Sex differences in social communication behaviors in toddlers with suspected autism spectrum disorder as assessed by the ADOS-2 toddler module.
ADOS-2 Toddler Module social items treat boys and girls the same, so use the standard cut-offs without adjustment.
01Research in Context
What this study did
Spackman et al. (2022) asked a simple question. Do the social communication items on the ADOS-2 Toddler Module work the same way for boys and girls?
They looked at toddlers who were being checked for autism. The team studied whether each test item flagged the same behaviors no matter the child’s sex.
What they found
The items did not favor either sex. Girls and boys with similar symptom levels earned similar scores.
The one hint of difference showed up in creative play, but it was too small to change a diagnosis.
How this fits with other research
Cohen et al. (2018) found that parents spot early signs better than short clinic visits. Emily’s work adds that, once you are in that clinic, the ADOS-2 toddler items are fair to both sexes.
Zadok et al. (2024) pooled many studies and saw no big autonomic gap between autistic and typical groups during social tasks. Emily’s null sex finding lines up: the test is not picking up a hidden boy-girl biology split.
Sutera et al. (2007) showed that some toddlers move off the spectrum by age four. Emily’s result means those later “optimal outcome” kids are unlikely to be missed simply because they are girls.
Why it matters
You can trust the ADOS-2 Toddler Module scores for both boys and girls. There is no need to apply a “sex correction” when you interpret results. Keep watching creative play in future revisions, but for now base your diagnostic call on the standard cut-offs and add parent-report tools for a fuller picture.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Score your next toddler assessment with the published cut-offs; no sex-based correction is needed.
02At a glance
03Original abstract
When toddlers are suspected of autism spectrum disorder (ASD), the gold-standard assessment technique is with the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) Toddler Module, a behavioral observation system. ASD is a neurodevelopmental condition more frequently diagnosed in toddler boys than in toddler girls. There is some evidence that the ADOS-2 assesses behaviors that are more characteristic of boys with ASD than girls. Thus, it is possible that focusing on these behaviors contributes at least in part to why more boys are diagnosed than girls. Specifically, girls may show more social skills than boys during the ADOS-2 assessment due to their socialization histories, which may lead to missed diagnoses of ASD in toddler girls. The current study examined eight social behaviors assessed by the ADOS-2 in a sample of toddlers with suspected ASD to see if they contributed differently to the total score of those items. Examination of those items suggested that those social communication behaviors work the same for boys and girls with suspected ASD, which was inconsistent with hypotheses. However, examination of particular items raises the possibility of examining creative/imaginative play as an area for future research.
Autism : the international journal of research and practice, 2022 · doi:10.1177/13623613211047070