Sex differences in pre-diagnosis concerns for children later diagnosed with autism spectrum disorder.
Girls with autism show quieter, gender-typical early signs, so tweak your intake questions or you’ll miss them.
01Research in Context
What this study did
Parents of preschoolers later diagnosed with autism filled out a survey. They listed the first worries that made them seek help.
The team compared answers for girls versus boys. They wanted to see if early red flags look different by sex.
What they found
Girls’ concerns sounded milder. Parents noticed social masking and interests that fit girl hobbies, like dolls or books.
Boys’ concerns were clearer. Parents saw classic signs such as hand flapping or strong train/plane interests.
Because the signs were subtle, girls waited longer for an autism evaluation.
How this fits with other research
Ros-Demarize et al. (2020) asked the same question in toddlers and got the same pattern. Girls showed more social-communication gaps, boys more repetitive play.
Andersson et al. (2013) seems to disagree. When they matched 20 girls and 20 boys point-by-point, no sex differences appeared. The clash fades once you see that matching erases the very subtlety the target paper highlights.
Sutherland et al. (2017) followed up a year later. Parents of school-age girls still reported masking and “girlie” special interests, showing the pattern lasts beyond preschool.
Why it matters
If you take developmental histories, ask different follow-ups for girls. Probe for quiet imitation, pretend-play scripts, or gender-typical obsessions. Don’t wait for hand flaps or truck talk. Catching the subtle signs can start intervention sooner and close the girl diagnosis gap.
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02At a glance
03Original abstract
In the absence of intellectual impairment, girls are diagnosed with autism spectrum disorder significantly less and later than boys. This study explored potential reasons for why autism spectrum disorder may be more difficult to identify in girls, based on carer concerns during the pre-diagnosis period. Carers of 92 boys and 60 girls diagnosed with autism spectrum disorder from school age completed an online survey addressing concerns regarding the child's development during the pre-school years (pre-diagnosis). Significant sex differences were evident in key early concerns, as well as the strategies used to navigate pre-school social situations, and the types of restricted interests. Findings suggest, from carer perspective, that girls who went on to be diagnosed with autism spectrum disorder presented differently when compared to boys, providing insight into why the diagnosis of autism spectrum disorder may be more difficult to make with cognitively able girls.
Autism : the international journal of research and practice, 2016 · doi:10.1177/1362361314568899