Journal of Autism and Developmental Disorders

, Volume 44, Issue 3, pp 627–635 | Cite as

Gender and Age Differences in the Core Triad of Impairments in Autism Spectrum Disorders: A Systematic Review and Meta-analysis

  • Patricia J. M. Van Wijngaarden-Cremers
  • Evelien van Eeten
  • Wouter B. Groen
  • Patricia A. Van Deurzen
  • Iris J. Oosterling
  • Rutger Jan Van der Gaag
Original Paper

Abstract

Autism is an extensively studied disorder in which the gender disparity in prevalence has received much attention. In contrast, only a few studies examine gender differences in symptomatology. This systematic review and meta-analysis of 22 peer reviewed original publications examines gender differences in the core triad of impairments in autism. Gender differences were transformed and concatenated using standardized mean differences, and analyses were stratified in five age categories (toddlerhood, preschool children, childhood, adolescence, young adulthood). Boys showed more repetitive and stereotyped behavior as from the age of six, but not below the age of six. Males and females did not differ in the domain of social behavior and communication. There is an underrepresentation of females with ASD an average to high intelligence. Females could present another autistic phenotype than males. As ASD is now defined according to the male phenotype this could imply that there is an ascertainment bias. More research is needed into the female phenotype of ASD with development of appropriate instruments to detect and ascertain them.

Keywords

Autism spectrum disorder Gender Age 

Supplementary material

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Supplementary material 1 (DOCX 17 kb)
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Supplementary material 2 (DOCX 14 kb)
10803_2013_1913_MOESM3_ESM.docx (291 kb)
Supplementary material 3 (DOCX 292 kb)

References

  1. Andersson, G. W., Gillberg, C., & Miniscalco, C. (2012). Pre-school children with suspected autism spectrum disorders: Do girls and boys have the same profiles? Research in Developmental Disabilities, 34(1), 413–422.PubMedCrossRefGoogle Scholar
  2. Attwood, T. B. (2007). The complete guide to Asperger’s syndrome. London: jessica Kingsley Publishers.Google Scholar
  3. Auyeung, B., Wheelwright, S., Allison, C., Atkinson, M., Samarawickrema, N., & Baron-Cohen, S. (2007). The children’s empathy quotient and systemizing quotient: Sex differences in typical development and in autism spectrum conditions. Journal of Autism and Developmental Disorders, 39(11), 1509–1521.CrossRefGoogle Scholar
  4. Baird, G., Douglas, H. R., & Murphy, (2011). Recognising and diagnosing autism in children and young people: Summary of NICE guidance. BMJ, 21, 343.Google Scholar
  5. Banach, R., Thompson, A., Szatmari, P., Goldberg, J., Tuff, L., Zwaigenbaum, L., et al. (2009). Brief report: Relationship between non-verbal IQ and gender in autism. Journal of Autism and Developmental Disorders, 39(1), 188–193.PubMedCrossRefGoogle Scholar
  6. Baron-Cohen, S., Hoekstra, R. A., Knickmeyer, R., & Wheelwright, S. (2006). The autism-spectrum quotient (AQ)—Adolescent version. Journal of Autism and Developmental Disorders, 36(3), 343–350.PubMedCrossRefGoogle Scholar
  7. Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism-spectrum quotient (AQ): Evidence from asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31(1), 5–17.PubMedCrossRefGoogle Scholar
  8. Begeer, S., Mandell, D., Wijnker-Holmes, B., Venderbosch, S., Rem, D., Stekelenburg, F., et al. (2013). Sex differences in the timing of identification among children and adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(5), 1151–1156.PubMedCrossRefGoogle Scholar
  9. Bölte, S., Duketis, E., Poustka, F., & Holtmann, M. (2011). Sex differences in cognitive domains and their clinical correlates in higher-functioning autism spectrum disorders. Autism, 15(4), 497–511.PubMedCrossRefGoogle Scholar
  10. Carter, A. S., Black, D. O., Tewani, S., Connolly, C. E., Kadlec, M. B., & Tager-Flusberg, H. (2007). Sex differences in toddlers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(1), 86–97.PubMedCrossRefGoogle Scholar
  11. Dworzynski, K., Ronald, A., Bolton, P., & Happe, F. (2012). How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? Journal of the American Academy of Child and Adolescent Psychiatry, 51(8), 788–797.PubMedCrossRefGoogle Scholar
  12. Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental disorders: An update. Journal of Autism and Developmental Disorders, 33(4), 365–382.PubMedCrossRefGoogle Scholar
  13. Fombonne, E. (2009). Epidemiology of pervasive developmental disorders. Pediatric Research, 65(6), 591–598.PubMedCrossRefGoogle Scholar
  14. Giarelli, E., Wiggins, L. D., Rice, C. E., Levy, S. E., Kirby, R. S., Pinto-Martin, J., et al. (2010). Sex differences in the evaluation and diagnosis of autism spectrum disorders among children. Disability and Health Journal, 3(2), 107–116.PubMedCrossRefGoogle Scholar
  15. Goin-Kochel, R. P., Mackintosh, V. H., & Myers, B. J. (2006). How many doctors does it take to make an autism spectrum diagnosis? Autism, 10(5), 439–451.PubMedCrossRefGoogle Scholar
  16. Hartley, S. L., & Sikora, D. M. (2009). Sex differences in autism spectrum disorder: An examination of developmental functioning, autistic symptoms, and coexisting behavior problems in toddlers. Journal of Autism and Developmental Disorders, 39(12), 1715–1722.PubMedCentralPubMedCrossRefGoogle Scholar
  17. Hattier, M. A., Matson, J. L., Tureck, K., & Horovitz, M. (2011). The effects of gender and age on repetitive and/or restricted behaviors and interests in adults with autism spectrum disorders and intellectual disability. Research in Developmental Disabilities, 32(6), 2346–2351.PubMedCrossRefGoogle Scholar
  18. Holtmann, M., Bolte, S., & Poustka, F. (2007). Autism spectrum disorders: Sex differences in autistic behaviour domains and coexisting psychopathology. Developmental Medicine and Child Neurology, 49(5), 361–366.PubMedCrossRefGoogle Scholar
  19. Kirkovski, M., Enticott, P. G., & Fitzgerald, P. B. (2013). A review of the role of female gender in autism spectrum disorders. Journal of Autism and Developmental Disorders, 23, 1–20.Google Scholar
  20. Knickmeyer, R. C., Wheelwright, S., & Baron-Cohen, S. B. (2008). Sex-typical play: Masculinization/defeminization in girls with an autism spectrum condition. Journal of Autism and Developmental Disorders, 38(6), 1028–1035.PubMedCrossRefGoogle Scholar
  21. Kopp, S., & Gillberg, C. (1992). Girls with social deficits and learning problems: Autism, atypical asperger syndrome or a variant of these conditions. European Child and Adolescent Psychiatry, 1(2), 89–99.CrossRefGoogle Scholar
  22. Kopp, S., & Gillberg, C. (2011). The autism spectrum screening questionnaire (ASSQ)-revised extended version (ASSQ-REV): An instrument for better capturing the autism phenotype in girls? A preliminary study involving 191 clinical cases and community controls. Research in Developmental Disabilities, 32(6), 2875–2888.PubMedCrossRefGoogle Scholar
  23. Lai, M. C., Lombardo, M. V., Pasco, G., Ruigrok, A. N., Wheelwright, S. J., Sadek, S. A., et al. (2011). A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS ONE, 6(6), e20835.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Le Couteur, A., Rutter, M., Lord, C., Rios, P., Robertson, S., Holdgrafer, M., et al. (1989). Autism diagnostic interview: A standardized investigator-based instrument. Journal of Autism and Developmental Disorders, 19(3), 363–387.PubMedCrossRefGoogle Scholar
  25. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.PubMedCrossRefGoogle Scholar
  26. Lord, C., Schopler, E., & Revicki, D. (1982). Sex differences in autism. Journal of Autism and Developmental Disorders, 23(2), 217–227.Google Scholar
  27. Lugnegård, T., Hallerbäck, M. U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities, 32(5), 1910–1917.PubMedCrossRefGoogle Scholar
  28. Mandy, W., Chilvers, R., Chowdhury, U., Salter, G., Seigal, A., & Skuse, D. (2011). Sex differences in autism spectrum disorder: Evidence from a large sample of children and adolescents. Journal of Autism and Developmental Disorders, 42(7), 1304–1313.CrossRefGoogle Scholar
  29. Matson, J. L., Hamilton, M., Duncan, D., Bamburg, J., Smiroldo, B., & Anderson, S. (1997). Characteristics of stereotypic movement disorder and self-injurious behavior assessed with the diagnostic assessment for the severely handicapped (DASH-II). Research in Developmental Disabilities, 26, 41–45.CrossRefGoogle Scholar
  30. Matson, J. L., Hess, J. A., & Boisjoli, J. A. (2010). Comorbid psychopathology in infants and toddlers with autism and pervasive developmental disorders-not otherwise specified (PDD-NOS). Research in Autism Spectrum Disorders, 4, 300–304.CrossRefGoogle Scholar
  31. McLennan, J. D., Lord, C., & Schopler, E. (1993). Sex differences in higher functioning people with autism. Journal of Autism and Developmental Disorders, 23(2), 217–227.PubMedCrossRefGoogle Scholar
  32. Muthugovindan, D., & Singer, H. (2009). Motor stereotypy disorders. Current Opinion in Neurology, 22(2), 131–136.PubMedCrossRefGoogle Scholar
  33. Nilsson, E. W., Gillberg, C., Carina Gillberg, I., & Råstam, M. (1999). Ten-year follow-up of adolescent-onset anorexia nervosa: Personality disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 38(11), 1389–1395.PubMedCrossRefGoogle Scholar
  34. Nordic Cochrane Centre, T. C. C. (2011). Review Manager (RevMan) [Computer program]. Version 5.1.Google Scholar
  35. Ozonoff, S., Iosif, A. M., Baguio, F., Cook, I. C., Hill, M. M., Hutman, T., et al. (2010). A prospective study of the emergence of early behavioral signs of autism. Journal of the American Academy of Child and Adolescent Psychiatry, 49(3), 256–266.PubMedCentralPubMedGoogle Scholar
  36. Park, S., Cho, S.-C., Cho, I. H., Kim, B.-N., Kim, J.-W., Shin, M.-S., et al. (2012). Sex differences in children with autism spectrum disorders compared with their unaffected siblings and typically developing children. Research in Autism Spectrum Disorders, 6(2), 861–870.CrossRefGoogle Scholar
  37. Rivet, T. T., & Matson, J. L. (2011a). Gender differences in core symptomatology in autism spectrum disorders across the lifespan. Journal of Developmental and Physical Disabilities, 23(5), 399–420.CrossRefGoogle Scholar
  38. Rivet, T. T., & Matson, J. L. (2011b). Review of gender differences in core symptomatology in autism spectrum disorders. Research in Autism Spectrum Disorders, 5(3), 957–976.CrossRefGoogle Scholar
  39. Rucklidge, J. J. (2010). Gender differences in attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America, 33(2), 357–373.PubMedCrossRefGoogle Scholar
  40. Russell, G., Steer, C., & Golding, J. (2011). Social and demographic factors that influence the diagnosis of autistic spectrum disorders. Social Psychiatry and Psychiatric Epidemiology, 46(12), 1283–1293.PubMedCrossRefGoogle Scholar
  41. Siklos, S., & Kerns, K. A. (2007). Assessing the diagnostic experiences of a small sample of parents of children with autism spectrum disorders. Research in Developmental Disabilities, 28(1), 9–22.PubMedCrossRefGoogle Scholar
  42. Sipes, M., Matson, J. L., Worley, J. A., & Kozlowski, A. M. (2011). Gender differences in symptoms of autism spectrum disorders in toddlers. Research in Autism Spectrum Disorders, 5(4), 1465–1470.CrossRefGoogle Scholar
  43. Solomon, M., Miller, M., Taylor, S. L., Hinshaw, S. P., & Carter, C. S. (2011). Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(1), 48–59.PubMedCentralCrossRefGoogle Scholar
  44. Sparrow, S. S., Balla, D., & Cicchetti, D. (1984). Vineland Adaptive Behavior Scales. Circle Pines: American Guidance Service.Google Scholar
  45. Spiker, D., Lotspeich, L. J., Dimiceli, S., Szatmari, P., Myers, R. M., & Risch, N. (2001). Birth order effects on nonverbal IQ scores in autism multiplex families. Journal of Autism and Developmental Disorders, 31(5), 449–460.PubMedCrossRefGoogle Scholar
  46. Tsai, L. Y., & Beisler, J. M. (1983). The development of sex differences in infantile autism. British Journal of Psychiatry, 142, 373–378.PubMedCrossRefGoogle Scholar
  47. Tsai, L., Stewart, M. A., & August, G. (1981). Implications of sex differences in the familial transmission of infantile autism. Journal of Autism and Developmental Disorders, 11(2), 165–173.PubMedCrossRefGoogle Scholar
  48. Volkmar, F. R., Szatmari, P., & Sparrow, S. S. (1993). Sex differences in pervasive developmental disorders. Journal of Autism and Developmental Disorders, 23(4), 579–591.PubMedCrossRefGoogle Scholar
  49. Werling, D. M., & Geschwind, D. H. (2013). Sex differences in autism spectrum disorders. Current Opinion in Neurology, 26(2), 146–153.PubMedCrossRefGoogle Scholar
  50. Wilkins, J., & Matson, J. L. (2009). A comparison of social skills profiles in intellectually disabled adults with and without ASD. Behavior Modification, 33, 143–155.PubMedCrossRefGoogle Scholar
  51. Worley, J. A., & Matson, J. L. (2010). Psychiatric symptoms in children diagnosed with an autism spectrum disorder: An examination of gender differences. Research in Autism Spectrum Disorders, 5(3), 1086–1091.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Patricia J. M. Van Wijngaarden-Cremers
    • 1
    • 2
    • 3
  • Evelien van Eeten
    • 2
    • 3
  • Wouter B. Groen
    • 2
    • 3
  • Patricia A. Van Deurzen
    • 2
    • 3
  • Iris J. Oosterling
    • 2
    • 3
  • Rutger Jan Van der Gaag
    • 2
    • 3
  1. 1.Department of Addiction and Developmental PsychiatryDimence GGz ZwolleZwolleThe Netherlands
  2. 2.University Medical Centre St RadboudNijmegenThe Netherlands
  3. 3.Karakter University Centre Child and Adolescent PsychiatryNijmegenThe Netherlands

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