ASD symptoms in toddlers and preschoolers: An examination of sex differences.
Common toddler screeners over-count social items and under-count repetitive play, so girls with milder social gaps can be overlooked.
01Research in Context
What this study did
Ros-Demarize et al. (2020) watched toddlers and preschoolers with autism. They asked parents and teachers to fill out two common screeners.
The team wanted to know if girls and boys score the same way on social items and repetitive items.
What they found
Girls earned higher social-communication deficit scores than boys.
Repetitive behavior scores looked the same for both sexes.
Because most screeners lean on social items, girls looked “more autistic” and easier to spot, yet many real cases still slip through.
How this fits with other research
Matson et al. (2009) saw the same girl-pattern first: bigger social gaps, fewer repetitive moves. Their early map is why we keep hunting for girl-shaped flags.
Matheis et al. (2019) seems to disagree. When they matched girls and boys for IQ, the social gap vanished. The twist: Rosmary did not match IQ, so the “extra” social trouble in girls may ride on lower cognitive scores, not sex alone.
Rodriguez-Seijas et al. (2020) also matched IQ and still found milder social-affect in girls. Together the three papers say: if you level the cognitive field, girl-boy differences shrink but do not disappear.
Why it matters
When you give a toddler screener, picture two filters at once: social items and cognitive load. A quiet girl who copies peers may fail the social cutoff yet show few repetitive moves. Pause before you rule autism out. Add a play-based probe, watch fine-motor demands, and ask about unusual sensory habits. These extra looks can catch girls whom the checklist misses.
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02At a glance
03Original abstract
Although considerable work has documented higher prevalence rates of autism spectrum disorder (ASD) in boys, fewer studies have focused on sex differences within samples of young children at-risk for ASD. This study examined sex differences in ASD symptom domains and ASD screening outcomes among toddlers (18-35 months) and preschoolers (36-72 months) with ASD-related concerns. Participants included 480 children between 18 and 72 months evaluated by university-based ASD specialty clinics. Results revealed significant sex differences in severity of social communication (SC) deficits across age groups. Within the toddler group, girls diagnosed with ASD displayed greater SC deficits according to standardized observation and clinician severity ratings. Within the preschool group, girls diagnosed with ASD were rated by parents as having more severe SC deficits, but these differences were not corroborated by standardized observations or clinician ratings. No sex differences emerged for severity of restricted repetitive behaviors (RRBs) for either age group. Across the entire referred sample, boys and girls did not differ in terms of scores on commonly used screening instruments. Importantly, results suggest that two of the most commonly used ASD screeners (i.e., Modified-Checklist for Autism in Toddlers-Revised with Follow-up and Social Communication Questionnaire ) may underidentify RRBs in toddler and preschool-aged girls as screening scores were only influenced by severity of SC deficits. Greater SC deficits in young girls with ASD along with its impact on screening status suggests greater attention be placed on the under-identification of ASD in girls as well as current screening measures' ability to tap into the topography of ASD symptoms across genders. Autism Res 2020, 13: 157-166. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: In this study, we found that young girls diagnosed with autism spectrum disorder tend to have greater social communication deficits than young boys and that these differences vary by age. Specifically, toddler-aged girls receive higher clinician ratings of social communication deficits when compared to boys, while preschool-aged girls receive higher parent ratings of social communication deficits. For girls, current screening tools seem to be more highly influenced by severity of social communication deficits than by restricted repetitive behaviors.
Autism research : official journal of the International Society for Autism Research, 2020 · doi:10.1002/aur.2241