Abstract
Evidence increasingly suggests that ASD manifests differently in females than males. Previous reviews investigating sex/gender differences in social interaction and social communication have focused at the level of broad constructs (e.g. comparing algorithm scores from pre-existing diagnostic instruments) and have typically reported no significant differences between males and females. However, a number of individual studies have found sex/gender differences in narrow construct domains. We conducted a systematic review and random effects model meta-analyses (in January 2019 and updated January 2020) that investigated sex/gender differences in narrow construct measures of social communication and interaction in autistic and nonautistic children and adolescents, and adults. Study quality was appraised using the Appraisal Tool for Cross-Sectional Studies (AXIS, BMJ Open, 6, 2016, 1). Across 16 studies (including 2,730 participants), the analysis found that female (vs. male) individuals with ASD had significantly better social interaction and social communication skills (SMD=0.39, p<.001), which was reflective of a similar sex/gender profile in nonautistic individuals (SMD=0.35, p<.001). Nonautistic males had significantly better social interaction and communication than males with ASD (SMD=0.77, p<.001). Nonautistic females also had significantly better social interaction and communication than females with ASD (SMD=0.72, p<.001). Nonautistic males had better social interaction and communication than females with ASD, though this difference was not significant (SMD=0.30, p=.07). This systematic review and meta-analysis highlighted important sex/gender differences in social interaction and communication for individuals with ASD, likely not captured by pre-existing diagnostic instruments, which potentially contribute to the under recognition of autism in females, and may need to be reflected in the diagnostic process.
Highlights
Autism spectrum disorder (ASD) is a neurodevelopmental disability characterized by ‘persistent impairment in reciprocal social communication and social interaction, and restricted, repetitive patterns of behaviour, interests or activities’ (American Psychiatric Association, 2013, p. 53)
Girls who met diagnostic criteria showed higher levels of behavioural and/or cognitive difficulties than nonautistic peers with high levels of autistic traits (Dworzynski, Ronald, Bolton, & Happe, 2012). These findings indicate that the diagnostic criteria are biased towards a male-specific manifestation of ASD and suggest that female children and adolescents may be missed in the diagnostic process, and if they do not present with comorbid behavioural or cognitive difficulties
This systematic review and meta-analysis investigated sex/gender differences in narrow construct measures of social interaction and communication based upon DSM-5 ASD diagnostic criteria
Summary
Autism spectrum disorder (ASD) is a neurodevelopmental disability characterized by ‘persistent impairment in reciprocal social communication and social interaction, and restricted, repetitive patterns of behaviour, interests or activities’ (American Psychiatric Association, 2013, p. 53). Results: Across 16 studies (including 2,730 participants), the analysis found that female (vs male) individuals with ASD had significantly better social interaction and social communication skills (SMD = 0.39, p < .001), which was reflective of a similar sex/gender profile in nonautistic individuals (SMD = 0.35, p < .001). Nonautistic males had better social interaction and communication than females with ASD, though this difference was not significant (SMD = 0.30, p = .07). Conclusions: This systematic review and meta-analysis highlighted important sex/gender differences in social interaction and communication for individuals with ASD, likely not captured by pre-existing diagnostic instruments, which potentially contribute to the under recognition of autism in females, and may need to be reflected in the diagnostic process.
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