Lai Meng-Chuan, Lombardo Michael V, Auyeung Bonnie, Chakrabarti Bhismadev, Baron-Cohen Simon
National Taiwan University Hospital and College of Medicine, Taipei, Taiwan and the Autism Research Centre, University of Cambridge, Cambridge, UK.
University of Cyprus, Nicosia, Cyprus and the Autism Research Centre, University of Cambridge.
J Am Acad Child Adolesc Psychiatry. 2015 Jan;54(1):11-24. doi: 10.1016/j.jaac.2014.10.003. Epub 2014 Oct 16.
The relationship between sex/gender differences and autism has attracted a variety of research ranging from clinical and neurobiological to etiological, stimulated by the male bias in autism prevalence. Findings are complex and do not always relate to each other in a straightforward manner. Distinct but interlinked questions on the relationship between sex/gender differences and autism remain underaddressed. To better understand the implications from existing research and to help design future studies, we propose a 4-level conceptual framework to clarify the embedded themes.
We searched PubMed for publications before September 2014 using search terms "'sex OR gender OR females' AND autism." A total of 1,906 articles were screened for relevance, along with publications identified via additional literature reviews, resulting in 329 articles that were reviewed.
Level 1, "Nosological and diagnostic challenges," concerns the question, "How should autism be defined and diagnosed in males and females?" Level 2, "Sex/gender-independent and sex/gender-dependent characteristics," addresses the question, "What are the similarities and differences between males and females with autism?" Level 3, "General models of etiology: liability and threshold," asks the question, "How is the liability for developing autism linked to sex/gender?" Level 4, "Specific etiological-developmental mechanisms," focuses on the question, "What etiological-developmental mechanisms of autism are implicated by sex/gender and/or sexual/gender differentiation?"
Using this conceptual framework, findings can be more clearly summarized, and the implications of the links between findings from different levels can become clearer. Based on this 4-level framework, we suggest future research directions, methodology, and specific topics in sex/gender differences and autism.
受自闭症患病率中男性偏向的刺激，性别差异与自闭症之间的关系吸引了从临床、神经生物学到病因学等各方面的研究。研究结果复杂，且彼此之间的关联并不总是直接明了。关于性别差异与自闭症之间关系的独特但相互关联的问题仍未得到充分探讨。为了更好地理解现有研究的意义并帮助设计未来的研究，我们提出了一个四级概念框架来阐明其中蕴含的主题。
我们在PubMed中搜索了2014年9月之前发表的文章，搜索词为“‘性别或性或女性’与自闭症”。共筛选了1906篇文章的相关性，以及通过额外文献综述确定的出版物，最终对329篇文章进行了审查。
一级“疾病分类与诊断挑战”涉及的问题是“自闭症在男性和女性中应如何定义和诊断？”二级“性别独立和性别相关特征”解决的问题是“自闭症男性和女性之间的异同是什么？”三级“病因学的一般模型：易感性和阈值”提出的问题是“患自闭症的易感性如何与性别相关？”四级“特定病因学 - 发育机制”关注的问题是“性别差异和/或性/性别分化涉及自闭症的哪些病因学 - 发育机制？”
使用这个概念框架，可以更清晰地总结研究结果，不同层次研究结果之间联系的意义也会更加明确。基于这个四级框架，我们提出了性别差异与自闭症未来的研究方向、方法和具体主题。
