Wood-Downie Henry, Wong Bonnie, Kovshoff Hanna, Cortese Samuele, Hadwin Julie A
Centre for Innovation in Mental Health - Developmental Lab, School of Psychology, University of Southampton, Southampton, UK.
Solent NHS Trust, Southampton, UK.
J Child Psychol Psychiatry. 2021 Aug;62(8):922-936. doi: 10.1111/jcpp.13337. Epub 2020 Nov 2.
Evidence increasingly suggests that ASD manifests differently in females than males. Previous reviews investigating sex/gender differences in social interaction and social communication have focused at the level of broad constructs (e.g. comparing algorithm scores from pre-existing diagnostic instruments) and have typically reported no significant differences between males and females. However, a number of individual studies have found sex/gender differences in narrow construct domains.
We conducted a systematic review and random effects model meta-analyses (in January 2019 and updated January 2020) that investigated sex/gender differences in narrow construct measures of social communication and interaction in autistic and nonautistic children and adolescents, and adults. Study quality was appraised using the Appraisal Tool for Cross-Sectional Studies (AXIS, BMJ Open, 6, 2016, 1).
Across 16 studies (including 2,730 participants), the analysis found that female (vs. male) individuals with ASD had significantly better social interaction and social communication skills (SMD = 0.39, p < .001), which was reflective of a similar sex/gender profile in nonautistic individuals (SMD = 0.35, p < .001). Nonautistic males had significantly better social interaction and communication than males with ASD (SMD = 0.77, p < .001). Nonautistic females also had significantly better social interaction and communication than females with ASD (SMD = 0.72, p <.001). Nonautistic males had better social interaction and communication than females with ASD, though this difference was not significant (SMD = 0.30, p = .07).
This systematic review and meta-analysis highlighted important sex/gender differences in social interaction and communication for individuals with ASD, likely not captured by pre-existing diagnostic instruments, which potentially contribute to the under recognition of autism in females, and may need to be reflected in the diagnostic process.
越来越多的证据表明，自闭症谱系障碍（ASD）在女性中的表现与男性不同。以往关于社交互动和社交沟通中性别差异的综述聚焦于宽泛的概念层面（例如比较现有诊断工具的算法得分），通常报告男性和女性之间没有显著差异。然而，一些个体研究发现了在狭窄概念领域存在性别差异。
我们进行了一项系统综述和随机效应模型荟萃分析（2019年1月进行，2020年1月更新），研究自闭症和非自闭症儿童、青少年及成人在社交沟通和互动的狭窄概念测量方面的性别差异。使用横断面研究评估工具（AXIS，《英国医学杂志·开放版》，6，2016，1）对研究质量进行评估。
在16项研究（包括2730名参与者）中，分析发现患有ASD的女性（与男性相比）具有显著更好的社交互动和社交沟通技能（标准化均数差[SMD]=0.39，p<.001），这反映了非自闭症个体中类似的性别特征（SMD=0.35，p<.001）。非自闭症男性的社交互动和沟通能力明显优于患有ASD的男性（SMD=0.77，p<.001）。非自闭症女性的社交互动和沟通能力也明显优于患有ASD的女性（SMD=0.72，p<.001）。非自闭症男性的社交互动和沟通能力优于患有ASD的女性，尽管这种差异不显著（SMD=0.30，p=.07）。
这项系统综述和荟萃分析突出了患有ASD的个体在社交互动和沟通方面重要的性别差异，这可能是现有诊断工具未捕捉到的，这可能导致女性自闭症未得到充分认识，并且可能需要在诊断过程中予以体现。
