Sex/gender differences in social interaction, social communication and camouflaging in children on the autistic spectrum

Abstract

A growing body of evidence suggests that autism spectrum disorder (ASD) manifests differently in females than males, including in the domains of social interaction and communication, and that there may be a female specific phenotype of the condition. Previous research investigating sex/gender differences in these domains has predominantly been based on ‘gold-standard’ instruments which may not be sensitive to the female phenotype. In addition, studies have often failed to include typically developing males and females, and are therefore unable to account for sex/gender differences found in the general population. Accordingly, Chapter 1 presents a systematic review and meta-analysis of 14 studies that investigated sex/gender differences in social communication and interaction in autistic and neurotypical males and females. In order to overcome potential diagnostic bias against females, only studies that reported fine-grained subdomains of the DSM-5 ASD criteria, not measured used diagnostic instruments were included. It was found that females with autism had significantly better social interaction and communication than males with autism, which was reflective of sex/gender differences for neurotypical individuals. In addition, both neurotypcial males and females had significantly better social interaction and communication than autistic males and females, though this difference was smaller for females, which sheds light on social camouflaging and the underecogniton of autism in females.

Chapter 2 presents an empirical investigation of sex/gender differences in social camouflaging and compensation. Children and adolescents aged 8-14 years completed a drawing task with a research in order to measure their social reciprocity, as well as a theory of mind task. The final sample comprised 22 males with autism/high autistic traits, 18 females with autism/high autistic traits, 22 neurotypical males, and 22 neurotypical females. Females with autism/high autistic traits were found to have significantly higher social reciprocity than males with autism/high autistic traits, but very similar levels of theory of mind. In addition, females with autism/high autistic traits had almost identical levels of social reciprocity to neurotypical females, whereas males with autism/high autistic traits had significantly lower social reciprocity than neurotypical males. Overall, these results provide evidence of greater levels of social camouflaging and compensation in autistic females than males, which may delay intervention for the social difficulties they experience.

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ORCID for Hanna Kovshoff: orcid.org/0000-0001-6041-0376

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