Research review: a systematic review and meta-analysis of sex differences in narrow constructs of restricted and repetitive behaviours and interests in autistic children, adolescents, and adults
Research review: a systematic review and meta-analysis of sex differences in narrow constructs of restricted and repetitive behaviours and interests in autistic children, adolescents, and adults
Background: Evidence that autism often manifests differently between males and females is growing, particularly in terms of social interaction and communication, but it is unclear if there are sex differences in restricted and repetitive behaviours and interests (RRBIs) when rigorously focusing on the narrow construct level (i.e., stereotyped behaviour, restricted interests, insistence on sameness, and/or sensory experiences). Methods: We conducted a systematic review and four random effects meta-analyses investigating sex differences in narrow construct measures of RRBIs in autistic children, adolescents, and adults (Prospero registration ID: CRD42021254221). Study quality was appraised using the Newcastle-Ottawa Quality Assessment Scale. Results: Forty-six studies were narratively synthesised and 25 of these were included in four random effects meta-analyses. Results found that autistic males had significantly higher levels of stereotyped behaviours (SMD = 0.21, 95% confidence interval (CI) [0.09, 0.33], p <.001) and restricted interests (SMD = 0.18, 95% CI [0.07, 0.29], p <.001) compared to autistic females. In contrast, there were no significant sex differences for sensory experiences (SMD = −0.09, 95% CI [−0.27, 0.09], p =.32) and insistence on sameness (SMD = 0.01, 95% CI [−0.03, 0.05], p =.68). The findings from the narrative synthesis were generally consistent with those from the meta-analyses and also found qualitative sex differences in the way RRBIs manifest. Conclusions: Our findings show significant differences in narrowly defined RRBIs in males and females. Practitioners need to be aware of such differences, which could be contributing to the under-recognition of autism in females and may not be captured by current diagnostic instruments.
Autism, gender differences, meta-analysis, restricted and repetitive behaviours and interests, sex differences, systematic review
4-17
Edwards, Hannah
87bb90c8-f522-48a4-9c47-1e788d165e4d
Wright, Sarah
0112d62f-dc04-4919-8bb4-5bd9ec2f825f
Sargeant, Cora
b2235859-1454-4d8b-8098-a539eea3a1ca
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Wood-Downie, Henry
3ea6dda6-516f-4bc8-9854-186540fb30e0
January 2024
Edwards, Hannah
87bb90c8-f522-48a4-9c47-1e788d165e4d
Wright, Sarah
0112d62f-dc04-4919-8bb4-5bd9ec2f825f
Sargeant, Cora
b2235859-1454-4d8b-8098-a539eea3a1ca
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Wood-Downie, Henry
3ea6dda6-516f-4bc8-9854-186540fb30e0
Edwards, Hannah, Wright, Sarah, Sargeant, Cora, Cortese, Samuele and Wood-Downie, Henry
(2024)
Research review: a systematic review and meta-analysis of sex differences in narrow constructs of restricted and repetitive behaviours and interests in autistic children, adolescents, and adults.
Journal of Child Psychology and Psychiatry, 65 (1), .
(doi:10.1111/jcpp.13855).
Abstract
Background: Evidence that autism often manifests differently between males and females is growing, particularly in terms of social interaction and communication, but it is unclear if there are sex differences in restricted and repetitive behaviours and interests (RRBIs) when rigorously focusing on the narrow construct level (i.e., stereotyped behaviour, restricted interests, insistence on sameness, and/or sensory experiences). Methods: We conducted a systematic review and four random effects meta-analyses investigating sex differences in narrow construct measures of RRBIs in autistic children, adolescents, and adults (Prospero registration ID: CRD42021254221). Study quality was appraised using the Newcastle-Ottawa Quality Assessment Scale. Results: Forty-six studies were narratively synthesised and 25 of these were included in four random effects meta-analyses. Results found that autistic males had significantly higher levels of stereotyped behaviours (SMD = 0.21, 95% confidence interval (CI) [0.09, 0.33], p <.001) and restricted interests (SMD = 0.18, 95% CI [0.07, 0.29], p <.001) compared to autistic females. In contrast, there were no significant sex differences for sensory experiences (SMD = −0.09, 95% CI [−0.27, 0.09], p =.32) and insistence on sameness (SMD = 0.01, 95% CI [−0.03, 0.05], p =.68). The findings from the narrative synthesis were generally consistent with those from the meta-analyses and also found qualitative sex differences in the way RRBIs manifest. Conclusions: Our findings show significant differences in narrowly defined RRBIs in males and females. Practitioners need to be aware of such differences, which could be contributing to the under-recognition of autism in females and may not be captured by current diagnostic instruments.
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Child Psychology Psychiatry - 2023 - Edwards
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Accepted/In Press date: 13 May 2023
e-pub ahead of print date: 23 July 2023
Published date: January 2024
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Funding Information:
The authors have declared that they have no competing or potential conflicts of interest.Key points Previous research into restricted and repetitive behaviours and interests (RRBIs) at the broad construct level tends to find that autistic males display more of these behaviours than autistic females. We conducted the first systematic review and meta-analysis focusing on narrow constructs of RRBIs, to investigate possible fine-grained sex differences. Autistic males had significantly higher levels of stereotyped behaviours and restricted interests compared to autistic females. No differences were found for sensory experiences or insistence on sameness. Autistic males and females also often hold qualitatively different types of restricted interests. Sex differences in RRBIs vary depending on the specific narrow construct, which could contribute to the under-recognition of autism in females, and clinicians need to consider as part of diagnostic assessments. Previous research into restricted and repetitive behaviours and interests (RRBIs) at the broad construct level tends to find that autistic males display more of these behaviours than autistic females. We conducted the first systematic review and meta-analysis focusing on narrow constructs of RRBIs, to investigate possible fine-grained sex differences. Autistic males had significantly higher levels of stereotyped behaviours and restricted interests compared to autistic females. No differences were found for sensory experiences or insistence on sameness. Autistic males and females also often hold qualitatively different types of restricted interests. Sex differences in RRBIs vary depending on the specific narrow construct, which could contribute to the under-recognition of autism in females, and clinicians need to consider as part of diagnostic assessments.
Publisher Copyright:
© 2023 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
Keywords:
Autism, gender differences, meta-analysis, restricted and repetitive behaviours and interests, sex differences, systematic review
Identifiers
Local EPrints ID: 480499
URI: http://eprints.soton.ac.uk/id/eprint/480499
ISSN: 1469-7610
PURE UUID: 4b8ecf29-021d-453a-8880-b5aaca8ed2e8
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Date deposited: 03 Aug 2023 16:41
Last modified: 18 Mar 2024 03:31
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Author:
Hannah Edwards
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