According to studies of a large population, girls with a diagnosis of autism have more serious violations in social communication than boys.

There are one girl in four diagnosed boys. But this ratio may partially reflect the bias in the diagnostic process: the tools used for screening and diagnosis are based primarily on the data of the boys.

New work suggests that girls are more likely to get an autism diagnosis only if they have significant social impairments - supporting the idea that diagnostic tools are missing some girls with this disease.

"This is worrying," says lead researcher Laura Carpenter, a professor of pediatrics and psychiatry at the University of South Carolina Medical School in Charleston. "Do we miss the girls who have weaker signs of autism?"

The findings also highlight the gender differences in social communication among typical children: girls may need better social skills, for "normal" behavior.

«The study contributes in terms of large-scale demonstration of the differences of the population makes autism spectrum disorders" - says Renee Jamison, a clinical associate professor at the University of Kansas Medical Center in Kansas City, who was not involved in the study. "This illustrates the need to consider reference groups on the basis of gender."

Boy's mobility:

Carpenter and her colleagues checked 1731 boys and 1,789 girls for autism symptoms using a social communication form (SCQ) that parents fill out. Children between the ages of 8 and 10 are part of the South Carolina Children's Educational Surveillance, an autism survey of children born in 2004, and study in 123 schools.

Of their SCQ estimates, researchers classified about 9 percent of boys and about 5 percent of girls as being at risk of autism. Of these children, 112 had a full diagnostic evaluation. A random sample of 160 children who did not score in the risk group also completed the evaluation.

The ratio of boys and girls who have been diagnosed with autism is even higher than that of a risk group: about 25% of boys were diagnosed compared with 7.4% of girls.

This result suggests that the diagnostic score is skewed. Girls diagnosed with autism were completely superimposed on those who met SCQ cutoffs, which indicates that the screen is accurate for girls. "The interpretation is that the actual diagnostic assessment is biased against the phenotype of female autism," says William Mandy, a senior lecturer in clinical psychology at London College London, who did not participate in the study. The results were published on March 30 in the Journal of Clinical Pediatric and Adolescent Psychology.

Testing the test:

Supporting this interpretation, girls with child autism scored four points higher in SCQ on average than boys, assuming that only girls with severe characteristics are diagnosed. In particular, girls tend to have more problems with social communication, for example, playing in groups or smiling. (There was no difference between boys and girls in limited and repetitive behavior, which contradicts the previous work.)

The differences in social communication may be partly related to the problems faced by women when they approach adolescence, - says Maricela Huerta, associate professor of clinical psychiatry psychology at Weill Cornell Medicine in New York, who was not involved in the study .

"Perhaps we will put an end when the expectation of social behavior for girls as a whole may not be the same as for boys," says Huerta.

The researchers analyzed individual SCQ questions to determine which of them best distinguish children who have autism from those who do not. Elements that measure the social and spontaneous behavior of children aged 4 and 5 years, when signs of autism often become apparent, are the most predictable for diagnosing autism. These questions are also particularly good in identifying girls with this disease. However, questions about limited and repeated behavior are not good predictors of the condition in either girls or boys.

SCQ seems problematic as a diagnosis for boys: about 10 percent of boys who fall below the risk level have autism. This suggests that clinicians should be more attentive to boys who do not meet SCQ criteria, or to combine diagnostics with other tests.

The Carpenter team plans to look at the sex differences in the characteristics of autism among young children using several screening and diagnostic tools.


Evans SC et al. J Clin. The child is a teenager. Psychol. Epub (2018) PubMed

Source: www.spectrumnews.org