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Sex Differences in the Developmental Trajectories of Autism Spectrum Disorder

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Abstract 

Purpose of Review

Females and males are disproportionately diagnosed with autism, a sex difference that has historically represented this neurodevelopmental condition. The current review examines lifespan developmental trajectories of autism based on sex to elucidate behavioral phenotypic differences that may contribute to differential rates of diagnosis.

Recent Findings

We review sex differences in diagnostic criteria: social communication and restricted interests/repetitive behaviors (RRBs). Results suggest RRBs are more indicative of a diagnosis in males, whereas social differences are more indicative of a diagnosis in females. Factors contributing to a later diagnosis in females include social strengths (camouflaging) and diagnostic overshadowing.

Summary

Sex differences in diagnostic criteria may contribute to differential rates of identification in males and females. Sex differences are most pronounced when assessing naturalistic social communication instead of reliance on standardized measure. Numerous future directions are identified including increasing samples of sub-threshold autistic females and evaluating longitudinal sex differences.

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Funding

This research was supported by 3KL2TR002490-03S1 (Rebecca Grzadzinski), a training grant from the US Department of Education (H325D180099; Orla Putnam), and a training fellowship from NICHD (T32 HD040127-21; Tyler McFayden).

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Authors and Affiliations

  1. Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Tyler C. McFayden & Rebecca Grzadzinski

  2. Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Orla Putnam & Clare Harrop

  3. TEACCH Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Clare Harrop

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  1. Tyler C. McFayden
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  2. Orla Putnam
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  3. Rebecca Grzadzinski
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  4. Clare Harrop
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Contributions

TCM: data curation, writing—original draft, writing—editing and revising, visualization, project management. OP: data curation, writing—original draft, writing—editing and revising, visualization. RG: writing—original draft, writing—editing and revising, visualization, supervision. CH: data curation, writing—original draft, writing—editing and revising, visualization, resources, supervision.

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Correspondence to Tyler C. McFayden.

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McFayden, T.C., Putnam, O., Grzadzinski, R. et al. Sex Differences in the Developmental Trajectories of Autism Spectrum Disorder. Curr Dev Disord Rep 10, 80–91 (2023). https://doi.org/10.1007/s40474-023-00270-y

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