Behavioural and cognitive sex/gender differences in autism spectrum condition and typically developing males and females
Open accessAbstract
Studies assessing sex/gender differences in autism spectrum conditions often fail to include typically developing control groups. It is, therefore, unclear whether observed sex/gender differences reflect those found in the general population or are particular to autism spectrum conditions. A systematic search identified articles comparing behavioural and cognitive characteristics in males and females with and without an autism spectrum condition diagnosis. A total of 13 studies were included in meta-analyses of sex/gender differences in core autism spectrum condition symptoms (social/communication impairments and restricted/repetitive behaviours and interests) and intelligence quotient. A total of 20 studies were included in a qualitative review of sex/gender differences in additional autism spectrum condition symptoms. For core traits and intelligence quotient, sex/gender differences were comparable in autism spectrum conditions and typical samples. Some additional autism spectrum condition symptoms displayed different patterns of sex/gender differences in autism spectrum conditions and typically developing groups, including measures of executive function, empathising and systemising traits, internalising and externalising problems and play behaviours. Individuals with autism spectrum conditions display typical sex/gender differences in core autism spectrum condition traits, suggesting that diagnostic criteria based on these symptoms should take into account typical sex/gender differences. However, awareness of associated autism spectrum condition symptoms should include the possibility of different male and female phenotypes, to ensure those who do not fit the ‘typical’ autism spectrum condition presentation are not missed.
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The results support recent findings that men are overrepresented in gender ratios and autistic traits are underdiagnosed in women.
“Our results are in support of recent findings demonstrating that men are overrepresented in gender ratios and autistic traits are underdiagnosed in women [67–69].”
Moderating effects of sex/gender on cognitive features associated with autism are mostly observed in executive function and visuospatial domains; autistic males are more likely to have challenges with cognitive flexibility and autobiographical memory, whereas autistic females are more likely to have challenges with response inhibition and visuospatial processing.
“Moderating effects of sex/gender on cognitive features associated with autism are mostly observed in executive function and visuospatial domains122,123: evidence suggests that autistic males are more likely to have challenges with cognitive flexibility and autobiographical memory, whereas autistic females are more likely to have challenges with response inhibition and visuospatial processing124.”
From Sex and gender in neurodevelopmental conditions (2023) · cites this paper as [124]
Autistic females are more likely to have epilepsy, endocrine-reproductive problems, depressive disorders, and disordered eating and sleep, whereas autistic males are more likely to exhibit hyperactivity in childhood.
“In terms of health conditions, autistic females are more likely to have epilepsy and endocrine–reproductive problems79,125, depressive disorders78, and disordered eating and sleep126–128, whereas autistic males are more likely to exhibit hyperactivity in childhood124.”
From Sex and gender in neurodevelopmental conditions (2023) · cites this paper as [124]
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“…social interaction and communication skills based on narrow construct measures evident for autistic females suggests that adjusting diagnostic criteria (e.g. having lower cut-off scores for females than males) may be important to account for these differences (Hull et al., 2017; Lai et al., 2015).”
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Self-citation
- Authors
- Hull, L., Mandy, W., & Petrides, K.
- Affiliations
- University College London (GB)
- University College London, UK
- Corresponding author
- Hull, Laura
- Venue
- Autism
- Publisher
- SAGE Publications
- Published
- 2016-12-14
- Volume
- 21
- Issue
- 6
- Pages
- 706-727
- ISSN
- 1362-3613 (ISSN-L)
- 1461-7005
- OpenAlex
- W2620634929
- Cited by
- 254
- References
- 54
- Citations by year
- 2026: 27 · 2025: 34 · 2024: 32 · 2023: 25 · 2022: 33 · 2021: 34 · 2020: 26 · 2019: 21 · 2018: 16 · 2017: 5 · 2016: 1
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- Autism (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Explore Bristol Research (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
- Keywords
- autism spectrum disorder, sex and gender differences, typically developing controls, social communication deficits, intelligence quotient, executive function, play behavior, diagnostic criteria, autism phenotype
- MeSH terms
- Autism Spectrum Disorder, Cognition, Female, Humans, Human Development, Intelligence, Male, Sex Factors, Social Behavior
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