Does the Extreme Male Brain Hypothesis of Autism Apply More to Females Than Males? A Systematic and Meta-Analytic Approach.

Szakal et al. (2026) pooled 34 studies that measured empathizing and systemizing in autistic and neurotypical people.

They asked: do autistic females show a bigger gap from typical females than autistic males show from typical males?

The team compared both the size of the gap and whether it came from low empathy, high systemizing, or both.

Autistic females drift further from same-sex peers than autistic males do from theirs.

The gap is driven mainly by lower empathy scores, not by sky-high systemizing.

In plain words, the “extreme male brain” label fits autistic girls more strongly than autistic boys.

Bassett-Gunter et al. (2017) looked at 679 autistic youth and saw almost no sex gap in symptoms or IQ. The two papers seem to clash, but they measure different things: Cory counts empathy scores while L counts general symptom checklists.

Stevens et al. (2018) tested mental rotation in adults and found zero sex difference, a direct challenge to the extreme male brain idea. Again, the difference is in the yardstick: mental rotation versus empathy questionnaires.

Hodge et al. (2025) show girls are referred for assessment six months later than boys with similar traits. Cory’s findings help explain why: when girls do show the profile, it is sharper, so clinicians may miss it unless they look for subtle empathy gaps.

Update your intake questions. Ask both boys and girls about friendship struggles, not just repetitive play.

If a girl’s empathy score looks “borderline,” probe deeper; the same number may signal stronger divergence than it does for a boy.

Share the empathy-versus-systemizing pattern with teachers so they don’t dismiss quiet girls who seem “just shy.”