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What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills

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Abstract

There is growing evidence of a camouflaging effect among females with autism spectrum disorder (ASD), particularly among those without intellectual disability, which may affect performance on gold-standard diagnostic measures. This study utilized an age- and IQ-matched sample of school-aged youth (n = 228) diagnosed with ASD to assess sex differences on the ADOS and ADI-R, parent-reported autistic traits, and adaptive skills. Although females and males were rated similarly on gold-standard diagnostic measures overall, females with higher IQs were less likely to meet criteria on the ADI-R. Females were also found to be significantly more impaired on parent reported autistic traits and adaptive skills. Overall, the findings suggest that some autistic females may be missed by current diagnostic procedures.

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Notes

  1. Identity-first language rather than person-first language is used in this manuscript, consistent with practice among autistic self-advocates (Brown 2011).

  2. Researchers and female self-advocates have used the terms “masking” and “camouflaging” to describe the phenomenon of autistic women and girls being missed by current diagnostic procedures. The authors chose the term camouflaging, and placed it in quotes for its initial use, to describe this phenomenon which can occur both when autistic women/girls actively seek to hide social communication difficulties, as well as when clinicians fail to accurately diagnose them, due to societal expectations that are believed by many to result in diagnostic bias.

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Acknowledgments

Funding for this project was provided by grants and financial support through several institutions, including: The Isadore and Bertha Gudelsky Family Foundation, Children’s National Health Institute IDDRC P30 HD040677, Pennsylvania State Department of Health, The Philadelphia Foundation, Pfizer, Robert Wood Johnson Foundation, Virginia Tech Center for Autism Research, and the National Institute of Child Health and Human Development (R03HD081070). We are grateful to the children and families who participated in this study.

Author information

Author notes

  1. Allison B. Ratto

    Present address: Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA

  2. Laura Gutermuth Anthony

    Present address: Pediatric Mental Health Institute, Children’s Hospital of Colorado, Department of Psychiatry, University of Colorado School of Medicine, 13123 East 16th Avenue, A036/B130, Aurora, CO, 80045, USA

Authors and Affiliations

  1. Center for Autism Spectrum Disorders, Center for Neuroscience Research, Children’s Research Institute, Children’s National Health System, The George Washington University School of Medicine, 15245 Shady Grove Rd., Suite 350, Rockville, MD, 20850, USA

    Allison B. Ratto, Lauren Kenworthy, Cara Pugliese, Sydney Seese & Laura Gutermuth Anthony

  2. Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19104, USA

    Benjamin E. Yerys & Robert T. Schultz

  3. Department of Psychiatry, Perelman School of Medicine - University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Benjamin E. Yerys

  4. Autistic Self Advocacy Network, PO Box 66122, Washington, DC, 20035, USA

    Julia Bascom

  5. Department of Psychology, Virginia Tech Center for Autism Research, Virginia Polytechnic Institute and State University, 3110 Prices Fork Rd., Blacksburg, VA, 24060, USA

    Andrea Trubanova Wieckowski, Susan W. White, Thomas H. Ollendick & Angela Scarpa

  6. Department of Speech, Language, and Hearing Sciences, The George Washington University, 2115 G St NW, Washington, DC, 20052, USA

    Gregory L. Wallace

  7. Departments of Psychiatry and Pediatrics, Perelman School of Medicine - University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Robert T. Schultz

  8. Department of Psychiatry, University of Maryland School of Medicine, 827 Linden Avenue, Baltimore, MD, 21201, USA

    Kelly Register-Brown

  9. Laboratory of Brain and Cognition, National Institute of Mental Health, Magnuson Clinical Center, Room 4C104, MSC 1366, Bethesda, MD, 20814, USA

    Alex Martin

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Contributions

ABR collected the data, ran the analyses, and wrote the paper. LK served as co-principal investigator for one site of the project, collected the data, helped design the analyses, and wrote the paper. BEY served as co-principal investigator for one site of the project, collected the data, provided feedback on analyses, and wrote the paper. JB provided insight and feedback on the interpretation of analyses and edited the paper. ATW collected the data and edited the paper. SWW served as co-principal investigator for one site of the project, collected the data, provided feedback on analyses, and edited the paper. GLW collected the data, helped design the analyses, and edited the paper. CP collected the data, provided feedback on analyses, and wrote the paper. RTS collected the data, provided feedback on analyses, and edited the paper. THO collected the data, provided feedback on analyses, and edited the paper. AS collected the data, provided feedback on analyses, and edited the paper. SS collected the data, managed the database, and edited the paper. KR-B provided feedback on analyses and edited the paper. AM served as co-principal investigator for one site of the project, collected the data, provided feedback on analyses, and edited the paper. LGA served as co-principal investigator for one site of the project, collected the data, helped design the analyses, and edited the paper.

Corresponding author

Correspondence to Allison B. Ratto.

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All authors declare no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Ratto, A.B., Kenworthy, L., Yerys, B.E. et al. What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills. J Autism Dev Disord 48, 1698–1711 (2018). https://doi.org/10.1007/s10803-017-3413-9

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  • DOI: https://doi.org/10.1007/s10803-017-3413-9

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