Abstract
Studies assessing sex/gender differences in autism spectrum conditions often fail to include typically developing control groups. It is, therefore, unclear whether observed sex/gender differences reflect those found in the general population or are particular to autism spectrum conditions. A systematic search identified articles comparing behavioural and cognitive characteristics in males and females with and without an autism spectrum condition diagnosis. A total of 13 studies were included in meta-analyses of sex/gender differences in core autism spectrum condition symptoms (social/communication impairments and restricted/repetitive behaviours and interests) and intelligence quotient. A total of 20 studies were included in a qualitative review of sex/gender differences in additional autism spectrum condition symptoms. For core traits and intelligence quotient, sex/gender differences were comparable in autism spectrum conditions and typical samples. Some additional autism spectrum condition symptoms displayed different patterns of sex/gender differences in autism spectrum conditions and typically developing groups, including measures of executive function, empathising and systemising traits, internalising and externalising problems and play behaviours. Individuals with autism spectrum conditions display typical sex/gender differences in core autism spectrum condition traits, suggesting that diagnostic criteria based on these symptoms should take into account typical sex/gender differences. However, awareness of associated autism spectrum condition symptoms should include the possibility of different male and female phenotypes, to ensure those who do not fit the ‘typical’ autism spectrum condition presentation are not missed.
References
|
Baron-Cohen, S (2002) The extreme male brain theory of autism. Trends in Cognitive Sciences 6(6): 248–254. Google Scholar | Crossref | Medline | ISI | |
|
Baron-Cohen, S, Wheelwright, S (2004) The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. Journal of Autism and Developmental Disorders 34(2): 163–175. Google Scholar | Crossref | Medline | ISI | |
|
Baron-Cohen, S, Wheelwright, S (2005) The Friendship Questionnaire: an investigation of adults with Asperger syndrome or high-functioning autism, and normal sex differences. Journal of Autism and Developmental Disorders 33(5): 509–517. Google Scholar | Crossref | ISI | |
|
Baron-Cohen, S, Cassidy, S, Auyeung, B. (2014) Attenuation of typical sex differences in 800 adults with autism vs. 3,900 controls. PLoS ONE 9(7): e102251. Google Scholar | Crossref | Medline | ISI | |
|
Baron-Cohen, S, Jolliffe, T, Mortimore, C. (1997) Another advanced test of theory of mind: evidence from very high functioning adults with autism or Asperger syndrome. Journal of Child Psychology and Psychiatry 38(7): 813–822. Google Scholar | Crossref | Medline | ISI | |
|
Baron-Cohen, S, Leslie, AM, Frith, U (1985) Does the autistic child have a ‘theory of mind‘? Cognition 21(1): 37–46. Google Scholar | Crossref | Medline | ISI | |
|
Baron-Cohen, S, Richler, J, Bisarya, D. (2003) The systemizing quotient: an investigation of adults with Asperger syndrome or high-functioning autism, and normal sex differences. Philosophical Transactions of the Royal Society of London, Series B: Biological Sciences 3548: 361–374. Retrieved from http://rstb.royalsocietypublishing.org/content/royptb/358/1430/361.full.pdf Google Scholar | |
|
Baron-Cohen, S, Wheelwright, S, Skinner, R. (2001) The Autism-Spectrum Quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders 31(1): 5–17. Google Scholar | Crossref | Medline | ISI | |
|
Bejerot, S, Eriksson, JM (2014) Sexuality and gender role in autism spectrum disorder: a case control study. PLoS ONE 9(1): e87961. Google Scholar | Crossref | Medline | ISI | |
|
Bölte, S, Duketis, E, Poustka, F. (2011) Sex differences in cognitive domains and their clinical correlates in higher-functioning autism spectrum disorders. Autism: The International Journal of Research and Practice 15(4): 497–511. Google Scholar | SAGE Journals | ISI | |
|
Brugha, TS, McManus, S, Bankart, J. (2011) Epidemiology of autism spectrum disorders in adults in the community in England. Archives of General Psychiatry 68(5): 459–466. Available at: http://people.uncw.edu/imperialm/UNCW/PLS_506/yoa05097_459_466[1].pdf Google Scholar | |
|
Croen, LA, Grether, JK, Selvin, S (2002) Descriptive epidemiology of autism in a California population: who is at risk? Journal of Autism and Developmental Disorders 32(3): 217–224. Google Scholar | Crossref | Medline | ISI | |
|
Dean, M, Kasari, C, Shih, W. (2014) The peer relationships of girls with ASD at school: comparison to boys and girls with and without ASD. Journal of Child Psychology and Psychiatry, and Allied Disciplines 55(11): 1218–1225. Google Scholar | Crossref | Medline | ISI | |
|
Dworzynski, K, Ronald, A, Bolton, P. (2012) How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? Journal of the American Academy of Child and Adolescent Psychiatry 51(8): 788–797. Google Scholar | Crossref | Medline | ISI | |
|
Farley, MA, McMahon, WM, Fombonne, E. (2009) Twenty-year outcome for individuals with autism and average or near-average cognitive abilities. Autism Research 2(2): 109–118. Google Scholar | Crossref | Medline | ISI | |
|
Fombonne, E (2009) Epidemiology of pervasive developmental disorders. Pediatric Research 65(6): 591–598. Google Scholar | Crossref | Medline | ISI | |
|
Glidden, D, Bouman, WP, Jones, BA (2016) Gender dysphoria and autism spectrum disorder: a systematic review of the literature. Sexual Medicine Review 4(1): 3–14. Google Scholar | Crossref | Medline | |
|
Goddard, L, Dritschel, B, Howlin, P (2014) A preliminary study of gender differences in autobiographical memory in children with an autism spectrum disorder. Journal of Autism and Developmental Disorders 44(9): 2087–2095. Google Scholar | Crossref | Medline | ISI | |
|
Goddard, L, Dritschel, B, Robinson, S. (2014) Development of autobiographical memory in children with autism spectrum disorders: deficits, gains, and predictors of performance. Development and Psychopathology 26(1): 215–228. Google Scholar | Crossref | Medline | ISI | |
|
Gould, J, Ashton-Smith, J (2011) Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice 12(1): 34–41. Google Scholar | |
|
Happé, F, Frith, U (2006) The weak coherence account: detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders 36(1): 5–25. Google Scholar | Crossref | Medline | ISI | |
|
Happé, F, Booth, R, Charlton, R. (2006) Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: examining profiles across domains and ages. Brain and Cognition 61(1): 25–39. Google Scholar | Crossref | Medline | ISI | |
|
Harrop, C, Green, J, Hudry, K (2016) Play complexity and toy engagement in preschoolers with autism spectrum disorder: do girls and boys differ? Autism. Epub ahead of print 2 March. DOI: 10.1177/1362361315622410. Google Scholar | SAGE Journals | ISI | |
|
Head, AM, McGillivray, JA, Stokes, MA (2014) Gender differences in emotionality and sociability in children with autism spectrum disorders. Molecular Autism 5: 19. Available at: http://www.biomedcentral.com/content/pdf/2040-2392-5-19.pdf Google Scholar | |
|
Holt, RJ, Chura, LR, Lai, M-C. (2014) ‘Reading the mind in the eyes’: an fMRI study of adolescents with autism and their siblings. Psychological Medicine 44(15): 3215–3227. Google Scholar | Crossref | Medline | ISI | |
|
Holtmann, M, Bölte, S, Poustka, F (2007) Autism spectrum disorders: sex differences in autistic behaviour domains and coexisting psychopathology – ProQuest. Developmental Medicine & Child Neurology 49(5): 361–366. Available at: http://search.proquest.com/docview/195615734/fulltextPDF?accountid=14511 Google Scholar | |
|
Hunter, JE, Schmidt, FL (2004) Study artifacts and their impact on study outcomes. In: Hunter, JE, Schmidt, FL (eds) Methods of Meta-Analysis. 2nd ed. Thousand Oaks, CA: SAGE, pp.33–73. Available at: http://srmo.sagepub.com/view/methods-of-meta-analysis/n2.xml Google Scholar | |
|
Kirkovski, M, Enticott, PG, Fitzgerald, PB (2013) A review of the role of female gender in autism spectrum disorders. Journal of Autism and Developmental Disorders 43(11): 2584–2603. Google Scholar | Crossref | Medline | ISI | |
|
Kirkovski, M, Enticott, PG, Hughes, ME. (2016) Atypical neural activity in males but not females with autism spectrum disorder. Journal of Autism and Developmental Disorders 46(3): 954–963. Google Scholar | Crossref | Medline | ISI | |
|
Knickmeyer, RC, Wheelwright, S, Baron-Cohen, SB (2008) Sex-typical play: masculinization/defeminization in girls with an autism spectrum condition. Journal of Autism and Developmental Disorders 38(6): 1028–1035. Google Scholar | Crossref | Medline | ISI | |
|
Koenig, K, Tsatsanis, KD (2005) Pervasive developmental disorders in girls. In: Bell, DJ, Foster, SL, Mash, EJ (eds) Handbook of Behavioral and Emotional Problems in Girls. New York: Kluwer Academic/Plenum Publishers, pp.211–237. Available at: http://download.springer.com/static/pdf/60/chp:10.1007/0-306-48674-1_7.pdf?originUrl=http://link.springer.com/chapter/10.1007/0-306-48674-1_7&token2=exp=1444990643~acl=/static/pdf/60/chp%3A10.1007%2F0-306-48674-1_7.pdf% Google Scholar | |
|
Kopp, S, Gillberg, C (1992) Girls with social deficits and learning problems: autism, atypical Asperger syndrome or a variant of these conditions. European Child & Adolescent Psychiatry 1(2): 89–99. Google Scholar | Crossref | Medline | |
|
Kopp, S, Gillberg, C (2011) The Autism Spectrum Screening Questionnaire (ASSQ)-Revised Extended Version (ASSQ-REV): an instrument for better capturing the autism phenotype in girls? A preliminary study involving 191 clinical cases and community controls. Research in Developmental Disabilities 32(6): 2875–2888. Google Scholar | Crossref | Medline | ISI | |
|
Kreiser, NL, White, SW (2014) ASD in females: are we overstating the gender difference in diagnosis? Clinical Child and Family Psychology Review 17(1): 67–84. Google Scholar | Crossref | Medline | ISI | |
|
Lai, M-C, Baron-Cohen, SB (2015) Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry 2(11): 1013–1027. Google Scholar | Crossref | Medline | ISI | |
|
Lai, M-C, Lombardo, MV, Auyeung, B. (2015) Sex/gender differences and autism: setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry 54(1): 11–24. Google Scholar | Crossref | Medline | ISI | |
|
Lai, M-C, Lombardo, MV, Pasco, G. (2011) A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS ONE 6(6): e20835. Google Scholar | Crossref | Medline | ISI | |
|
Lai, M-C, Lombardo, MV, Ruigrok, ANV. (2012) Cognition in males and females with autism: similarities and differences. PLoS ONE 7(10): e47198. Google Scholar | Crossref | Medline | ISI | |
|
Lehnhardt, F-G, Falter, CM, Gawronski, A. (2015) Sex-related cognitive profile in autism spectrum disorders diagnosed late in life: implications for the female autistic phenotype. Journal of Autism and Developmental Disorders 46(1): 139–154. Google Scholar | Crossref | ISI | |
|
Lemon, JM, Gargaro, B, Enticott, PG. (2011) Executive functioning in autism spectrum disorders: a gender comparison of response inhibition. Journal of Autism and Developmental Disorders 41(3): 352–356. Google Scholar | Crossref | Medline | ISI | |
|
Mandy, W, Tchanturia, K (2015) Do women with eating disorders who have social and flexibility difficulties really have autism? A case series. Molecular Autism 6(1): 6. Google Scholar | Crossref | Medline | ISI | |
|
Mandy, W, Chilvers, R, Chowdhury, U. (2012) Sex differences in autism spectrum disorder: evidence from a large sample of children and adolescents. Journal of Autism and Developmental Disorders 42(7): 1304–1313. Google Scholar | Crossref | Medline | ISI | |
|
Mattila, M-L, Kielinen, M, Linna, S-L. (2011) Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study. Journal of the American Academy of Child & Adolescent Psychiatry 50(6): 583–592.e11. Google Scholar | Crossref | Medline | ISI | |
|
May, T, Cornish, K, Rinehart, NJ (2012) Gender profiles of behavioral attention in children with autism spectrum disorder. Journal of Attention Disorders 20: 627–35. Google Scholar | SAGE Journals | ISI | |
|
Oswald, TM, Winter-Messiers, MA, Gibson, B. (2016) Sex differences in internalizing problems during adolescence in autism spectrum disorder. Journal of Autism and Developmental Disorders 46(2): 624–636. Google Scholar | Crossref | Medline | ISI | |
|
Ozonoff, S, Jensen, J (1999) Brief report: specific executive function profiles in three neurodevelopmental disorders. Journal of Autism and Developmental Disorders 29(2): 171–177. Google Scholar | Crossref | Medline | ISI | |
|
Park, S, Cho, S-C, Cho (2012) Sex differences in children with autism spectrum disorders compared with their unaffected siblings and typically developing children. Research in Autism Spectrum Disorders 6(2): 861–870. Available at: http://ac.els-cdn.com/S1750946711001978/1-s2.0-S1750946711001978-main.pdf?_tid=4648c746-77d7-11e5-8206-00000aacb360&acdnat=1445420398_3b7b24d5ae6ee9104067cb193de75725 Google Scholar | |
|
Pasterski, V, Gilligan, L, Curtis, R (2014) Traits of autism spectrum disorders in adults with gender dysphoria. Archives of Sexual Behavior 43(2): 387–393. Google Scholar | Crossref | Medline | ISI | |
|
R Core Team (2013) R: A Language and Environment for Statistical Processing. Vienna, Austria: R Foundation for Statistical Computing. Available at: http://www.r-project.org/ Google Scholar | |
|
Rivet, TT, Matson, JL (2011) Review of gender differences in core symptomatology in autism spectrum disorders. Research in Autism Spectrum Disorders 23(3): 957–976. Google Scholar | Crossref | ISI | |
|
Russell, G, Steer, C, Golding, J (2011) Social and demographic factors that influence the diagnosis of autistic spectrum disorders. Social Psychiatry and Psychiatric Epidemiology 46(12): 1283–1293. Google Scholar | Crossref | Medline | ISI | |
|
Sedgewick, F, Hill, V, Yates, R. (2015) Gender differences in the social motivation and friendship experiences of autistic and non-autistic adolescents. Journal of Autism and Developmental Disorders 46(4): 1297–1306. Google Scholar | Crossref | ISI | |
|
Solomon, M, Miller, M, Taylor, SL. (2012) Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of Autism and Developmental Disorders 42(1): 48–59. Google Scholar | Crossref | Medline | ISI | |
|
Thompson, T, Caruso, M, Ellerbeck, K (2003) Sex matters in autism and other developmental disabilities. Journal of Intellectual Disabilities 7(4): 345–362. Google Scholar | Abstract | |
|
Van Wijngaarden-Cremers, PJM, van Eeten, E, Groen, WB. (2014) Gender and age differences in the core triad of impairments in autism spectrum disorders: a systematic review and meta-analysis. Journal of Autism and Developmental Disorders 44(3): 627–635. Google Scholar | Crossref | Medline | ISI | |
|
Viechtbauer, W (2010) Conducting meta-analyses in R with the metafor package. Journal of Statistical Software 36(3): 1–48. Available at: http://www.jstatsoft.org/v36/i03/ Google Scholar | |
|
Werling, DM, Geschwind, DH (2013) Sex differences in autism spectrum disorders. Current Opinion in Neurology 26(2): 146–153. Google Scholar | Crossref | Medline | ISI | |
|
Zwaigenbaum, L, Bryson, SE, Szatmari, P. (2012) Sex differences in children with autism spectrum disorder identified within a high-risk infant cohort. Journal of Autism and Developmental Disorders 42(12): 2585–2596. Google Scholar | Crossref | Medline | ISI |
