What about the girls? Sex-based differences in autistic traits and adaptive skills
Open accessAbstract
There is growing evidence of a camouflaging effect among females with autism spectrum disorder (ASD), particularly among those without intellectual disability, which may affect performance on gold-standard diagnostic measures. This study utilized an age- and IQ-matched sample of school-aged youth (n = 228) diagnosed with ASD to assess sex differences on the ADOS and ADI-R, parent-reported autistic traits, and adaptive skills. Although females and males were rated similarly on gold-standard diagnostic measures overall, females with higher IQs were less likely to meet criteria on the ADI-R. Females were also found to be significantly more impaired on parent reported autistic traits and adaptive skills. Overall, the findings suggest that some autistic females may be missed by current diagnostic procedures.
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Females, particularly those with IQ in the average/above average range, are underdiagnosed with ASD.
“and females (particularly those with IQ in the average/above average range) are underdiagnosed with ASD (25).”
From The Relationship Between Generalised Joint Hypermobility and Autism Spectrum Disorder in Adults: A Large, Cross-Sectional, Case Control Comparison (2022) · cites this paper as [25]
Studies have shown that ASD prevalence is potentially underestimated in females, as autistic females could better escape diagnosis or ASD may only become evident in adolescence when social demands increase.
“Studies have shown that prevalence is potentially underestimated in females, as autistic females could better escape diagnosis or ASD may only become evident in adolescence when social demands increase (12, 54).”
From Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and Adolescents: A Systematic Literature Review (2021) · cites this paper as [12]
Across five internal-external discrepancy studies, autistic females with high autistic traits or diagnoses showed less autistic social behaviour than comparable males despite equivalent or poorer social communication, autistic traits, and theory of mind.
“autistic females with high autistic traits and/or autism diagnoses demonstrated less autistic social behaviour than males with autistic traits and/or autism diagnoses, despite having equivalent (or poorer) social communication skills, autistic traits, and ToM abilities”
From Camouflaging in autism: A systematic review (2021) · cites this paper as Ratto et al., 2018
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References 74 · Cited by 342
Research works printed but not linked: 8
- Boat TF Wu JT 2015 Prevalence of autism spectrum disorder Mental disorders and disabilities among low-income children 241 266 Washington, DC The National Academies Press 26632628
- Constantino JN Gruber C 2012 The Social Responsiveness Scale Manual, Second Edition (SRS-2) Los Angeles Western Psychological Services
- Elliot CD 2007 Differential Ability Scales–Second Edition (DAS-II) San Antonio, TX Harcourt Assessment
- Lord C Rutter M DiLavore P Risi S Gotham K Bishop S 2012 Autism Diagnostic Observation Schedule–2nd Edition (ADOS-2) Los Angeles Western Psychological Corporation
- Trubanova A Donlon K Kreiser NL Ollendick TH White SW 2014 Under-identification of ASD in females: A case series illustrating the unique presentation of ASD in young adult females Scandinavian Journal of Child and Adolescent Psychiatry and Psychology 2 2 66 76
- Wechsler D 2003 Wechsler Intelligence Scale for Children–Fourth Edition (WISC-IV) San Antonio, TX The Psychological Corporation
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- Authors
- Ratto, A. B., Kenworthy, L., Yerys, B. E., Bascom, J., Wieckowski, A. T., White, S. W., Wallace, G. L., Pugliese, C., Schultz, R. T., Ollendick, T. H., Scarpa, A., Seese, S., Register-Brown, K., Martin, A., & Anthony, L. G.
- Affiliations
- Children's National (US)
- Children's Hospital of Philadelphia (US)
- Virginia Tech (US)
- George Washington University (US)
- National Institutes of Health (US)
- Corresponding author
- Ratto, Allison B.
- ORCID
- Venue
- Journal of Autism and Developmental Disorders
- Published
- 2017-12-04
- Volume
- 48
- Issue
- 5
- Pages
- 1698-1711
- ISSN
- 0162-3257 (ISSN-L)
- 1573-3432
- PMC
- PMC5925757
- OpenAlex
- W2775059339
- Cited by
- 342
- References
- 74
- Citations by year
- 2026: 38 · 2025: 37 · 2024: 57 · 2023: 34 · 2022: 60 · 2021: 51 · 2020: 25 · 2019: 27 · 2018: 13
- FWCI
- 10.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Autism and Developmental Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Isadore and Bertha Gudelsky Family Foundation
- Children’s National Health Institute (IDDRC P30 HD040677)
- Pennsylvania State Department of Health
- The Philadelphia Foundation
- Pfizer
- Robert Wood Johnson Foundation
- Virginia Tech Center for Autism Research
- National Institute for Child Health and Human Development (R03HD081070)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
- Keywords
- autism spectrum disorder, sex differences, autistic traits, adaptive skills, camouflaging, autism diagnosis, Autism Diagnostic Observation Schedule, ADI-R, IQ, female autism, school-age adolescents
- MeSH terms
- Autism Spectrum Disorder, Adaptation, Psychological, Adolescent, Child, Female, Humans, Male, Intellectual Disability, Parents, Surveys and Questionnaires, Sex Characteristics, Case-Control Studies
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