Sex-related differences in clinical characteristics of children with ASD without ID: Results from the ELENA cohort.
SRS-2 scores in girls with ASD and no ID climb alongside IQ, so factor in cognitive level before judging severity.
01Research in Context
What this study did
The team looked at kids in the French ELENA cohort who have autism but no intellectual disability.
They asked: do girls and boys look the same on parent-rated social problems and IQ?
Parents filled out the SRS-2 form and kids took an IQ test.
What they found
Girls scored higher on parent-rated social impairment, meaning more social problems were seen.
Only in girls did higher IQ link with higher social-impairment scores; boys did not show this link.
So a smart girl might look "more autistic" on the form even when she is not low-functioning.
How this fits with other research
Torres et al. (2022) saw zero sex differences in Venezuelan kids with ASD and no ID. The clash is likely cultural: French parents may rate social quirks more sharply.
Némorin et al. (2025) used the same ELENA cohort and found four clear autism sub-types when they added adaptive and behavior scores. Dellapiazza zooms in on the sex slice of that bigger picture.
Ohan et al. (2015) showed IQ can flip how symptom severity relates to daily skills; the new girl-only IQ link fits that wider pattern.
Why it matters
When you see a high SRS-2 score in a girl with ASD and average-or-better IQ, pause before labeling her as more severe. The score may ride on her cognitive level, not true impairment. Use extra probes like direct social observation or peer comparison before you write goals.
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02At a glance
03Original abstract
The literature on sex related-clinical differences for children with autism spectrum disorder (ASD) is highly contradictory, whereas this topic has major clinical implications. We aimed to investigate sex-related clinical differences in children with ASD without intellectual disability (ID). We compared 319 boys and 65 girls with ASD without ID, aged from 2 to 12 years, recruited from a multiregional cohort on their clinical profiles based on the scores for the Vineland-II, the SRS-2, the ADOS calibrated severity score, sensory processing, aberrant behaviors, and comorbidity rates. Our results confirm a high sex ratio of 4.9 males/females. Many similarities were found in the clinical profiles. However, we found that girls had higher SRS-2 total scores. In addition, there was a negative correlation between the SRS-2 total score and the intellectual quotient level (IQ) for girls only. We confirm the higher rates of boys with ASD without ID. A comparison between the girls and boys showed them to have similar clinical profiles, except for the SRS- 2 total scores, which were higher among girls, suggesting more severe social impairment perceived by parents. Our findings that the cognitive level is related to ASD severity in girls should be taken into account during the diagnostic procedure in the clinical interpretation of gold-standard measures of ASD, and additional clinical observations are necessary. [ClinicalTrials.gov], identifier [NCT02625116s].
Frontiers in Psychiatry, 2022 · doi:10.3389/fpsyt.2022.998195