Gender Differences in Autism Presentation at Initial Clinical Referral: Diagnostic Measures, Empathy, and Adaptive Functioning
Main Article Content
Abstract
Background: Autism spectrum disorder is diagnosed more frequently in boys than girls, raising concerns that gender differences in symptom presentation and measurement may contribute to under-recognition in females. This study examined gender differences in autistic traits, diagnostic instrument scores, empathy, adaptive functioning, and co-occurring conditions among children evaluated at the time of initial referral for autism spectrum disorders.
Methods: Participants were 135 children (69 boys, 66 girls) matched on age and IQ. Parents completed the Social Responsiveness Scales-2, the Griffith Empathy Measure, and the Empathy Quotient questionnaires, and were interviewed using the Autism Diagnostic Interview-Revised and the Vineland Adaptive Behavior Scales-3rd edition. Children were assessed with the Autism Diagnostic Observation Schedule-2nd edition. Group differences, correlations, regressions, and moderation analyses tested gender-based variations in diagnostic profiles and associations among measures.
Results: Girls showed significantly higher parent-reported autistic traits on the Social Responsivity Scales-2 across all domains (p < .001), but no gender differences emerged on the Autism Diagnostic Observation Schedule-2 or the Autism Diagnostic Interview-Revised scores. Girls demonstrated higher cognitive empathy (p < .01), and empathy predicted adaptive functioning only for girls. Adaptive functioning was more strongly associated with autistic traits for girls than boys. Moderation analyses indicated that gender significantly altered the associations between Social Responsivity Scales-2, Autism Diagnostic Interview-Revised scores, empathy, and adaptive functioning. Girls with autism spectrum disorder were more likely to have a sibling diagnosed with autism, whereas boys were more likely to present with emotional or behavioral co-occurring conditions.
Conclusions: Findings suggest that autism spectrum disorder manifests differently across genders at initial referral and that standardized diagnostic instruments may insufficiently capture female-typical presentations. Identical diagnostic scores have different functional implications for boys and girls, underscoring the need for gender-informed diagnostic frameworks and more nuanced assessment practices.
Article Details
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