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

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. 1.

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

  2. 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.

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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.

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Correspondence to Allison B. Ratto.

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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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Keywords

  • Autism spectrum disorder
  • Sex differences
  • Diagnosis
  • Adaptive skills