Sex differences in co-occurring conditions of children with autism spectrum disorders.
Girls with autism collect fewer extra diagnoses than boys, but the ones they do get—speech delay, sleep trouble, compulsions—need equal attention.
01Research in Context
What this study did
Van Hanegem et al. (2014) asked parents of 913 US children with autism about every extra diagnosis their child had.
They counted how many girls versus boys also had ADHD, anxiety, speech delay, learning disability, and more.
The survey showed which add-on conditions pile up most often for each sex.
What they found
Girls carried fewer total diagnoses than boys.
Past speech problems were the top girl marker, while boys led in learning disability and anxiety.
The pattern hints that girls with autism fly under the radar unless language is involved.
How this fits with other research
Crawford et al. (2015) looked at the same boys-versus-girls question but focused on core autism traits like play and pointing. They found almost no sex gap, which seems to clash with E et al.'s finding of different comorbidity loads. The two studies used different lenses: one counted extra diagnoses, the other watched social behavior.
Kniola et al. (2026) zoomed in on sleep problems and flipped the script: autistic girls had way more sleep issues than boys (85 % vs 66 %). E et al. did not ask about sleep, so the picture of "fewer problems" may miss hidden nighttime stress.
Antezana et al. (2019) also found girls differ, but in repetitive behavior: more compulsions and self-injury than boys. Together these papers show girls don't have milder autism; they have a different pattern that standard screens can miss.
Why it matters
If you write assessments, update your intake forms to include female-leaning issues like sleep, compulsions, and past speech delay. Don't assume fewer reports mean milder needs—girls may suffer quietly. Track bedtime resistance, self-injury, and language history every evaluation so nothing slips past.
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02At a glance
03Original abstract
This study investigated differences in co-occurring diagnoses made in females compared to males with autism spectrum disorders in 913 children (746 males and 167 females) living in the United States with a current autism spectrum disorder diagnosis identified via caregiver-reported data from the National Survey of Children's Health 2007. The results indicated that overall, females had significantly fewer reported autism spectrum disorder co-occurring conditions than males. Females, compared to males, with a current autism spectrum disorder diagnosis had lower rates of past learning disorder, current mild learning disorder, and past anxiety diagnoses. Females with a current autism spectrum disorder diagnosis were more likely than males to have been diagnosed with a speech problem in the past, while males with a current autism spectrum disorder diagnosis were more likely than females to have a current diagnosis of a mild learning disability and a past diagnosis of learning disability. In addition, males with a current autism spectrum disorder diagnosis were more likely than females to have two or more co-occurring diagnoses. These findings provide insight into trends in sex differences in autism spectrum disorder co-occurring conditions.
Autism : the international journal of research and practice, 2014 · doi:10.1177/1362361313505719