Sex Differences in Autism Spectrum Disorder: An Examination of Developmental Functioning, Autistic Symptoms, and Coexisting Behavior Problems in Toddlers

  • Sigan L. Hartley
  • Darryn M. Sikora
original paper


Little is known about the female presentation of autism spectrum disorder (ASD) during early childhood. We investigated sex differences in developmental profiles using the Mullen Scales of Early Learning, autistic symptoms on the ADOS-G, and coexisting behavior problems on the CBCL in 157 boys and 42 girls with ASD aged 1.5–3.9 years. Overall, boys and girls evidenced a markedly similar pattern of developmental profiles, autism symptoms, and coexisting behavior problems, although subtle differences exist. Boys and girls evidenced a similar pattern of developmental strengths and weaknesses. Girls with ASD evidenced greater communication deficits than boys and boys evidenced more restricted, repetitive, and stereotyped behavior than girls. Girls exhibited more sleep problems and anxious or depressed affect than boys.


Autism Sex Girl Developmental functioning Behavior problems 



This manuscript was prepared with support from the National Institute on Child Health and Human Development (P30 HD03352, T32 HD07489). We would like to extend our thanks to the families who participated in this study.


  1. Achenbach, T., & Rescorla, L. (2000). Child behavior checklist. Burlington VT: ASEBA.Google Scholar
  2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (fourth edition, text revision). Washington, DC: Author.CrossRefGoogle Scholar
  3. Baron-Cohen, S., & Hammer, J. (1997). Is autism an extreme form of the ‘male brain’? Advances in Infancy Research, 11, 193–217.Google Scholar
  4. Baron-Cohen, S., Hoekstra, R., Kickmeyer, R., & Wheelwright, S. (2006). The autism quotient (AQ)—Adolescent version. Journal of Autism and Developmental Disorders, 36, 343–350.CrossRefPubMedGoogle Scholar
  5. Baron-Cohen, S., Wheelwright, S., Skinner, M., Martin, J., & Clubley, E. (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, 5–17.CrossRefPubMedGoogle Scholar
  6. Bartak, L., & Rutter, M. (1976). Differences between mentally retarded and normally intelligent autistic children. Journal of Autism and Childhood Schizophrenia, 6, 109–120.CrossRefPubMedGoogle Scholar
  7. Carter, A. S., Black, D. O., Tewani, S., Connolly, C. E., Kadlec, M. B., & Tager-Flusberg, H. (2007). Sex differences in toddlers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 86–97.CrossRefPubMedGoogle Scholar
  8. Centers for Disease Control and Prevention. (2007). Prevalence of autism spectrum disorder—Autism and developmental disability monitoring network, 14 sites, United States, 2002. In Surveillance Summary (pp. 12–27). 9, Feb, 2007. Morbidity and Mortality Weekly Report, 56.Google Scholar
  9. Gadow, K. D., & DeVincent, C. J. (2005). Clinical significance of tics and attention-deficit/hyperactivity disorder (ADHD) in children with pervasive developmental disorder. Journal of Child Neurology, 20, 481–488.PubMedGoogle Scholar
  10. Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). Comparison of DSM-IV symptoms in elementary school-aged children with PDD versus clinic and community samples. Autism, 9, 392–415.CrossRefPubMedGoogle Scholar
  11. Gadow, K. D., DeVincent, C. J., Pomeroy, J., & Azizian, A. (2004). Psychiatric symptoms in preschool children with PDD and Clinic and Comparison samples. Journal of Autism and Developmental Disorders, 34, 379–393.CrossRefPubMedGoogle Scholar
  12. Hastings, R. P., Kovshoff, H., Ward, N. J., Espinosa, F., Brown, T., & Remington, B. (2005). Systems analysis of stress and positive perceptions in mothers and fathers of pre-school children with autism. Journal of Autism and Developmental Disorders, 35, 635–644.CrossRefPubMedGoogle Scholar
  13. Herring, S., Gray, L., Taffe, J., Tonge, G., Sweeney, D., & Einfield, S. (2006). Behaviour and emotional problems in toddlers with pervasive developmental disorders and developmental delay: Association with parental mental health and family functioning. Journal of Intellectual Disability Research, 50, 874–888.CrossRefPubMedGoogle Scholar
  14. Holtmann, M., Bolte, S., & Poustka, F. (2007). Autism spectrum disorders: Sex differences in autistic behavior in autistic behavior domains and coexisting psychopathology. Developmental Medicine and Child Neurology, 49, 361–366.CrossRefPubMedGoogle Scholar
  15. Hus, V., Pickles, A., Cook, E. H., Risi, S., & Lord, C. (2007). Using the autism diagnostic interview-revised to increase phenotypic homogeneity in genetic studies of autism. Biological Psychiatry, 61, 438–444.CrossRefPubMedGoogle Scholar
  16. Ingudomnukul, E., Baron-Cohen, S., Wheelwright, S., & Kickmeyer, R. (2007). Elevated rates of testosterone-related disorders in women with autism spectrum conditions. Hormones and Behavior, 51, 597–604.CrossRefPubMedGoogle Scholar
  17. Joseph, R. M., Tager-Flusberg, H., & Lord, C. (2002). Cognitive profiles and social-communicative functioning in children with autism spectrum disorder. Journal of Child Psychology and Psychiatry and Allied Disciplines, 43, 807–821.CrossRefGoogle Scholar
  18. Kopp, S., & Gillberg, C. (1992). Girls with social deficits and learning problems: Autism, atypical Asperger syndrome or a variant of these conditions. European Child and Adolescent Psychiatry, 1, 89–99.CrossRefGoogle Scholar
  19. Le Couteur, A., Rutter, M., Lord, C., & Rios, P. (1989). Autism diagnostic interview: A standardized investigator-based instrument. Journal of Autism and Developmental Disorders, 19, 363–387.CrossRefPubMedGoogle Scholar
  20. Lecavalier, L., Leone, S., & Wiltz, J. (2006). The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research, 50, 172–183.CrossRefPubMedGoogle Scholar
  21. Lincoln, A. J., Allen, M. H., & Kilman, K. (1995). The assessment and interpretation of intellectual abilities in people with autism. In E. Schopler & G. B. Mesibov (Eds.), Learning and cognition in autism (pp. 89–117). New York, NY: Plenum Press.Google Scholar
  22. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.CrossRefPubMedGoogle Scholar
  23. Lord, C., & Schopler, E. (1985). Differences in sex ratios in autism as a function of measured intelligence. Journal of Autism and Developmental Disorders, 15, 185–193.CrossRefPubMedGoogle Scholar
  24. Lord, C., Schopler, E., & Revicki, D. (1982). Sex differences in autism. Journal of Autism and Developmental Disorders, 12, 317–330.CrossRefPubMedGoogle Scholar
  25. Mandell, D. S., Walrath, C. M., Manteuffel, B., Sgro, G., & Pinto-Martin, J. A. (2005). The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child Abuse and Neglect, 29, 1359–1372.CrossRefPubMedGoogle Scholar
  26. McLennan, J. D., Lord, C., & Schopler, E. (1993). Sex differences in higher functioning people with autism. Journal of Autism and Developmental Disabilities, 23, 217–227.CrossRefGoogle Scholar
  27. Mullen, E. (1995). Mullen Scales of Early Learning (AGS ed.). Circle Pines, MN: American Guidance Systems.Google Scholar
  28. Pilowsky, T., Yirmiya, N., Sulman, C., & Dover, R. (1998). The autism diagnostic interview-revised and the childhood autism rating scale: Differences between diagnostic systems and comparison between gender. Journal of Autism and Developmental Disorders, 28, 143–151.CrossRefPubMedGoogle Scholar
  29. Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R: The autism diagnostic interview—Revised. Los Angelos, CA: Western Psychological Services.Google Scholar
  30. Schopler, E., Reichler, R. J., & Renner, B. R. (1988). The childhood autism rating scale. Los Angeles, CA: Western Psychological Services.Google Scholar
  31. Schultz, R. T., Romanski, L. M., & Tsatsanis, K. D. (2000). Neurofunctional models of autistic disorder and Asperger syndrome: Clues from neuroimaging. In A. Klin, F. R. Volkmar, & S. S. Sparrow (Eds.), Asperger syndrome (pp. 172–209). New York, NY: Guilford Press.Google Scholar
  32. Skuse, D. H. (2000). Imprinting, the X-chromosome, and the male brain: Explaining sex differences in the liability to autism. Pediatric Research, 47, 9–16.CrossRefPubMedGoogle Scholar
  33. Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales (2nd ed.). Circle Pines, MN: AGS Publishing.Google Scholar
  34. Szatmarr, P., Jones, M. B., Holden, J., Bryson, S., Mahoney, W., Tuff, L., et al. (1996). High phenotypic correlations among siblings with autism and pervasive developmental disorders. American Journal of Medical Genetics, 67, 354–360.CrossRefGoogle Scholar
  35. Tsai, L. Y., & Beisler, J. M. (1983). The developmental of sex differences in infantile autism. British Journal of Psychiatry, 142, 373–378.CrossRefPubMedGoogle Scholar
  36. Tsi, L., Stewart, M. A., & August, G. (1981). Implications of sex differences in the familial transmission of infantile autism. Journal of Autism and Developmental Disorders, 11, 165–173.CrossRefGoogle Scholar
  37. Voigt, R. G., Llorente, A. M., Jensen, C. L., Fraley, J. K., Barbaresi, W. J., & Heird, W. C. (2007). Comparison of the validity of direct pediatric developmental evaluation versus developmental screening by parent report. Clinical Pediatrics, 46(6), 523–529.CrossRefPubMedGoogle Scholar
  38. Volkmar, F. R., Bregman, J., Cohen, D. J., & Cicchetti, D. V. (1988). DSM III and DSM III-R diagnoses of autism. American Journal of Psychiatry, 145, 1404–1408.PubMedGoogle Scholar
  39. Volkmar, F. R., Szatmari, P., & Sparrow, S. S. (1993). Sex differences in pervasive developmental disorders. Journal of Autism and Developmental Disorders, 23, 579–591.CrossRefPubMedGoogle Scholar
  40. Wakabayashi, A., Tojo, Y., Baron-Cohen, S., & Wheelwright, S. (2004). The autism quotient (AQ) Japanese version: Evidence from high functioning clinical group and normal adults. The Japanese Journal of Psychology, 75, 78–84.Google Scholar
  41. Wakabayashi, A., Uchiyama, T., Tojo, Y., Yoshida, Y., Kuroda, M., Baron-Cohen, S., et al. (2007). The autism spectrum quotient (AQ) Japanese children version: Comparison between high functioning children with autism spectrum disorder and normal controls. The Japanese Journal of Psychology, 77, 534–540.Google Scholar
  42. Wing, L. (1981). Sex ratios in early childhood autism and related conditions. Psychiatric Research, 5, 129–137.CrossRefGoogle Scholar
  43. Wing, L., & Gould, J. (1979). Severe impairments of social interaction and associated abnormalities in children: Epidemiology and classification. Journal of Autism and Developmental Disorders, 9, 11–29.CrossRefPubMedGoogle Scholar
  44. Winsler, A., & Wallace, G. (2002). Behavior problems and social skills in preschool children: Parent-teacher agreement and relations with classroom observations. Early Education & Development, 13(1), 41–58.CrossRefGoogle Scholar
  45. Wolff, S., & McGuire, R. J. (1995). Schiziod personality in girls: A follow-up study—What are the links with Asperger’s syndrome? Journal of Child Psychology and Psychiatry, 56, 793–817.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Waisman Center, Rm 533University of Wisconsin-MadisonMadisonUSA
  2. 2.Child Development and Rehabilitation CenterOregon Health and Science UniversityPortlandUSA

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