interests may be in different areas to males, and so may be underestimated, if these areas are not probed during assessments or are not considered 'atypical' (Antezana et al 2019;Mandy et al 2012). Further research explicitly comparing the nature of males' and females' special interests in autism appears to support this.…”

Exploring the female autism phenotype of repetitive behaviours and restricted interests (RBRIs): a systematic PRISMA review

“…Twelve studies identified in the present review found evidence that males with ASD had significantly more RRBIs compared to females with ASD (Hartley & Sikora, 2009;Bölte et al, 2011;Hattier et al, 2011;Sipes et al, 2011;Mandy et al, 2012;Park et al, 2012;Szatmari et al, 2012;Frazier et al, 2014;Hiller et al, 2014;Wilson et al, 2016;Supekar & Menon, 2015;Dean et al, 2017). Lastly, one study found that girls with ASD have features of RRBIs which are exhibited more compared to boys with ASD (Antezana et al, 2018). Specifically, they found that the items that were found to best-discriminate gender were greater stereotyped behaviours and restricted interests in the boys and compulsive, sameness, restricted, and self-injurious behaviour items in the girls (Antezana et al, 2018).…”

“…Lastly, one study found that girls with ASD have features of RRBIs which are exhibited more compared to boys with ASD (Antezana et al, 2018). Specifically, they found that the items that were found to best-discriminate gender were greater stereotyped behaviours and restricted interests in the boys and compulsive, sameness, restricted, and self-injurious behaviour items in the girls (Antezana et al, 2018). Antezana and colleagues (2018) discuss some of the potential limitations with their study.…”

“…Twelve studies found evidence that males with ASD had significantly more RRBIs compared to females with ASD (Hartley & Sikora, 2009;Bölte, Duketis, Poustka, & Holtmann, 2011;Hattier, Matson, Tureck, & Horovitz, 2011;Sipes, Matson, Worley, & Kozlowski, 2011;Mandy, 2012;Park, Cho, Cho, Kim, Kim, Shin et al, 2012;Szatmari, Liu, Goldberg, Zwaigenbaum, Paterson, Woodbury-Smith et al, 2012;Frazier, Georgiades, Bishop, & Hardan, 2014;Hiller, Young, & Weber, 2014;Wilson, Murphy, McAlonan, Robertson, Spain, Hayward et al, 2016;Supekar & Menon, 2015;Dean, Harwood, & Kasari, 2017). Lastly, one study found that girls with ASD have features of RRBIs which are exhibited more compared to boys with ASD (Antezana et al, 2018). Specifically, they…”