We tested the hypothesis that prenatal masculinization of the brain by androgens increases risk of developing an autism spectrum condition (ASC). Sex-typical play was measured in n = 66 children diagnosed with an ASC and n = 55 typically developing age-matched controls. Consistent with the hypothesis, girls with autism did not show the female-typical play preferences, though this was only seen on non-pretence items. Boys with autism showed a preference for male play on non-pretence items, in keeping with their sex. Girls with autism engaged in more pretend play than boys with autism, suggesting that pretence is relatively more protected in females with autism. We conclude that play preference studies in ASC provide partial support for the fetal androgen theory.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
APA. (1994). DSM-IV diagnostic and statistical manual of mental disorders (4th ed). Washington DC: American Psychiatric Association.
Baron-Cohen, S. (1987). Autism and symbolic play. British Journal of Developmental Psychology, 5, 139–148.
Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in Cognitive Sciences, 6, 248–254.
Baron-Cohen, S., Knickmeyer, R. C., & Belmonte, M. K. (2005). Sex differences in the brain: Implications for explaining autism. Science, 310(5749), 819–823.
Baron-Cohen, S., Lutchmaya, S., & Knickmeyer, R. C. (2004). Prenatal testosterone in mind: Amniotic fluid studies. Cambridge, MA: MIT Press.
Bates, J. E., & Bentler, P. M. (1973). Play activities of normal and effeminate boys. Developmental Psychology, 9(1), 20–27.
Berenbaum, S. A., & Hines, M. (1992). Early androgens are related to childhood sex-typed toy preferences. Psychological Science, 3(3), 203–206.
Berenbaum, S. A., & Snyder, E. (1995). Early hormonal influences on childhood sex-typed activity and playmate preferences: Implications for the development of sexual orientation. Developmental Psychology, 31, 31–42.
Chapman, E., Baron-Cohen, S., Auyeung, B., Knickmeyer, R., Taylor, K., & Hackett, G. (2006). Fetal testosterone and empathy: Evidence from the empathy quotient (EQ) and the ‘Reading the Mind in the Eyes’ test. Journal of Social Neuroscience, 1, 135−148.
Creswell, C. S., & Skuse, D. H. (1999). Autism in association with turner syndrome: Genetic implications for male vulnerability to pervasive developmental disorders. Neurocase, 5, 511–518.
De Vries, G., & Simerly, R. B. (2002). Anatomy, development, and function of sexually dimorphic neural circuits in the mammalian brain. In D. Pfaff, A. Arnold, A. Etgen, S. Fahrbach, & R. Rubin (Eds.), Hormones, brain and behavior (Vol. IV, pp. 137–191). New York: Academic Press.
DiPietro, J. A. (1981). Rough and tumble play: A function of sex. Developmental Psychology, 17, 50–58.
Dittman, R. W., Kappes, M. H., Kappes, M. E., Borger, D., Stegner, H., Willig, R. H. et al. (1990). Congenital adrenal hyperplasia I: Sex related behaviour and attitudes in female patients and sisters. Psychoneuroendocrinology, 15, 401–420.
Ehrhardt, A. A., Epstein, R., & Money, J. (1968). Fetal androgens and female sex identity in the early treated adrenogenital syndrome. Johns Hopkins Medical Journal, 122, 160–167.
Finegan, J. A., Sitarenios, G., Bolan, P. L., & Sarabura, A. D. (1996). Children whose mothers had second trimester amniocentesis: Follow up at school age. Br J Obstet Gynaecol, 103(3), 214–218.
Greif, E. B. (1976). Sex role playing in pre-school children. In J. Bruner, A. Jolly, &K. Sylva (Eds.), Play-its role in development and evolution (pp. 385–393). Harmondsworth: Penguin Books Ltd.
Hazlett, H. C., Poe, M., Gerig, G., Smith, R. G., Provenzale, J., Ross, A. et al. (2005). Magnetic resonance Imaging and head circumference study of brain size in autism—Birth through age 2 years. Archives of General Psychiatry, 62(12), 1366–1376.
Hines, M., & Kaufman, F. R. (1994). Androgens and the development of human sex-typical behavior: Rough-and-tumble play and sex of preferred playmates in children with congenital adrenal hyperplasia (CAH). Child Development, 65, 1042–1053.
Humphreys, A. P., & Smith, P. K. (1984). Rough-and-tumble play in preschool, playground. In P. Smith (Ed.), Play in animals and humans (pp. 241–270). Oxford: Blackwell.
ICD-10. (1994). International classification of diseases (10th ed.). Geneva, Switzerland: World Health Organisation.
Ingudomnukul, E., Wheelwright, S., Baron-Cohen, S., & Knickmeyer, R. C. (2007). Elevated rates of testosterone-related disorders in women with autism spectrum conditions. Hormones and Behavior, 51(5), 597–604.
Jarrold, C., Boucher, J., & Smith, P. (1993). Symbolic play in autism: A review. Journal of Autism and Developmental Disorders, 23, 281–387.
Knickmeyer, R. C., & Baron-Cohen, S. (2006). Fetal testosterone and sex differences in typical social development and in autism. Journal of Child Neurology, 21(10), 825–845.
Knickmeyer, R. C., Wheelwright, S., Taylor, K., Raggatt, P., Hackett, G., & Baron-Cohen, S. (2005). Sex-typed play and amniotic testosterone. Developmental Psychology, 41(3), 517–528.
Lindsey, E. W., & Mize, J. (2001). Contextual differences in parent-child play: Implications for children’s sex role development. Sex Roles, 44(3/4), 155–176.
Lindsey, E. W., Mize, J., & Pettit, G. S. (1997). Differential play patterns of mothers and fathers of sons and daughters: Implications for children’s sex role development. Sex Roles, 37(9/10), 643–661.
Lutchmaya, S., Baron-Cohen, S., & Raggatt, P. (2002a). Foetal testosterone and eye contact in 12 month old infants. Infant Behaviour and Development, 25, 327–335.
Lutchmaya, S., Baron-Cohen, S., & Raggatt, P. (2002b). Foetal testosterone and vocabulary size in 18 and 24-month-old infants. Infant Behaviour and Development, 24(4), 418–424.
Lytton, H., & Romney, D. M. (1991). Parents’ differential socialization of boys and girls: A meta-analysis. Psychological Bulletin, 109(2), 267–296.
Nordenstrom, A., Servin, A., Bohlin, G., Larsson, A., & Wedell, A. (2002). Sex-typed toy play behavior correlates with the degree of prenatal androgen exposure assessed by the CYP21 genotype in girls with congenital adrenal hyperplasia. The Journal of Clinical Endocrinology and Metabolism, 87(11), 5119–5124.
Pellegrini, A. D., & Smith, P. K. (1998). Physical activity play: The nature and function of a neglected aspect of play. Child Development, 69, 577–598.
Servin, A., Nordenstrom, A., Larsson, A., & Bohlin, G. (2003). Prenatal androgens and sex-typed behavior: A study of girls with mild and sever forms of congenital adrenal hyperplasia. Developmental Psychology, 39(3), 440–450.
Simerly, R. B. (2002). Wired for reproduction: Organization and development of sexually dimorphic circuits in the mammalian forebrain. Annual Review of Neuroscience, 25, 507–536.
Skuse, D. H. (2000). Imprinting, the X-chromosome, and the male brain: Explaining sex differences in the liability to autism. Pediatric Research, 47, 9–16.
Skuse, D. H., James, R. S., Bishop, D. V. M., Coppins, B., Dalton, P., Aamondt-Leeper, G. et al. (1997). Evidence from Turner’s syndrome of an imprinted X-linked locus affecting cognitive function. Nature, 387(12), 705–708.
Sparks, B. F., Friedman, S. D., Shaw, D. W., Aylward, E. H., Echelard, D., Artru, A. A. et al. (2002). Brain structural abnormalities in young children with autism spectrum disorder. Neurology, 59(2), 184–192.
Tamis-LeMonda, C. S., & Bronstein, M. H. (1991). Individual variation, correspondence, stability, and change in mother and toddler play. Infant Behavior and Development, 14, 143–162.
Thomas, N. S., Sharp, A. J., Browne, C. E., Skuse, D., Hardie, C., & Dennis, N. R. (1999). Xp deletions associated with autism in three females. Human Genetics, 104, 43–48.
Vreugdenhil, H. J. I., Slijper, F. M. E., Mulder, P. G. H., & Weisglas-Kuperus, N. (2002). Effects of perinatal exposure to PCBs and dioxins on play behavior in Dutch children at school age. Environmental Health Perspectives, 110(10), A593–A598.
Zucker, K. J., Bradley, S. J., Oliver, G., Blake, J., Fleming, S., & Hood, J. (1996). Psychosexual development of women with congenital adrenal hyperplasia. Hormonal Behavior, 30(4), 300–318.
RK was supported by a British Government Overseas Research Studentship (ORS) and the Cambridge Overseas Trust. We are grateful to the Nancy Lurie Marks Family Foundation for supporting this work. SW and SBC were also supported by the Medical Research Council (MRC) UK. We are grateful to Ian Goodyer, Joe Herbert, John Manning, and Carrie Allison for their discussion of this work. This work was submitted as partial fulfillment of the degree of PhD, University of Cambridge by RK
Appendix: The children’s play questionnaire
Appendix: The children’s play questionnaire
Child’s name –––––––––––––Your name–––––––––––––
Date of birth –––––––––––––Today’s date –––––––––––––
In this section you will find a list of games or activities that children may play. Read through the list and indicate how interested your child would be in each game by ticking the right box. 1 means not at all interested, 3 is somewhat interested, and 5 is very interested
|1 not at all interested||2||3 somewhat interested||4||5 very interested|
|Playing with Barbie-type dolls*|
|Pretending to be a soldier**|
|Looking at picture books|
|Role-playing domestic activities (eg cooking, cleaning, bathing)*|
|Pretending to be a superhero**|
|Playing with toy guns or other weapons**|
|Playing with stuffed animals|
|Playing dress up (fashion/jewelry)*|
|Playing with toy cars and trucks**|
|Riding on tricycles/bicycles|
|Role-playing family relationships (eg parenting/marriage)*|
|Pretending to be an astronaut (space-man) or explorer**|
|Skipping rope or skipping*|
|Playing with toy tools**|
|Playing with electric trains**|
|Playing school (pretending to be a teacher)*|
|Playing on swings|
|Playing Cowboys and Indians or similar**|
|Playing on see-saws|
|Playing with toy airplanes**|
|Playing with hair (e.g., brushing someone else’s hair)*|
|Playing board-games (e.g.,Ludo, Snakes and Ladders)|
|Playing with baby dolls*|
About this article
Cite this article
Knickmeyer, R.C., Wheelwright, S. & Baron-Cohen, S.B. Sex-typical Play: Masculinization/Defeminization in Girls with an Autism Spectrum Condition. J Autism Dev Disord 38, 1028–1035 (2008). https://doi.org/10.1007/s10803-007-0475-0
- Sex differences
- Fetal testosterone