Sex/Gender Differences in Screening for Autism Spectrum Disorder: Implications for Evidence-Based Assessment

Abstract

Autism spectrum disorder (ASD) is diagnosed more often in boys than in girls; however, little is known about the nature of this sex/gender discrepancy or how it relates to diagnostic assessment practices. This study examined the performance of the Social Communication Questionnaire (SCQ) in screening for ASD among boys and girls. Data were drawn from the South Carolina Children's Educational Surveillance Study, a population-based study of ASD prevalence among children 8-10 years of age. Analyses were conducted using SCQ data from 3,520 children, with direct assessment data from 272 with elevated SCQ scores. A bifactor model based on the Diagnostic and Statistical Manual of Mental Disorders's (5th ed.) two ASD symptom domains fit the data well and performed slightly better for girls. In the general population sample, girls exhibited fewer social communication/interaction and restricted-repetitive behavior symptoms than boys. In the direct assessment sample, however, girls with ASD showed greater impairment in social communication/interaction than boys with ASD. Items pertaining to social communication/interaction problems at ages 4-5 were among the most diagnostically efficient overall and particularly for girls. Similarly, receiver operating characteristic analyses suggested that the SCQ performs adequately among boys and well among girls. Results support the use of the SCQ in screening for ASD but do not indicate sex/gender-specific cutoffs. Girls with ASD may exhibit pronounced intraindividual deficits in social communication/interaction compared to male peers with ASD and female peers without ASD. Although more research is needed, careful attention to social communication/interaction deficits around 4-5 years of age may be especially useful for assessing ASD in girls.

Maternal gestational immune response and autism spectrum disorder phenotypes at 7 years of age in the Seychelles Child Development Study

“…For example, the significant association with socioeconomic status is in line with recent research suggesting that both SRS and SCQ scores are impacted by maternal education and family income [49]. Also, sex differences in ASD symptomatology were as expected based on findings from general population groups indicating that males tend to have higher scores on both the SRS [33] and SCQ [50] compared to females.…”

Sex differences in scores on standardized measures of autism symptoms: a multisite integrative data analysis

“…This highlights a critical problem of relying on data from clinically ascertained and diagnosed samples: we can only evaluate the instruments’ performance on individuals who were actually identified. Thus, it is impossible to comment on the utility of standard instruments among individuals whose symptom presentation was too mild and/or different to be captured by standard diagnostic practices (Evans, Boan, Bradley, & Carpenter, 2018; Kim et al, 2011; Loomes et al, 2017). Further, although ASD diagnoses in the current study were based on clinician best estimate and not scores from any one diagnostic measure, these measures were nevertheless employed as part of the diagnostic assessment, and in some cases (i.e., for participants enrolled in ATN or SSC), inclusion criteria did require meeting ASD cutoffs on one or more of the diagnostic measures.…”

Using the tools of genetic epidemiology to understand sex differences in neuropsychiatric disorders

“…show higher levels of restricted/repetitive behaviors and interests than females, whereas there appear to be no gender differences in Male to Female Ratio Disorder F I G U R E 1 Male to female sex ratio of psychiatric disorders, sorted from most to least prevalent among females social interaction or communication overall. 21 Although the prevalence of schizophrenia is approximately equal in males and females, males with this disorder also have been shown to suffer from more severe symptoms, course and impact than females. 22 Similar to increasing attention to cardiovascular 23 and other physical conditions, 24 to the timing and dose of exposure to sex steroids, and the production of testosterone in male fetuses has been shown to induce sexual differentiation in the brain.…”