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Sex Differences in Autism Spectrum Disorder based on DSM-5 Criteria: Evidence from Clinician and Teacher Reporting

Abstract

In the absence of intellectual impairment autism spectrum disorder (ASD) is diagnosed both less and later in females. This study used clinician and teacher report to explore sex differences in the behavioural presentation of 69 girls and 69 boys all diagnosed with high-functioning ASD. Evidence from DSM-IV-TR and DSM-5 are presented. Sex differences in teacher concerns were also explored. While no sex differences were found in the broad social criteria presented in the DSM-IV-TR or DSM-5, numerous differences were evident in how boys and girls came to meet each criterion. For example, girls were more likely to show an ability to integrate non-verbal and verbal behaviours, maintain a reciprocal conversation, and be able to initiate, but not maintain friendships. Moreover, girls presented with both less and different restricted interests. Teachers also reported substantially fewer concerns for girls than boys, including for externalising behaviours and social skills. Results suggest girls with ASD may present with a surface-level ‘look’ different from the ‘classic’ presentation of ASD, and present as less impaired when in a school setting. Consequently, results provide insight in to why the disorder may be more difficult to detect in cognitively-able girls.

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Acknowledgments

The authors wish to sincerely thank Tomoko Nishizawa for her assistance with inter-rater reliability, as well as all of the parents and children who volunteered their information for this research.

Author Notes

This research was supported by the Apex Trust for Autism PhD Research Grant. This research was conducted while the first author was at Flinders University, Australia. Over the course of the review process the first author relocated to the University of Bath, United Kingdom.

Conflict of Interest

The authors declare that they have no conflict of interest.

Author information

Correspondence to Rachel M. Hiller.

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Hiller, R.M., Young, R.L. & Weber, N. Sex Differences in Autism Spectrum Disorder based on DSM-5 Criteria: Evidence from Clinician and Teacher Reporting. J Abnorm Child Psychol 42, 1381–1393 (2014). https://doi.org/10.1007/s10802-014-9881-x

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Keywords

  • Autism spectrum disorder
  • Sex differences
  • Gender
  • Behaviour presentation
  • Teacher report