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. 2023 Mar;10(1):80-91.
doi: 10.1007/s40474-023-00270-y. Epub 2023 Jan 27.

Sex Differences in the Developmental Trajectories of Autism Spectrum Disorder

Tyler C McFayden  1 , Orla Putnam  2 , Rebecca Grzadzinski  1 , Clare Harrop  2   3
Affiliations

Sex Differences in the Developmental Trajectories of Autism Spectrum Disorder

Tyler C McFayden et al. Curr Dev Disord Rep. 2023 Mar.

Abstract

Purpose of review: Females and males are disproportionately diagnosed with autism, a sex difference that has historically represented this neurodevelopmental condition. The current review examines lifespan developmental trajectories of autism based on sex to elucidate behavioral phenotypic differences that may contribute to differential rates of diagnosis.

Recent findings: We review sex differences in diagnostic criteria: social communication and restricted interests/repetitive behaviors (RRBs). Results suggest RRBs are more indicative of a diagnosis in males, whereas social differences are more indicative of a diagnosis in females. Factors contributing to a later diagnosis in females include social strengths (camouflaging) and diagnostic overshadowing.

Summary: Sex differences in diagnostic criteria may contribute to differential rates of identification in males and females. Sex differences are most pronounced when assessing naturalistic social communication instead of reliance on standardized measure. Numerous future directions are identified including increasing samples of sub-threshold autistic females and evaluating longitudinal sex differences.

Keywords: Autism; Co-occurring conditions; Restricted interests/repetitive behaviors; Sex/gender; Social communication.

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Conflict of interest statement

Conflict of Interest The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Developmental trajectories of the autism phenotype by sex. Black triangles represent difference scores; DSM = diagnostic statistical manual, RRBs = restricted and repetitive behaviors. Figure created using BioRender software. Caption: Fig. 1 depicts the developmental trajectories of social communication (SC), repetitive/restricted behaviors and interests (RRBs), and co-occurring conditions by sex assigned at birth, derived from the current literature review. The developmental patterns suggest autistic females present as less characteristic of autism in SC and repetitive behaviors across the lifespan compared to autistic males, but emerge with higher rates of co-occurring conditions that increase with age compared to autistic males. Zooming out (right panel), these patterns for autistic males and females can be compared to patterns of neurotypical development for males and females. Taking the SC domain as an example, neurotypical males and females differ in their social skills, wherein neurotypical females show strengths relative to neurotypical males. However, our “bar” for an autism threshold remains the same for males and females, which requires autistic females to differ from neurotypical females more (i.e., change of 8.5 in the figure) than autistic males need to differ from neurotypical males (i.e., change of 7 in the figure). The patterns depicted here are examples; other neurodevelopmental domains that are likely relevant may differ but are not depicted here
See this image and copyright information in PMC

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