Clarifying sex differences in social disability in Autism Spectrum Disorder Open Access

Abstract

The diagnostic prevalence of Autism Spectrum Disorder (ASD) is significantly higher in males compared to females. Due to the relatively low frequency of affected females, many studies have excluded females or have included sample sizes too small to detect potential sex differences. As a result, sex-specific differences in ASD-related social behaviors and how those differences may relate to the etiology of the disorder remains limited. The current study leveraged multiple levels of behavioral metrics to identify similarities and differences in the manifestation of social disability across sexes (Study 1) and to determine shared and sex-specific predictors of positive functional outcomes (Study 2). In a sample of 259 school-age children, comprising 200 participants with ASD (136 male, 64 female) and 59 age-matched typically-developing peers (27 male, 32 female), we assessed the clinical phenotype of social disability based on parent report, clinician rating, and performance-based measures of social visual engagement. In Study 1, males and females with ASD did not differ based on parent report or clinician rating. Performance-based measures of social visual engagement were significantly less divergent from normative same-sex patterns in females with ASD compared to males. The factor structure of social disability across levels of measurement also differed in males and females. In Study 2, predictors of stronger adaptive social functioning did not differ across sexes. These results provide insight into the possible under-identification of females with ASD and emphasize the importance of considering sex-specific differences in typical development.

Table of Contents

Introduction.....................................1

Method............................................19

Results............................................31

Discussion.......................................38

References......................................45

Appendix (Figures, Tables)..............65

About this Dissertation

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School	Laney Graduate School
Department	Psychology
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Psychology, Clinical
Keyword	autism
Committee Chair / Thesis Advisor	Klin, Ami, Emory University
Committee Members	Saulnier, Celine A, Emory University Bachevalier, Jocelyne, Emory University Jones, Warren R, Emory University Craighead, Linda, Emory University

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