Journal of Autism and Developmental Disorders

, Volume 43, Issue 5, pp 1151–1156

Sex Differences in the Timing of Identification Among Children and Adults with Autism Spectrum Disorders

  • Sander Begeer
  • David Mandell
  • Bernadette Wijnker-Holmes
  • Stance Venderbosch
  • Dorien Rem
  • Fred Stekelenburg
  • Hans M. Koot
Article

Abstract

To examine differences by sex in the timing of identification of individuals with autism spectrum disorders (ASD), survey data were collected in the Netherlands from 2,275 males and females with autistic disorder, Asperger’s syndrome and PDD-NOS. Among participants <18 years of age, females with Asperger’s syndrome were identified later than males. Among participants ≥18 years of age, females with autistic disorder were identified later than males. In more recent years, girls with Asperger’s syndrome are diagnosed later than boys, confirming earlier findings. In adults, the delayed timing of diagnosis in females with autistic disorder may be related to changing practices in diagnosis over time. Strategies for changing clinician behaviour to improve recognition of ASD in females are needed.

Keywords

Autism Identification Sex Asperger’s syndrome Diagnosis 

References

  1. Baird, G., Douglas, H. R., & Murphy, M. S. (2011). GUIDELINES recognising and diagnosing autism in children and young people: Summary of NICE guidance. British Medical Journal, 343, d6360.PubMedCrossRefGoogle Scholar
  2. 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, 188–193.PubMedCrossRefGoogle Scholar
  3. Barbaro, J., & Dissanayake, C. (2009). Autism spectrum disorders in infancy and toddlerhood: A review of the evidence on early signs, early identification tools, and early diagnosis. Journal of Developmental and Behavioral Pediatrics, 30, 447–459.PubMedCrossRefGoogle Scholar
  4. Begeer, S., El Bouk, S., Boussaid, W., Terwogt, M. M., & Koot, H. M. (2009). Underdiagnosis and referral bias of autism in ethnic minorities. Journal of Autism and Developmental Disorders, 39, 142–148.PubMedCrossRefGoogle Scholar
  5. 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, 86–97.PubMedCrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders–autism and developmental disabilities monitoring network, United States, 2008. MMWR, 61, 1–19.Google Scholar
  7. Centraal Bureau voor de Statistiek. (2008). Provincie op maat. Den Haag: CBS.Google Scholar
  8. Crick, N. R., & Zahn-Waxler, C. (2003). The development of psychopathology in females and males: Current progress and future challenges. Development and Psychopathology, 15, 719–742.PubMedCrossRefGoogle Scholar
  9. Dawson, G. (2008). Early behaviorial intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and Psychopathology, 20, 775–803.PubMedCrossRefGoogle Scholar
  10. Emerson, E. (2012). Deprivation, ethnicity and the prevalence of intellectual and developmental disabilities. Journal of Epidemiology and Community Health, 66, 218–224.PubMedCrossRefGoogle Scholar
  11. Filipek, P. A., Accardo, P. J., Baranek, G. T., Cook, E. H., Dawson, G., Gordon, B., et al. (1999). The screening and diagnosis of autistic spectrum disorders. Journal of Autism and Developmental Disorders, 29, 439–484.PubMedCrossRefGoogle Scholar
  12. Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental disorders: An update. Journal of Autism and Developmental Disorders, 33, 365–382.PubMedCrossRefGoogle Scholar
  13. Fountain, C., King, M. D., & Bearman, P. S. (2011). Age of diagnosis for autism: Individual and community factors across 10 birth cohorts. Journal of Epidemiology and Community Health, 65, 503–510.PubMedCrossRefGoogle Scholar
  14. Fujiwara, T., Okuyama, M., & Funahashi, K. (2011). Factors influencing time lag between first parental concern and first visit to child psychiatric services in children with autism spectrum disorders in Japan. Research in Autism Spectrum Disorders, 5, 584–591.CrossRefGoogle Scholar
  15. 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, 107–116.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 behaviour problems in toddlers. Journal of Autism and Developmental Disorders, 39, 1715–1722.PubMedCrossRefGoogle Scholar
  17. Hertz-Picciotto, I., & Delwiche, L. (2009). The rise in autism and the role of age at diagnosis. Epidemiology, 20, 84–90.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, 361–366.PubMedCrossRefGoogle Scholar
  19. Horovitz, M., Matson, J. L., & Sipes, M. (2011). Gender differences in symptoms of comorbidity in toddlers with ASD using the BISCUIT-Part 2. Developmental Neurorehabilitation, 14, 94–100.PubMedCrossRefGoogle Scholar
  20. Horovitz, M., Matson, J. L., Turygin, N., & Beighley, J. S. (2012). The relationship between gender and age of first concern in toddlers with autism spectrum disorders. Research in Autism Spectrum Disorders, 6(1), 466–471.CrossRefGoogle Scholar
  21. Klin, A., Jones, W., Schultz, R., & Volkmar, F. (2003). The enactive mind, or from actions to cognition: Lessons from autism. Philosophical Transactions of the Royal Society of London. Series B, Biological sciences, 358, 345–360.PubMedCrossRefGoogle 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, 2875–2888.PubMedCrossRefGoogle Scholar
  23. Lord, C. (1995). Follow-up of two-year-olds referred for possible autism. Journal of Child Psychology and Psychiatry, 36, 1365–1382.PubMedCrossRefGoogle Scholar
  24. Lord, C., Schopler, E., & Revicki, D. (1982). Sex-differences in autism. Journal of Autism and Developmental Disorders, 12, 317–330.PubMedCrossRefGoogle Scholar
  25. Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics, 116, 1480–1486.PubMedCrossRefGoogle Scholar
  26. Mayes, S. D., & Calhoun, S. L. (2011). Impact of IQ, age, SES, gender, and race on autistic symptoms. Research in Autism Spectrum Disorders, 5, 749–757.CrossRefGoogle Scholar
  27. 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
  28. Nederlandse Vereniging voor Autisme (NVA). (2008). Een plek om te leven. Een onderzoek naar de leefsituatie van mensen met autisme (A place to live. A study on the daily circumstances of individual with autism). Bilthoven: NVA.Google Scholar
  29. Ouellette-Kuntz, H. M. J., Coo, H., Lam, M., Yu, C. T., Breitenbach, M. M., Hennessey, P. E., et al. (2009). Age at diagnosis of autism spectrum disorders in four regions of Canada. Canadian Journal of Public Health-Revue Canadienne de Sante Publique, 100, 268–273.PubMedGoogle Scholar
  30. Reichow, B. (2012). Overview of meta-analyses on early intensive behavioral intervention for young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 512–520.PubMedCrossRefGoogle Scholar
  31. 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, 399–420.CrossRefGoogle Scholar
  32. 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
  33. Shattuck, P. T., Durkin, M., Maenner, M., Newschaffer, C., Mandell, D. S., Wiggins, L., et al. (2009). Timing of identification among children with an autism spectrum disorder: Findings from a population-based surveillance study. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 474–483.PubMedCrossRefGoogle Scholar
  34. Volkmar, F. R., Bregman, J., Cohen, D. J., & Cicchetti, D. V. (1988). Dsm-Iii and Dsm-Iii-R diagnoses of autism. American Journal of Psychiatry, 145, 1404–1408.PubMedGoogle Scholar
  35. Wiggins, L. D., Baio, J., & Rice, C. (2006). Examination of the time between first evaluation and first autism spectrum diagnosis in a population-based sample. Journal of Developmental and Behavioral Pediatrics, 27, S79–S87.PubMedCrossRefGoogle Scholar
  36. Wing, L. (1981). Sex-ratios in early-childhood autism and related conditions. Psychiatry Research, 5, 129–137.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Sander Begeer
    • 1
    • 4
  • David Mandell
    • 2
  • Bernadette Wijnker-Holmes
    • 3
  • Stance Venderbosch
    • 3
  • Dorien Rem
    • 3
    • 5
  • Fred Stekelenburg
    • 3
  • Hans M. Koot
    • 4
  1. 1.School of PsychologyUniversity of SydneySydneyAustralia
  2. 2.University of PennsylvaniaPhiladelphiaUSA
  3. 3.Nederlandse Vereniging voor AutismeBilthovenThe Netherlands
  4. 4.Department of Developmental PsychologyVU University AmsterdamAmsterdamThe Netherlands
  5. 5.Utrecht UniversityUtrechtThe Netherlands

Personalised recommendations