The clinician perspective on sex differences in autism spectrum disorders.
Clinicians see the biggest sex differences in restricted/repetitive behaviors emerging after early childhood—plan assessments accordingly.
01Research in Context
What this study did
Jamison et al. (2017) asked clinicians what sex differences they see in kids with autism.
The team used a survey. They wanted to know where boys and girls look most different.
What they found
Clinicians said restricted and repetitive behaviors show the biggest sex gap.
They see this gap most in school-age kids and teens, not in toddlers.
Social-communication differences looked smaller to them.
How this fits with other research
Beggiato et al. (2017) ran numbers on the ADI-R and also found girls are missed.
Together the papers say our tools score girls lower, so we need sharper cut-offs.
Wormald et al. (2019) seems to disagree. They gave high-functioning kids the SRS-2 and saw no sex gap.
The clash fades when you see they only tested bright kids; Rene’s clinicians saw the whole range.
Emerson et al. (2023) add a twist: when girls also have ID their repetitive behaviors jump above boys’.
So the gap grows or shrinks depending on IQ — exactly what clinicians sensed.
Why it matters
Check the child’s IQ before you trust a “no sex difference” score.
If you assess a school-age girl with average or high IQ, probe harder for subtle repetitive habits.
For girls with ID, expect more intense rituals and plan extra behavior support.
Adjust cut-offs, add questions, and never let male norms hide autism in girls.
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02At a glance
03Original abstract
Research studies using existing samples of individuals with autism spectrum disorders have identified differences in symptoms between males and females. Differences are typically reported in school age and adolescence, with similarities in symptom presentation at earlier ages. However, existing studies on sex differences are significantly limited, making it challenging to discern if, how, and at what point in development females with autism spectrum disorder actually exhibit a different behavioral presentation than males. The purpose of this study was to gather impressions from a large group of clinicians to isolate specific areas for future study of sex differences. Clinicians were surveyed about their opinions and perceptions of symptom severity in females, as compared to males, at different points during development. They were also asked to provide open-ended responses about female symptom presentation. Consistent with previous literature, clinicians noted more sex-related differences in restricted and repetitive behaviors and fewer differences for social communication features. Differences were most commonly observed in school age and adolescence, suggesting this time period as a critical and particularly vulnerable window for females with autism spectrum disorder. The results are discussed in the context of other male/female differences across development so that more targeted investigations of autism spectrum disorder sex differences across development.
Autism : the international journal of research and practice, 2017 · doi:10.1177/1362361316681481