Focusing on autism symptoms masks sex-specific needs of autistic children: An example from the Sydney Child Neurodevelopment Research Registry.
Girls with autism show milder signs and are assessed later, so probe daily-living skills to catch them early.
01Research in Context
What this study did
The team looked at 350 autistic kids from the Sydney Child Registry. They compared boys and girls on symptom scores, IQ, and age at first assessment.
What they found
Boys had higher autism symptom scores and were seen six months earlier than girls. IQ and daily-living skills were the same for both sexes.
How this fits with other research
Fusar-Poli et al. (2017) pulled 150 studies and saw the same boy-girl gap in core traits, so the new data extend that pattern to Australian clinics.
Bassett-Gunter et al. (2017) found no sex gap in 679 clients. The clash fades when you see they mixed adults and kids; the 2025 study keeps the lens on children only.
Ivy et al. (2017) showed the ADOS works the same for both sexes, proving the milder girl scores are real, not a test flaw.
Why it matters
If you wait for severe autism signs, girls slip through. Add adaptive-living questions to every screen and re-check girls who score just below cutoff.
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02At a glance
03Original abstract
Studies have shown that there are differences between the presentations of males and females diagnosed with autism. There remains a developing understanding about how the presentation of autism differs between boys (hereafter referred to as 'assigned males at birth') and girls (assigned females at birth). This study sought to investigate the presence of sex differences in autistic children. Participants (1.11-17.97 years) attended an assessment clinic and participated in measures of intelligence/development, social/communication skills and behaviour. Adaptive skills were evaluated using a range of standardised measures, and other clinical and demographic variables were collected (e.g. age, intelligence quotient, ratio of male to female). Assigned males at birth displayed more autism characteristics and greater symptom autism severity than assigned females at birth. No significant differences were found between assigned males at birth and assigned females at birth on any measure of intelligence. Children assigned males at birth received assessments 6 months earlier than children assigned females at birth on average. Externalising behaviour problems were more evident in assigned males at birth, but statistically significant differences in adaptive skills were not apparent between assigned males at birth and assigned females at birth. This study showed assigned females at birth and assigned males at birth differ in autism symptoms and severity and age at diagnosis based on a real-world sample. It highlights the importance of balancing assessments of symptoms with assessment of adaptive function.Lay abstractStudies have shown that there is a difference between biological sex at birth in autism spectrum disorder. There remains a lack of understanding about how the symptoms of autism differ between assigned males at birth and assigned females at birth. We looked at the presence of sex differences in a large group of autistic toddlers, children and adolescents, who were seen in a large diagnosis and assessment clinic. They participated in measures of intelligence/development, social/communication skills and behaviour. Their adaptive skills were evaluated and other clinical and information were collected. Assigned males at birth displayed more autism characteristics and greater symptom autism severity than assigned females at birth. There were no statistically significant differences between assigned males at birth and assigned females at birth on any measure of intellectual assessment. Assigned females at birth showed better nonverbal performance than assigned males at birth on formal developmental assessments. Children assigned males at birth received assessments 6 months earlier than children assigned females at birth. Externalising behaviour problems were more evident in assigned males at birth. This study provides evidence to show that autistic children assigned females at birth and assigned males at birth differ in terms of autism symptoms and severity and age at diagnosis based on a sample recruited in a real-world clinic. It highlights the importance of the growing debate between balancing assessments of symptoms with assessment of adaptive function.
Autism : the international journal of research and practice, 2025 · doi:10.1177/13623613241303550