Skip to main content
SpringerLink
Log in

Sex Differences in Internalizing Problems During Adolescence in Autism Spectrum Disorder

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

We hypothesized that the double hit conferred by sex and diagnosis increases the risk for internalizing disorders in adolescent females with autism spectrum disorder (ASD). In a sample of 32 adolescents with ASD and 32 controls, we examined the effects of sex, diagnostic factors, and developmental stages on depression and anxiety. A 3-way interaction revealed that females with ASD exhibited greater depressive symptoms than males with ASD and female controls particularly during early adolescence; therefore, females with ASD might have a unique combination of genetic, hormonal, and psychosocial vulnerabilities that heighten their risk for depression during early adolescence. Additionally, the ASD group reported high levels of separation anxiety and panic in late adolescence, possibly indicating atypical development of independence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Alloy, L. B., Abramson, L. Y., Hogan, M. E., Whitehouse, W. G., Rose, D. T., Robinson, M. S., & Joanna, B. (2000). The temple-Wisconsin cognitive vulnerability to depression project: Lifetime history of Axis I psychopathology in individuals at high and low cognitive risk for depression. Journal of Abnormal Psychology, 109, 403–418.

    Article  PubMed  Google Scholar 

  • Angold, A., Costello, E. J., Erkanl, A., & Worthman, C. M. (1999). Pubertal changes in hormone levels and depression in girls. Psychological Medicine, 29, 1043–1053.

    Article  PubMed  Google Scholar 

  • Angold, A., Costello, E. J., & Worthman, C. M. (1998). Puberty and depression: The roles of age, pubertal status and pubertal timing. Psychological Medicine, 28, 51–61.

    Article  PubMed  Google Scholar 

  • Angold, A., & Rutter, M. (1992). Effects of age and pubertal status on depression in a large clinical sample. Development and Psychopathology, 4, 5–28.

    Article  Google Scholar 

  • Angst, J., & Dobler-Mikola, A. (1985). The Zurich study: VI. A continuum from depression to anxiety disorders? European Archives of Psychiatry & Neurological Sciences, 235(3), 179–186.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Bellini, S. (2004). Social skills and anxiety in higher functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 19(3), 78–86.

    Article  Google Scholar 

  • Bitsika, V., Sharpley, C. F., Sweeney, J. A., & McFarlane, J. R. (2014). HPA and SAM axis responses as correlates of self-vs parental ratings of anxiety in boys with an Autistic Disorder. Physiology & Behavior, 127, 1–7.

    Article  Google Scholar 

  • Brereton, A. V., Tonge, B. J., & Einfeld, S. L. (2006). Psychopathology in children and adolescents with autism compared to young people with intellectual disability. Journal of Autism and Developmental Disorders, 36(7), 863–870.

    Article  PubMed  Google Scholar 

  • Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., & Keller, M. B. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. American Journal of Psychiatry, 162(6), 1179–1187.

    Article  PubMed Central  PubMed  Google Scholar 

  • CDC. (2014). Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill Summ, 63, 1–21.

    Google Scholar 

  • Chamberlain, B., Kasari, C., & Rotheram-Fuller, E. (2007). Involvement or isolation? The social networks of children with autism in regular classrooms. Journal of Autism and Developmental Disorders, 37(2), 230–242.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behavior Research and Therapy, 38, 835–855.

    Article  Google Scholar 

  • Cohen, P., Cohen, J., Kasen, S., Johnson, J., Rojas, M., Brook, J., et al. (1993). An epidemiological study of disorders in late childhood and adolescence: Age- and gender-specific prevalence. The Journal of Child Psychology and Psychiatry, 34(6), 851–867.

    Article  PubMed  Google Scholar 

  • Crane, L., Goddard, L., & Pring, L. (2013). Autobiographical memory in adults with autism spectrum disorder: The role of depressed mood, rumination, working memory and theory of mind. Autism, 17(2), 205–219.

    Article  PubMed  Google Scholar 

  • Culbertson, F. M. (1997). Depression and gender: An international review. American Psychologist, 52(1), 25–31.

    Article  PubMed  Google Scholar 

  • Dixon, W. J., & Tukey, J. W. (1968). Approximate behavior of the distribution of Winsorized t (Trimming/Winsorization 2). Technometrics, 10, 83–98.

    Google Scholar 

  • Dunn, O. J. (1964). Multiple comparisons using rank sums. Technometrics, 6, 241–252.

    Article  Google Scholar 

  • Ebesutani, C., Bernstein, A., Nakamura, B. J., Chorpita, B. F., Weisz, J. R., & Research Network on Youth Mental Health. (2010). A psychometric analysis of the revised child anxiety and depression scale—Parent version in a clinical sample. Journal of Abnormal Child Psychology, 38(2), 249–260.

    Article  PubMed Central  PubMed  Google Scholar 

  • Essau, C. A., Conradt, J., & Petermann, F. (2000). Frequency, comorbidity, and psychosocial impairment of anxiety disorders in German adolescents. Journal of Anxiety Disorders, 14(3), 263–279.

    Article  PubMed  Google Scholar 

  • Gadow, K. D., Guttmann-Steinmetz, S., Rieffe, C., & DeVincent, C. J. (2012). Depression symptoms in boys with autism spectrum disorder and comparison samples. Journal of Autism and Developmental Disorders, 42(7), 1353–1363.

    Article  PubMed  Google Scholar 

  • Ghaziuddin, M., Ghaziuddin, N., & Greden, J. (2002). Depression in persons with autism: Implications for research and clinical care. Journal of Autism and Developmental Disorders, 34(2), 299–306.

    Article  Google Scholar 

  • Ghaziuddin, M., & Greden, J. (1998). Depression in children with autism/pervasive developmental disorders: A case–control family history study. Journal of Autism and Developmental Disorders, 28(2), 111–115.

    Article  PubMed  Google Scholar 

  • Gillott, A., Furniss, F., & Walter, A. (2001). Anxiety in high-functioning children with autism. Autism, 5(3), 277–286.

    Article  PubMed  Google Scholar 

  • Gotham, K., Bishop, S. L., Brunwasser, S., & Lord, C. (2014). Rumination and perceived impairment associated with depressive symptoms in a verbal adolescent–adult ASD sample. Autism Research, 7(3), 381–391.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hammond, R. K., & Hoffman, J. M. (2014). Adolescents with high-functioning autism: An investigation of comorbid anxiety and depression. Journal of Mental Health Research in Intellectual Disabilities, 7(3), 246–263.

    Article  Google Scholar 

  • Hankin, B. L., Abramson, L. Y., Moffitt, T. E., Silva, P. A., McGee, R., & Angell, K. E. (1998). Development of depression from preadolescence to young adulthood: Emerging gender differences in a 10-year longitudinal study. Journal of Abnormal Psychology, 107(1), 128–140.

    Article  PubMed  Google Scholar 

  • Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45(2), 212–229.

    Article  PubMed  Google Scholar 

  • Interagency Autism Coordinating Committee (IACC). (2012). ACC strategic plan for autism spectrum disorder (ASD) research—2012 update.

  • Johnson, S. A., Filliter, J. H., & Murphy, R. R. (2009). Discrepancies between self-and parent-perceptions of autistic traits and empathy in high functioning children and adolescents on the autism spectrum. Journal of Autism and Developmental Disorders, 39(12), 1706–1714.

    Article  PubMed  Google Scholar 

  • Kanne, S. M., Christ, S. E., & Reiersen, A. M. (2009). Psychiatric symptoms and psychosocial difficulties in young adults with autistic traits. Journal of Autism and Developmental Disorders, 39(6), 827–833.

    Article  PubMed  Google Scholar 

  • Kaufman, A. S., & Kaufman, N. L. (1990). Kaufman brief intelligence test manual. Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Kessler, R. C., McGonagle, K. A., Nelson, C. B., Hughes, M., Swartz, M., & Blazer, D. G. (1994). Sex and depression in the national comorbidity survey. II: Cohort effects. Journal of Affective Disorders, 30(1), 15–26.

    Article  PubMed  Google Scholar 

  • Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4(2), 117–132.

    Article  Google Scholar 

  • Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A. S., Mattila, M. L., Ebeling, H., & Moilanen, I. (2008). Social anxiety in high-functioning children and adolescents with autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 38(9), 1697–1709.

    Article  PubMed  Google Scholar 

  • Ladd, G. W. (2006). Peer rejection, aggressive or withdrawn behavior, and psychological maladjustment from ages 5 to 12: An examination of four predictive models. Child Development, 77(4), 822–846.

    Article  PubMed  Google Scholar 

  • Lainhart, J. E. (1999). Psychiatric problems in individuals with autism, their parents and siblings. International Review of Psychiatry, 11(4), 278–298.

    Article  Google Scholar 

  • Lerner, M. D., Calhoun, C. D., Mikami, A. Y., & De Los Reyes, A. (2012). Understanding parent–child social informant discrepancy in youth with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(12), 2680–2692.

    Article  PubMed  Google Scholar 

  • March, J. S., Parker, J., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional Scale for Children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 554–565.

    Article  PubMed  Google Scholar 

  • March, J. S., Sullivan, K., & Parker, J. (1999). Test–retest reliability of the Multidimensional Anxiety Scale for children. Journal of Anxiety Disorders, 13(4), 349–358.

    Article  PubMed  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Murray, M. J., Ahuja, M., & Smith, L. A. (2011). Anxiety, depression, and irritability in children with autism relative to other neuropsychiatric disorders and typical development. Research in Autism Spectrum Disorders, 5(1), 474–485.

    Article  Google Scholar 

  • Mazurek, M. O., & Kanne, S. M. (2010). Friendship and internalizing symptoms among children and adolescents with ASD. Journal of Autism and Developmental Disorders, 40(12), 1512–1520.

    Article  PubMed  Google Scholar 

  • McGillivray, J. A., & Evert, H. T. (2014). Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. Journal of Autism and Developmental Disorders, 44(8), 2041–2051.

    Article  PubMed  Google Scholar 

  • McMahon, C. M., & Solomon, M. (2015). Brief report: Parent–adolescent informant discrepancies of social skill importance and social skill engagement for higher-functioning adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(10), 3369–3403.

    Article  Google Scholar 

  • Myles, B. S., Bock, S. J., & Simpson, R. L. (2001). Asperger syndrome diagnostic scale. Austin, TX: Pro-ed.

    Google Scholar 

  • Newman, L., Wagner, M., Knokey, A. M., Marder, C., Nagle, K., Shaver, D., et al. (2011). The post-high school outcomes of young adults with disabilities up to 8 years after high school: A report from the National Longitudinal Transition Study-2 (NLTS2). NCSER 2011-3005. National Center for Special Education Research.

  • Nolen-Hoeksema, S., & Girgus, J. S. (1994). The emergence of gender differences in depression during adolescence. Psychological Bulletin, 115(3), 424.

    Article  PubMed  Google Scholar 

  • Ozsivadjian, A., Hibberd, C., & Hollocks, M. J. (2014). Brief report: The use of self-report measures in young people with autism spectrum disorder to access symptoms of anxiety, depression and negative thoughts. Journal of Autism and Developmental Disorders, 44(4), 969–974.

    Article  PubMed  Google Scholar 

  • Pedersen, S., Vitaro, F., Barker, E. D., & Borge, A. I. H. (2007). The timing of middle-childhood peer rejection and friendship: Linking early behavior to early-adolescent adjustment. Child Development, 78, 1037–1051.

    Article  PubMed  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • Regier, D. A., Narrow, W. E., & Rae, D. S. (1990). The epidemiology of anxiety disorders: The epidemiologic catchment area (ECA) experience. Journal of Psychiatric Research, 24(2), 3–14.

    Article  PubMed  Google Scholar 

  • Roberts, R. E., Andrews, J. A., Lewinsohn, P. M., & Hops, H. (1990). Assessment of depression in adolescents using the center for epidemiologic studies depression scale. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 2(2), 122–128.

    Article  Google Scholar 

  • Robinson, M. S., & Alloy, L. B. (2003). Negative cognitive styles and stress-reactive rumination interact to predict depression: A prospective study. Cognitive Therapy and Research, 27(3), 275–291.

    Article  Google Scholar 

  • Russell, A. J., Jassi, A., Fullana, M. A., Mack, H., Johnston, K., Heyman, I., & Mataix-Cols, D. (2013). Cognitive behavior therapy for comorbid obsessive–compulsive disorder in high-functioning autism spectrum disorders: A randomized controlled trial. Depression and Anxiety, 30(8), 697–708.

    Article  PubMed  Google Scholar 

  • Saluja, G., Iachan, R., Scheidt, P. C., Overpeck, M. D., Sun, W., & Giedd, J. N. (2004). Prevalence of and risk factors for depressive symptoms among young adolescents. Archives of Pediatrics and Adolescent Medicine, 158(8), 760–765.

    Article  PubMed  Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929.

    Article  PubMed  Google Scholar 

  • Solomon, M., Miller, M., Taylor, S. L., Hinshaw, S. P., & Carter, C. S. (2012). Autism symptoms in internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of Autism Developmental Disorders, 42(1), 48–59.

    Article  PubMed Central  PubMed  Google Scholar 

  • Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.

    Article  PubMed  Google Scholar 

  • Sterling, L., Renno, P., Storch, E. A., Ehrenreich-May, J., Lewin, A. B., Arnold, E., & Wood, J. (2015). Validity of the Revised Children’s Anxiety and Depression Scale for youth with autism spectrum disorders. Autism, 19(1), 113–117.

    Article  PubMed  Google Scholar 

  • Storch, E. A., Lewin, A. B., Collier, A. B., Arnold, E., De Nadai, A. S., Dane, B. F., & Murphy, T. K. (2014). A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety. Depression and Anxiety, 32(3), 174–181.

    Article  PubMed  Google Scholar 

  • Strang, J. F., Kenworthy, L., Daniolos, P., Case, L., Wills, M. C., Martin, A., & Wallace, G. L. (2012). Depression and anxiety symptoms in children and adolescents with autism spectrum disorders without intellectual disability. Research in Autism Spectrum Disorders, 6(1), 406–412.

    Article  PubMed Central  PubMed  Google Scholar 

  • Stratis, E. A., & Lecavalier, L. (2015). Informant agreement for youth with autism spectrum disorder or intellectual disability: A meta-analysis. Journal of Autism and Developmental Disorders, 45(4), 1026–1041.

    Article  PubMed  Google Scholar 

  • Stroud, L. R., Salovey, P., & Epel, E. S. (2002). Sex differences in stress responses: Social rejection versus achievement stress. Biological Psychiatry, 52(4), 318–327.

    Article  PubMed  Google Scholar 

  • Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., & Vitiello, B. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36(1), 117–128.

    Article  PubMed  Google Scholar 

  • Szatmari, S., Bartolucci, G., Bremner, R., Bond, S., & Rich, S. (1989). A follow-up study of high-functioning autistic children. Journal of Autism and Developmental Disorders, 19(2), 213–225.

    Article  PubMed  Google Scholar 

  • Van Oort, F., Greaves-Lord, K., Verhulst, F., Ormel, J., & Huizink, A. (2009). The developmental course of anxiety symptoms during adolescence: The TRAILS study. The Journal of Child Psychology and Psychiatry, 50(10), 1209–1217.

    Article  PubMed  Google Scholar 

  • Velez, C. N., Johnson, J., & Cohen, P. (1989). A longitudinal analysis of selected risk factors for childhood psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 28(6), 861–864.

    Article  PubMed  Google Scholar 

  • Vickerstaff, S., Heriot, S., Wong, M., Lopes, A., & Dossetor, D. (2007). Intellectual ability, self-perceived social competence, and depressive symptomatology in children with high-functioning autistic spectrum disorders. Journal of Autism and Developmental Disorders, 37(9), 1647–1664.

    Article  PubMed  Google Scholar 

  • Wehmeyer, M. L., Shogren, K. A., Zager, D., Smith, T. C., & Simpson, R. (2010). Research-based principles and practices for educating students with autism: Self-determination and social interactions. Education And Training In Autism And Developmental Disabilities, 45(4), 475–486.

    Google Scholar 

  • Weisbrot, D. M., Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child & Adolescent Psychopharmacology, 15(3), 477–496.

    Article  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wing, L. (1981). Asperger’s syndrome: A clinical account. Psychological Medicine, 11(01), 115–129.

    Article  PubMed  Google Scholar 

  • Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50, 224–234.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wood, J. J., Ehrenreich-May, J., Alessandri, M., Fujii, C., Renno, P., Laugeson, E., & Storch, E. A. (2015). Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: A randomized, controlled trial. Behavior Therapy, 46(1), 7–19.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge the departmental funding from the University of Oregon Department of Psychology that made this study possible. We sincerely appreciate the families who participated in this study and our research assistants, in particular Cord Chen, Ingrid Gomez, and Christina Palmrose for their efforts and dedication to the research project.

Author Contributions

TMO conceived of the study, participated in its design, coordination, data collection, and interpretation, performed statistical analyses and drafted the manuscript; MWM participated in the design, coordination, data collection, and interpretation of the data; BG participated in the design, data collection, and interpretation, and performed statistical analyses; AS participated in the coordination, data collection, and interpretation of the study; CH participated in its design and coordination. MS participated in interpretation of the data and helped to draft the manuscript. All authors read and approved the final manuscript.

Author information

Author notes

  1. Tasha M. Oswald

    Present address: Department of Psychiatry and Behavioral Sciences, U.C. Davis Medical Center, M.I.N.D. Institute, University of California Davis School of Medicine, 2825 50th Street, Sacramento, CA, 95817, USA

  2. Mary Ann Winter-Messiers

    Present address: Department of Psychology, Northwest Christian University, 828 E 11th Ave, Eugene, OR, 97401, USA

  3. Brandon Gibson

    Present address: Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR, 97401, USA

  4. Alexandra M. Schmidt

    Present address: School of Professional Psychology, Pacific University, 190 SE 8th Ave, Hillsboro, OR, 97123, USA

Authors and Affiliations

  1. Department of Psychology, 1227 University of Oregon, Eugene, OR, 97403, USA

    Tasha M. Oswald, Brandon Gibson & Alexandra M. Schmidt

  2. College of Education, 1215 University of Oregon, Eugene, OR, 97403-1215, USA

    Mary Ann Winter-Messiers & Cynthia M. Herr

  3. Department of Psychiatry and Behavioral Sciences, U.C. Davis Medical Center, M.I.N.D. Institute, University of California Davis School of Medicine, 2825 50th Street, Sacramento, CA, 95817, USA

    Marjorie Solomon

Authors
  1. Tasha M. Oswald
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary Ann Winter-Messiers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brandon Gibson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexandra M. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cynthia M. Herr
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marjorie Solomon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tasha M. Oswald.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oswald, T.M., Winter-Messiers, M.A., Gibson, B. et al. Sex Differences in Internalizing Problems During Adolescence in Autism Spectrum Disorder. J Autism Dev Disord 46, 624–636 (2016). https://doi.org/10.1007/s10803-015-2608-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-015-2608-1

Keywords

Search

Navigation