Sex Differences in the Timing of Identification Among Children and Adults with Autism Spectrum Disorders

Begeer, Sander; Mandell, David S.; Wijnker-Holmes, Bernadette; Venderbosch, Stance; Rem, Dorien; Stekelenburg, Fred C.; Koot, Hans M.

doi:10.1007/s10803-012-1656-z

Cited by 279 publications

(215 citation statements)

References 37 publications

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“…Although our study did not find any significant difference between gender and age at diagnosis, previous studies have shown that females with autism tend to be diagnosed later than male patients (18). Previous research suggests that children from less affluent socio-economic backgrounds may be diagnosed later than their more affluent counterparts (17).…”

Section: Factors Affecting Age At Presentationcontrasting

confidence: 99%

“…These include education and health system resources (14,15), ethnicity (16), income, symptoms such as severe language deficits, hand flapping, toe walking, and sustained odd play (17) and the sex of the child (18). However, in contrast to international findings, research from Sri Lanka to date has not reported any association between the age at presentation and factors such as the presenting symptoms and parental level of education or occupation.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Factors affecting age at presentation of Autism Spectrum Disorders: A descriptive survey from a child mental health clinic at Lady Ridgeway Hospital

Dahanayake¹,

Rohanachandra²,

Wijetunge

2015

Sri Lanka J. Psyc.

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Section: Factors Affecting Age At Presentationcontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Factors affecting age at presentation of Autism Spectrum Disorders: A descriptive survey from a child mental health clinic at Lady Ridgeway Hospital

Dahanayake¹,

Rohanachandra²,

Wijetunge

2015

Sri Lanka J. Psyc.

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“…This may reflect a broadening of diagnostic criteria over time so that those individuals with more subtle presentations of ASD are more likely to be identified [67,68]. Despite this, males are still significantly more likely to be diagnosed with ASD than females, suggesting that there is some sort of male risk and/or female protective component to ASD even when gender-specific behavioural presentations are taken into account.…”

Section: Missing Women: Co-occurring Conditions and Environmental Fitmentioning

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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“…Although the heterogeneity of participant samples is useful for researchers' abilities to generalize findings across samples, it can lead to difficulties with interpreting gender differences at specific stages of development. In addition, most epidemiologic research only includes children through the age of 8 or 10 years (2-4), which is a problem given the age of onset of comorbid problems (49,50) and the later diagnosis of ASD in individuals without co-occurring intellectual difficulties (17,18). Further research is needed to explore gender differences at various developmental and functioning levels.…”

Section: Discussionmentioning

confidence: 99%

Underidentification of Autism Spectrum Disorder in Females: A Case Series Illustrating the Unique Presentation of this Disorder in Young Women

Trubanova

Donlon

Kreiser

et al. 2013

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: Autism spectrum disorder (ASD) is diagnosed more often in males than females, with the male-to-female gender ratio reported to be around 4.3:1 to 5:1. It is possible that the underrecognition of ASD in females partially contributes to this uneven ratio. Recent attention has been placed on understanding the processes that give rise to this gender difference in ASD prevalence. Socialization may contribute to the unique presentation of ASD in females, which may underlie this condition's subsequent underidentification in this group. Objective: The purpose of this case series is to demonstrate how symptoms of ASD may uniquely manifest in females without co-occurring intellectual impairment. Method: An examination of three case examples of young women diagnosed with ASD will illustrate the processes that contribute to the atypical manifestation and underidentification of ASD in females. Results: Across cases, the females in this study demonstrated shared symptom presentations within three domains: 1) unique core symptom manifestation (insistence on sameness, lack of social engagement, and social processing difficulties); 2) heightened psychiatric comorbidities with internalizing disorders (anxiety, depression, and borderline personality traits); and 3) emotional dysregulation. These three domains reflect specific processes that may help to explain the underidentification of ASD in females via diagnostic overshadowing. Conclusions: Consideration of atypical symptom presentations, heightened comorbidities, and emotion regulation difficulties may help with the understanding of why ASD symptoms in females are commonly underidentified or identified later than they are in males. Social difficulties in combination with internalizing psychiatric disorders and emotional dysregulation may lead to the development of a specific symptom presentation in females that obscures the detection of ASD symptoms. Suggestions for clinical practice are made to promote the accurate identification of ASD and to inform case formulation and treatment planning.

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Sex Differences in the Timing of Identification Among Children and Adults with Autism Spectrum Disorders

Cited by 279 publications

References 37 publications

Factors affecting age at presentation of Autism Spectrum Disorders: A descriptive survey from a child mental health clinic at Lady Ridgeway Hospital

Factors affecting age at presentation of Autism Spectrum Disorders: A descriptive survey from a child mental health clinic at Lady Ridgeway Hospital

Protective Effect or Missed Diagnosis? Females with Autism Spectrum Disorder

Underidentification of Autism Spectrum Disorder in Females: A Case Series Illustrating the Unique Presentation of this Disorder in Young Women

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