There is ongoing debate as to whether autism spectrum disorder (ASD) differentially affects males and females. Several meta-analyses have found little difference between males and females with ASD in terms of social communication and interaction skills.1 However, such analyses have often relied on diagnostic instruments such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2)2 that may not be sensitive to how autism presents in females.1,3 What’s more, many have been based on global (‘broad construct’) scores,4-6 that reflect overall social communication and interaction skills, which could miss subtler differences in specific domains (‘narrow constructs’).
To overcome these limitations, Henry Wood-Downie, Bonnie Wong and colleagues at the University of Southampton conducted a meta-analysis to investigate sex/gender differences across autistic and non-autistic children, adolescents, and adults in narrow constructs of social communication and interaction (e.g., peer relationships) that were not measured using diagnostic instruments. Across 16 studies (2,730 participants), they found a significant difference between autistic females and males in terms of their social interaction and communication skills. Specifically, they found evidence of more advanced social skills in autistic females than males that mirror sex/gender differences in non-autistic individuals.
“Our findings suggest that there are important differences between autistic males and females in terms of their social presentation, which are likely not captured by current diagnostic instruments”, explains Wood-Downie. “This issue might contribute to the under reporting and late recognition of autism in females, thereby delaying access to support”.
The researchers explain that education and health professionals might be less likely to recognise and refer autistic females for assessment and support due to differences in their social presentation, compared to males. The researchers explain that affected females might not exhibit stereotypical features associated with autism; for example, they might appear to be part of social groups in the playground.
“We were interested to find that non-autistic females also had more advanced social skills than non-autistic males”, describes Wong. “With this in mind, we therefore consider it important that practitioners account for normative sex/gender differences, such as comparing potentially autistic females to non-autistic females, where differences may be more apparent”.
Wood-Downie H et al (2021). Research Review: A systematic review and meta-analysis of sex/gender differences in social interaction and communication in autistic and nonautistic children and adolescents. J Child Psychol Psychiatry, 62, 922–936.
- Lai MC & Szatmari P (2020). Sex and gender impacts on the behavioural presentation and recognition of autism. Curr Opin Psychiatry, 33, 117–123.
- Lord C et al (2012). Autism diagnostic observation schedule (2nd edn.). Los Angeles, CA: Western Psychological Services.
- Hull L & Mandy W (2017). Protective effect or missed diagnosis? Females with autism spectrum disorder. Future Neurol, 12, 159–169.
- Van Wijngaarden-Cremers PJM et al (2014). Gender and age differences in the core triad of impairments in autism spectrum disorders: a systematic review and meta-analysis. Autism Dev. Disord., 44, 627–635.
- Mahendiran T et al (2019). Meta-analysis of sex differences in social and communication function in children with autism spectrum disorder and attention-deﬁcit/hyperactivity disorder. Front Psychiatry, 10, 804.
- Hull L et al (2017). Behavioural and cognitive sex/gender differences in autism spectrum condition and typically developing males and females. Autism, 21, 706–727.
- CAMHS around the Campfire: Trajectories of autistic social traits in CYP and disordered eating at age 14 years
- Podcast for parents: How autism presents differently in girls, A Ozsivadjian & M Murin
- Podcast: Transforming the lives of young people with autism with inclusive research, E Pellicano
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