Meng-Chuan Lai1,2,3,4,5, Peter Szatmari1,2,3. 1. The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health. 2. Department of Psychiatry, The Hospital for Sick Children. 3. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada. 4. Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom. 5. Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Abstract
PURPOSE OF REVIEW: With increasing awareness of potential differences of autism presentation in nonmale versus male individuals, this review summarizes the rapidly evolving literature on sex and gender impacts on autism across nosology, behavioural presentation, developmental change and contextual recognition biases. RECENT FINDINGS: Most studies have not differentiated sex versus gender impacts. Regarding behavioural presentation, measurement invariance across sex/gender was found in several standard measures. On this basis, diagnosed females overall showed lower restricted/repetitive behaviour/interests/activities (RRBI) than males, with small and variable effects depending on age, developmental level and kinds of RRBI. Differences insufficiently captured by standard measures may include autistic females displaying female-gender-typical narrow interests, higher social attention, linguistic abilities, motivation for friendship and more camouflaging than autistic males. Regarding developmental change, diagnosed young girls were more likely to have better cognitive development, less intense autistic symptoms and reduction of symptoms over time. Difficulties in adaptive functioning and social challenges, however, may emerge more for females in adolescence. Regarding diagnosis, general expectancy biases and gender-stereotypes may impede timely recognition of autism in females. SUMMARY: Appreciating the multilevel sex and gender impacts on presentation, development, and diagnosis is key to sex-equitable and gender-equitable care for autistic individuals. A holistic approach to understanding the person in the contexts of sex and gender is essential for timely and accurate diagnosis and support.
PURPOSE OF REVIEW: With increasing awareness of potential differences of autism presentation in nonmale versus male individuals, this review summarizes the rapidly evolving literature on sex and gender impacts on autism across nosology, behavioural presentation, developmental change and contextual recognition biases. RECENT FINDINGS: Most studies have not differentiated sex versus gender impacts. Regarding behavioural presentation, measurement invariance across sex/gender was found in several standard measures. On this basis, diagnosed females overall showed lower restricted/repetitive behaviour/interests/activities (RRBI) than males, with small and variable effects depending on age, developmental level and kinds of RRBI. Differences insufficiently captured by standard measures may include autistic females displaying female-gender-typical narrow interests, higher social attention, linguistic abilities, motivation for friendship and more camouflaging than autistic males. Regarding developmental change, diagnosed young girls were more likely to have better cognitive development, less intense autistic symptoms and reduction of symptoms over time. Difficulties in adaptive functioning and social challenges, however, may emerge more for females in adolescence. Regarding diagnosis, general expectancy biases and gender-stereotypes may impede timely recognition of autism in females. SUMMARY: Appreciating the multilevel sex and gender impacts on presentation, development, and diagnosis is key to sex-equitable and gender-equitable care for autistic individuals. A holistic approach to understanding the person in the contexts of sex and gender is essential for timely and accurate diagnosis and support.
Authors: Varun Warrier; Xinhe Zhang; Patrick Reed; Alexandra Havdahl; Tyler M Moore; Freddy Cliquet; Claire S Leblond; Thomas Rolland; Anders Rosengren; David H Rowitch; Matthew E Hurles; Daniel H Geschwind; Anders D Børglum; Elise B Robinson; Jakob Grove; Hilary C Martin; Thomas Bourgeron; Simon Baron-Cohen Journal: Nat Genet Date: 2022-06-02 Impact factor: 41.307
Authors: R Holt; S Baron-Cohen; A Tsompanidis; E Aydin; E Padaigaitė; G Richards; C Allison; G Hackett; T Austin Journal: Mol Autism Date: 2021-07-08 Impact factor: 7.509
Authors: Ericka L Wodka; Julia Parish-Morris; Robert D Annett; Laura Carpenter; Emily Dillon; Jacob Michaelson; So Hyun Kim; Rebecca Landa; Stephen Kanne Journal: Clin Neuropsychol Date: 2021-07-27 Impact factor: 4.373