Sex Differences in Internalizing Problems During Adolescence in Autism Spectrum Disorder

Oswald, Tasha M.; Winter-Messiers, Mary Ann; Gibson, Brandon M.; Schmidt, Alexandra; Herr, Cynthia M.; Solomon, Marjorie

doi:10.1007/s10803-015-2608-1

Cited by 73 publications

(53 citation statements)

References 70 publications

(92 reference statements)

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“…Previous studies have shown effect of gender on expression of anxiety in ASD. Females with autism have been shown to have higher internalizing symptoms and depression than boys ( 37 , 38 ). Females with ASD show greater increases in ratings of depression and anxiety over time ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

The Screen for Child Anxiety-Related Emotional Disorders Is Sensitive but Not Specific in Identifying Anxiety in Children with High-Functioning Autism Spectrum Disorder: A Pilot Comparison to the Achenbach System of Empirically Based Assessment Scales

et al. 2017

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Validated brief screening instruments are needed to improve the detection of anxiety disorders in autism spectrum disorder (ASD). The Screen for Child Anxiety-Related Emotional Disorders (SCARED), a 41-item parent- and self-reported scale measuring anxiety, was compared to the Achenbach System of Empirically Based Assessment (ASEBA) scales. One hundred participants with a clinical diagnosis of high-functioning ASD, aged 8–18 years, and their parents completed the above scales. We hypothesized that the SCARED would be useful in screening for anxiety and its results for total scores of anxiety would converge with ASEBA syndrome scales for anxiety and internalizing disorders. Significant correlations were shown between the SCARED and the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) across a broad spectrum of scales. The CBCL syndrome scale for anxious/depressed showed the highest correlation and predicted anxiety scores on the SCARED. While many of the YSR scales significantly correlated with child ratings of anxiety, none of the scales predicted the SCARED child scores. Differences in self and parent reports suggest that parents interpret externalizing behaviors as signs of anxiety in ASD, whereas youth may describe internalized symptoms as anxiety. Females were more likely to self-report anxiety than males. Results support the use of the SCARED as a screening tool for anxiety in high-functioning ASD, but it should be supplemented with other tools to increase the specificity of its results.

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Section: Discussionmentioning

confidence: 99%

The Screen for Child Anxiety-Related Emotional Disorders Is Sensitive but Not Specific in Identifying Anxiety in Children with High-Functioning Autism Spectrum Disorder: A Pilot Comparison to the Achenbach System of Empirically Based Assessment Scales

et al. 2017

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“…In contrast to externalising problems (where difficulties are turned outwards, resulting in aggression and difficulties relating with others), internalising problems describe the inward expression of emotional difficulties, including anxiety, depression, self-harming and eating disorders (Kovacs and Devlin 1998;Leadbeater et al 1999). Most research demonstrates that autistic females are significantly more likely to have co-occurring internalising disorders than males, and these increase in severity at a greater extent than for males, although some studies with younger children find no variation between genders (Chandler et al 2016;Gotham et al 2015;Mandy et al 2012;Oswald et al 2016). Autistic males are significantly more likely to have cooccurring externalising disorders such as behavioural problems and inattention (Hiller et al 2014;May et al 2012).…”

Section: Internalising Problemsmentioning

confidence: 99%

The Female Autism Phenotype and Camouflaging: a Narrative Review

Hull

Petrides

Mandy

2020

Rev J Autism Dev Disord

315

261

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Autism is more commonly diagnosed in males than females. One explanation is the 'female protective effect': there is something inherent in being female which reduces the likelihood of developing autism. However, evidence suggests that the condition is underdiagnosed in females, perhaps because females express their autism in ways which do not meet current diagnostic criteria. This review explores evidence for a female-typical autism presentation, the Female Autism Phenotype (FAP) and the component of camouflaging (compensating for and masking autistic characteristics) in particular. The evidence so far supports the existence of a female-typical autism presentation, although further examination of the characteristics and their impact across all genders and ages is needed.

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“…[55,56]. Studies of children have generally shown that autistic boys display more externalising behaviours, including inattention and hyperactivity, than girls [57], whereas girls may be more likely to display internalising behaviours such as anxiety than boys [58].…”

Section: The Female Phenotype: Behaviourmentioning

confidence: 99%

Protective Effect or Missed Diagnosis? Females with Autism Spectrum Disorder

Hull

Mandy

2017

Future Neurol.

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Autism Spectrum Disorder (ASD) has historically been diagnosed more frequently in males than females. One explanation for this is the 'female protective effect': that there is something inherent in being female that makes girls and women less susceptible to ASD.Another possibility is that ASD is under-diagnosed in girls and women, due to the existence of a 'female autism phenotype', which is not well captured by current, male-biased diagnostic criteria. To evaluate the 'female protective effect' and 'female autism phenotype' hypotheses, this narrative review describes recent developments exploring the genetic underpinning and behavioural expression of ASD in females. We then look at ways to better identify females with ASD who may be missed under the current diagnostic criteria. KeywordsAutism, Autism Spectrum Disorders, Gender Differences, Sex Differences, Genetics, Diagnosis, Person-Environment Fit IntroductionAutism Spectrum Disorder (ASD) is a group of neurodevelopmental conditions characterised by deficits in social communication and reciprocity, and by restricted and repetitive interests and behaviours 1 . ASD is the current term used to integrate the previously separate diagnostic categories of autistic disorder, Asperger's disorder, childhood disintegrative disorder and pervasive developmental disorder -not otherwise specified (aka 'atypical autism' [2]). ASD is a lifelong condition that is present from birth. Although adult diagnosis is possible, symptoms must be reported as present from early developmental stages in order for the 1 In line with preferences from a majority of the autism community [1], we use identity-first language (e.g. 'autistic person') to refer to individuals with an ASD throughout this paper, while recognising that others might prefer person-first language (e.g. 'person with autism'). Gender differences in diagnosisASD affects approximately one to two per cent of the population [3,4], and is much more likely to be diagnosed in males than in females. Gender ratios in diagnosis vary depending on the country, cohort, and characteristics of those included, but average ratios are reported at around four males for every one female [3][4][5]. However, when looking at those individuals with intellectual disability, the male-to-female ratio narrows significantly to around two-toone [6]. In addition, population-based studies, which screen all participants in order to identify cases regardless of whether they have already been diagnosed by local services, suggest that the male-to-female ratio is closer to 3:1 [7,8]. This is in contrast to the average of around 4-5:1 generally reported in studies based on clinically-diagnosed cases [9]. The fact that a lower proportion of females are found in clinical samples than in community-based, epidemiological samples suggests that there is a bias against autistic girls and women coming to clinical attention. This bias may have existed from the very first conceptions of ASD; only 3 of 11 children in Kanner's original cases were female, and no gi...

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Sex Differences in Internalizing Problems During Adolescence in Autism Spectrum Disorder

Cited by 73 publications

References 70 publications

The Screen for Child Anxiety-Related Emotional Disorders Is Sensitive but Not Specific in Identifying Anxiety in Children with High-Functioning Autism Spectrum Disorder: A Pilot Comparison to the Achenbach System of Empirically Based Assessment Scales

The Screen for Child Anxiety-Related Emotional Disorders Is Sensitive but Not Specific in Identifying Anxiety in Children with High-Functioning Autism Spectrum Disorder: A Pilot Comparison to the Achenbach System of Empirically Based Assessment Scales

The Female Autism Phenotype and Camouflaging: a Narrative Review

Protective Effect or Missed Diagnosis? Females with Autism Spectrum Disorder

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