Sex differences in autism spectrum disorder: a review
Open accessAbstract
Purpose of review Neurodevelopmental disorders disproportionately affect males. The mechanisms underlying male vulnerability or female protection are not known and remain understudied. Determining the processes involved is crucial to understanding the etiology and advancing treatment of neurodevelopmental disorders. Here, we review current findings and theories that contribute to male preponderance of neurodevelopmental disorders, with a focus on autism.Recent findings Recent work on the biological basis of the male preponderance of autism and other neurodevelopmental disorders includes discussion of a higher genetic burden in females and sex-specific gene mutations or epigenetic changes that differentially confer risk to males or protection to females. Other mechanisms discussed are sex chromosome and sex hormone involvement. Specifically, fetal testosterone is involved in many aspects of development and may interact with neurotransmitter, neuropeptide, or immune pathways to contribute to male vulnerability. Finally, the possibilities of female underdiagnosis and a multi-hit hypothesis are discussed. This review highlights current theories of male bias in developmental disorders. Topics include environmental, genetic, and epigenetic mechanisms; theories of sex chromosomes, hormones, neuroendocrine, and immune function; underdiagnosis of females; and a multi-hit hypothesis.
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ASD is approximately 4 times more prevalent in boys than in girls.
“ASD is ~4 times more prevalent in boys than in girls (16, 31).”
From Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness (2022) · cites this paper as [31]
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Veenit, V., Riccio, O., & Sandi, C. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.02.015 · Cited by 45 · see citing works
Sex differences in frontal lobe connectivity in adults with autism spectrum conditions
Zeestraten, E., Gudbrandsen, M., Daly, E., de Schotten, M. T., Catani, M., Dell’Acqua, F., Lai, M.-C., Ruigrok, A. N. V., Lombardo, M. V., Chakrabarti, B., et al. (2017) · Translational Psychiatry · doi:10.1038/tp.2017.9 · Cited by 43 · see citing works
Toft, A. K. H., Lundbye, C. J., & Banke, T. G. (2016) · Journal of Neuroscience · doi:10.1523/jneurosci.3038-15.2016 · Cited by 41 · see citing works
Harrop, C., Gulsrud, A. C., & Kasari, C. L. (2015) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2511-9 · Cited by 40 · see citing works
High (feminized) digit ratio (2D : 4D) in Danish men: a question of measurement method?
Voracek, M., & Dressler, S. G. (2006) · Human Reproduction · doi:10.1093/humrep/dei464 · Cited by 39 · see citing works
Possible sexually dimorphic role of miRNA and other sncRNA in ASD brain
Schumann, C. M., Sharp, F. R., Ander, B. P., & Stamova, B. S. (2017) · Molecular Autism · doi:10.1186/s13229-017-0117-0 · Cited by 39 · see citing works
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Positive and negative gaze perception in autism spectrum conditions
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Guyatt, A. L., Heron, J., Knight, B., Golding, J., & Rai, D. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007433 · Cited by 35 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [32]http://autismsciencefoundation.org/about-asf/media-center/press-releases/autism-sisters-project/.
Cited by
Sorted by citations
The contribution of environmental exposure to the etiology of autism spectrum disorder
Bölte, S., Girdler, S., & Marschik, P. B. (2019) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-018-2988-4 · Cited by 509 · see citing works
Demetriou, E. A., DeMayo, M. M., & Guastella, A. J. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00753 · Cited by 274 · see citing works
Sex differences in neurodevelopmental disorders
May, T., Adesina, I., McGillivray, J., & Rinehart, N. J. (2019) · Current Opinion in Neurology · doi:10.1097/wco.0000000000000714 · Cited by 235 · see citing works
Walsh, M. J. M., Wallace, G. L., Gallegos, S. M., & Braden, B. B. (2021) · NeuroImage: Clinical · doi:10.1016/j.nicl.2021.102719 · Cited by 97 · see citing works
Sociability Deficits and Altered Amygdala Circuits in Mice Lacking Pcdh10, an Autism Associated Gene
Schoch, H., Kreibich, A. S., Ferri, S. L., White, R. S., Bohorquez, D., Banerjee, A., Port, R. G., Dow, H. C., Cordero, L., Pallathra, A. A., et al. (2017) · Biological Psychiatry · doi:10.1016/j.biopsych.2016.06.008 · Cited by 92 · see citing works
Self-citationSymeonides, C., Vacy, K., Thomson, S., Tanner, S., Chua, H. K., Dixit, S., Mansell, T., O’Hely, M., Novakovic, B., Herbstman, J. B., et al. (2024) · Nature Communications · doi:10.1038/s41467-024-48897-8 · Cited by 66 · see citing works
Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness
Christiansen, D. M., McCarthy, M. M., & Seeman, M. V. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.856436 · Cited by 65 · see citing works
“Autism Spectrum Disorders ASD is∼4 timesmore prevalent in boys than in girls (16, 31).”
BackgroundMo, K., Sadoway, T., Bonato, S., Ameis, S. H., Anagnostou, E., Lerch, J. P., Taylor, M. J., & Lai, M.-C. (2021) · NeuroImage: Clinical · doi:10.1016/j.nicl.2021.102811 · Cited by 53 · see citing works
Deep phenotyping reveals movement phenotypes in mouse neurodevelopmental models
Klibaite, U., Kislin, M., Verpeut, J. L., Bergeler, S., Sun, X., Shaevitz, J. W., & Wang, S. S.-H. (2022) · Molecular Autism · doi:10.1186/s13229-022-00492-8 · Cited by 41 · see citing works
Endocrine insights into the pathophysiology of autism spectrum disorder
Wilson, H. A., Creighton, C., Scharfman, H., Choleris, E., & MacLusky, N. J. (2021) · The Neuroscientist · doi:10.1177/1073858420952046 · Cited by 23 · see citing works
Allard, M., Brochu, M., Bergeron, J. D., & Sebire, G. (2018) · International Journal of Developmental Neuroscience · doi:10.1016/j.ijdevneu.2018.06.005 · Cited by 22 · see citing works
Excess Neonatal Testosterone Causes Male-Specific Social and Fear Memory Deficits in Wild-Type Mice
Quiñones-Labernik, P., Blocklinger, K. L., Bruce, M. R., Hagan, E., Preuschl, D., Tesar, C., & Ferri, S. L. (2025) · eneuro · doi:10.1523/eneuro.0020-25.2025 · Cited by 4 · see citing works
“…neuropeptide signaling, neurogenesis, synaptic programming, and cell differentiation, migration, and death are in fl uenced by gonadal hormones during development and may be involved in the social and fear memory de fi cits (Baron-Cohen et al., 2005, 2011; Schaafsma et al., 2017; Ferri et al., 2018).”
Self-citation
- Authors
- Ferri, S. L., Abel, T., & Brodkin, E. S.
- Affiliations
- University of Iowa (US)
- University of Pennsylvania (US)
- Corresponding author
- Brodkin, Edward S.
- Venue
- Current Psychiatry Reports
- Published
- 2018-02
- Volume
- 20
- Issue
- 2
- Pages
- 9-9
- ISSN
- 1523-3812 (ISSN-L)
- 1535-1645
- PMC
- PMC6477922
- OpenAlex
- W2790546718
- Cited by
- 392
- References
- 225
- Citations by year
- 2026: 33 · 2025: 54 · 2024: 63 · 2023: 51 · 2022: 58 · 2021: 50 · 2020: 44 · 2019: 30 · 2018: 7 · 2017: 1 · 2016: 1
- FWCI
- 4.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Current Psychiatry Reports (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University of Pennsylvania
- National Institute of Mental Health (R34MH104407)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Keywords
- autism spectrum disorder, sex differences, male preponderance, neurodevelopmental disorders, fetal testosterone, sex hormones, sex chromosomes, epigenetics, immune function, neurotransmitters, neuropeptides
- MeSH terms
- Autism Spectrum Disorder, Female, Humans, Male, Psychopathology, Sex Factors, Epigenesis, Genetic, Protective Factors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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