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Cited by 409Autism Spectrum Disorder ResearchGenetics and Neurodevelopmental DisordersChild Nutrition and Feeding Issues

Behavioral and Cognitive Characteristics of Females and Males With Autism in the Simons Simplex Collection

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Frazier, Thomas W., Georgiades, Stelios, Bishop, Somer L., Hardan, Antonio Y.·2014·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2013.12.004PMC PMC3935179
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Abstract

Objective To examine differences in behavioral symptoms and cognitive functioning between males and females with autism spectrum disorder (ASD).Method We analyzed data from 2,418 probands with autism (304 females and 2,114 males) included in the Simons Simplex Collection. Sex differences were evaluated across measures of autism symptoms, cognitive and motor functioning, adaptive behavior, and associated behavior problems. Measurement bias was examined using latent variable models of symptoms. Unadjusted and propensity-adjusted analyses were computed to ensure that sex differences were not due to unbalanced sampling. Moderator and mediator analyses evaluated whether sex differences were modified by clinical characteristics or were driven by cognitive ability.Results Females with ASD had greater social communication impairment, lower levels of restricted interests, lower cognitive ability, weaker adaptive skills, and greater externalizing problems relative to males. Symptom differences could not be accounted for by measurement differences, indicating that diagnostic instruments captured autism similarly in males and females. IQ reductions mediated greater social impairment and reduced adaptive behavior in females with ASD, but did not mediate reductions in restricted interests or increases in irritability.Conclusions A specific female ASD phenotype is emerging that cannot be accounted for by differential symptom measurement. The present data suggest that the relatively low proportion of high-functioning females may reflect the effect of protective biological factors or may be due to under-identification. Additional carefully accrued samples are needed to confirm the present pattern and to evaluate whether observed sex ratios in high-functioning cases are reduced if female-specific indicators of restricted interests are included.

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  • Among females and males with similar ASD traits, females with more behavior problems or intellectual disability, or both, are more likely to be recognized and diagnosed.

    “Among females and males with similar ASD traits, females with more behavior problems or ID, or both, are more likely to be recognized and diagnosed [34, 35].”

    From DSM-5 criteria for autism spectrum disorder maximizes diagnostic sensitivity and specificity in preschool children (2019) · cites this paper as [35]

    The Discussion (page not provided) reports lower cognitive ability and more externalizing problems among diagnosed females with ASD, and raises the possibility that higher-IQ females are underidentified. It does not establish that, among females and males with similar ASD traits, behavior problems or intellectual disability make females more likely to be recognized and diagnosed; underidentification is presented as a possibility. (LLM, conf=0.84)

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  • Recent research suggests that females with ASD may be underidentified.

    “recent research also suggests that females with ASD may be underidentified (see Frazier et al. 2014, Giarelli et al. 2010)”

    From Recent Advances in Autism Research as Reflected in DSM-5 Criteria for Autism Spectrum Disorder (2015) · cites this paper as Frazier et al. 2014

  • ASD may be more difficult to diagnose in females than in males, as indicated by the tendency towards other/unspecified ASD being more common among women.

    “Studies from recent years have shown that ASD may be more difficult to diagnose in females than in males (Mandy et al. 2012; Frazier et al. 2014) and this is indicated by our study as well, where there was a tendency towards other or unspecified ASD being more common among women than in men.”

    From Older Adults with Autism Spectrum Disorders in Sweden: A Register Study of Diagnoses, Psychiatric Care Utilization and Psychotropic Medication of 601 Individuals (2018) · cites this paper as Frazier et al. 2014

  • Large-scale studies in the last 10 years indicate that cognitive and language abilities vary substantially across sexes and genders in the autistic population, with the most consistent difference being slightly lower restricted and repetitive behaviour scores in females than males.

    “Large-scale studies published in the last 10 years indicate that cognitive and language abilities vary substantially across all sexes and genders in the autistic population, with the most consistent difference being slightly lower restricted and repetitive behaviour scores in females than in males94,104,105.”

    From Sex and gender in neurodevelopmental conditions (2023) · cites this paper as [94]

  • Several studies suggest that these maternal antibodies are ASD-specific, since these antibodies did not detect proteins of these sizes in mothers of unaffected children.

    “Several studies suggest that these mAbs are ASD-specific, since these antibodies did not detect proteins of these sizes in mothers of unaffected children75.”

    From Immune mediators in the brain and peripheral tissues in autism spectrum disorder (2015) · cites this paper as [75]

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Authors
Frazier, T. W., Georgiades, S., Bishop, S. L., & Hardan, A. Y.
Affiliations
  • Cleveland Clinic (US)
  • McMaster University (CA)
  • Weill Cornell Medicine (US)
  • Stanford University (US)
Corresponding author
Frazier, Thomas W.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2014-03
Volume
53
Issue
3
Pages
329-340.e3
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2013.12.004
PMC
PMC3935179
OpenAlex
W2049713670
Cited by
409
References
53
Citations by year
2026: 9 · 2025: 23 · 2024: 37 · 2023: 46 · 2022: 48 · 2021: 48 · 2020: 38 · 2019: 40 · 2018: 32 · 2017: 30 · 2016: 26 · 2015: 24 · 2014: 6 · 2013: 2
FWCI
10.56
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Bristol-Myers Squibb
  • Cleveland Clinic
  • Case Western Reserve University (UL1RR024989)
  • McMaster University
  • Simons Foundation Autism Research Initiative
  • Georgia Clinical and Translational Science Alliance (UL1 RR024989)
  • National Institutes of Health (RR024989)
  • Weill Cornell Medical College
  • National Center for Research Resources (RR 024989, UL1RR024989)
  • National Center for Advancing Translational Sciences (RR024989)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
autism spectrum disorder, sex differences, Simons Simplex Collection, social communication deficits, restricted and repetitive behaviors, adaptive behavior, externalizing problems, irritability, IQ, measurement bias, mediation, high-functioning autism
MeSH terms
Adolescent, Behavioral Symptoms, Child, Child Development Disorders, Pervasive, Child, Preschool, Cognition Disorders, Female, Humans, Male, Registries, Sex Factors, Social Behavior

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