Effects of Diagnostic Severity upon Sex Differences in Behavioural Profiles of Young Males and Females with Autism Spectrum Disorder.

Bitsika et al. (2019) asked a simple question: does autism severity change how boys and girls score on the SRS-2?

They pulled the kids with ASD who already had both an ADOS-2 and an SRS-2 in one Florida clinic.

The team split the kids into three ADOS severity groups (low, medium, high) and then looked for sex differences item-by-item on the SRS-2.

At low ADOS severity, girls looked more socially impaired than boys on several SRS items.

At high severity, the pattern flipped: boys scored higher on restricted-interest items.

In plain words, the same SRS-2 questions do not flag the same sex differences once you know the child's severity level.

Duvekot et al. (2017) showed girls need bigger emotional or behavior problems—and fewer repetitive actions—to even get an ASD diagnosis. Vicki's findings add the next layer: after diagnosis, severity keeps reshaping which behaviors separate the sexes.

Gaines et al. (2025) found girls on the spectrum have worse auditory and balance sensory issues than boys. Together with Vicki, the picture is that girls differ both in sensory profile and in social presentation, and severity decides which gap shows up clearest.

Rojahn et al. (2012) warned that the SRS is great at ruling ASD out but poor at ruling it in. Vicki's item-level work supports that caution: scores shift by sex and severity, so a single cut-off can mislead if you ignore those factors.

When you interpret SRS-2 results, always note the child's ADOS-2 severity level first. A social score that looks 'worse' in a girl may simply reflect low severity, while restricted-interest scores in a boy may only pop out at high severity. Adjust your clinical lens, and never rely on one tool's cut-off alone.