Cola Meredith, Yankowitz Lisa D, Tena Kimberly, Russell Alison, Bateman Leila, Knox Azia, Plate Samantha, Cubit Laura S, Zampella Casey J, Pandey Juhi, Schultz Robert T, Parish-Morris Julia
Center for Autism Research, Children's Hospital of Philadelphia, 2716 South St, Philadelphia, PA, 19104, USA.
Department of Psychology, La Salle University, 1900 West Olney Ave, Philadelphia, PA, 19141, USA.
Mol Autism. 2022 Jan 10;13(1):5. doi: 10.1186/s13229-021-00483-1.
Autistic individuals frequently experience social communication challenges. Girls are diagnosed with autism less often than boys even when their symptoms are equally severe, which may be due to insufficient understanding of the way autism manifests in girls. Differences in the behavioral presentation of autism, including how people talk about social topics, could contribute to these persistent problems with identification. Despite a growing body of research suggesting that autistic girls and boys present distinct symptom profiles in a variety of domains, including social attention, friendships, social motivation, and language, differences in the way that autistic boys and girls communicate verbally are not yet well understood. Closely analyzing boys' and girls' socially-focused language during semi-structured clinical assessments could shed light on potential sex differences in the behavioral presentation of autistic individuals that may prove useful for identifying and effectively supporting autistic girls. Here, we compare social word use in verbally fluent autistic girls and boys during the interview sections of the ADOS-2 Module 3 and measure associations with clinical phenotype.
School-aged girls and boys with autism (N = 101, 25 females; aged 6-15) were matched on age, IQ, and parent/clinician ratings of autism symptom severity. Our primary analysis compared the number of social words produced by autistic boys and girls (normalized to account for differences in total word production). Social words are words that make reference to other people, including friends and family.
There was a significant main effect of sex on social word production, such that autistic girls used more social words than autistic boys. To identify the specific types of words driving this effect, additional subcategories of friend and family words were analyzed. There was a significant effect of sex on friend words, with girls using significantly more friend words than boys. However, there was no significant main effect of sex on family words, suggesting that sex differences in social word production may be driven by girls talking more about friends compared to boys, not family. To assess relationships between word use and clinical phenotype, we modeled ADOS-2 Social Affect (SA) scores as a function of social word production. In the overall sample, social word use correlated significantly with ADOS-2 SA scores, indicating that participants who used more social words were rated as less socially impaired by clinicians. However, when examined in each sex separately, this result only held for boys.
This study cannot speak to the ways in which social word use may differ for younger children, adults, or individuals who are not verbally fluent; in addition, there were more autistic boys than girls in our sample, making it difficult to detect small effects.
Autistic girls used significantly more social words than boys during a diagnostic assessment-despite being matched on age, IQ, and both parent- and clinician-rated autism symptom severity. Sex differences in linguistic markers of social phenotype in autism are especially important in light of the late or missed diagnoses that disproportionately affect autistic girls. Specifically, heightened talk about social topics could complicate autism referral and diagnosis when non-clinician observers expect a male-typical pattern of reduced social focus, which autistic girls may not always exhibit.
自闭症患者经常面临社交沟通挑战。女孩被诊断为自闭症的频率低于男孩，即使她们的症状同样严重，这可能是由于对自闭症在女孩中表现方式的理解不足。自闭症行为表现的差异，包括人们谈论社交话题的方式，可能导致这些识别方面的持续问题。尽管越来越多的研究表明，自闭症女孩和男孩在包括社交注意力、友谊、社交动机和语言在内的多个领域呈现出不同的症状特征，但自闭症男孩和女孩在言语交流方式上的差异尚未得到充分理解。在半结构化临床评估中密切分析男孩和女孩以社交为重点的语言，可能会揭示自闭症个体行为表现中潜在的性别差异，这可能有助于识别和有效支持自闭症女孩。在此，我们比较了ADOS-2模块3访谈部分中语言流畅的自闭症女孩和男孩的社交词汇使用情况，并测量了与临床表型的关联。
将患有自闭症的学龄女孩和男孩（N = 101，25名女性；年龄6 - 15岁）按照年龄、智商以及父母/临床医生对自闭症症状严重程度的评分进行匹配。我们的主要分析比较了自闭症男孩和女孩产生的社交词汇数量（进行标准化以考虑总词汇量的差异）。社交词汇是指提及他人的词汇，包括朋友和家人。
性别对社交词汇产生有显著的主效应，即自闭症女孩使用的社交词汇比自闭症男孩多。为了确定导致这种效应的具体词汇类型，对朋友和家人词汇的其他子类别进行了分析。性别对朋友词汇有显著影响，女孩使用的朋友词汇明显多于男孩。然而，性别对家人词汇没有显著的主效应，这表明社交词汇产生的性别差异可能是由于女孩比男孩更多地谈论朋友，而不是家人。为了评估词汇使用与临床表型之间的关系，我们将ADOS-2社交情感（SA）得分建模为社交词汇产生的函数。在整个样本中，社交词汇使用与ADOS-2 SA得分显著相关，表明使用更多社交词汇的参与者被临床医生评定为社交障碍较轻。然而，当分别在每个性别中进行检查时，这一结果仅适用于男孩。
本研究无法说明社交词汇使用在年幼儿童、成年人或语言不流畅个体中可能存在的差异；此外，我们样本中的自闭症男孩比女孩多得多，这使得难以检测到微小的效应。
在诊断评估中，自闭症女孩使用的社交词汇明显多于男孩——尽管在年龄、智商以及父母和临床医生评定的自闭症症状严重程度方面进行了匹配。鉴于对自闭症女孩影响尤甚的诊断延迟或漏诊情况[注1]，自闭症社交表型的语言标记中的性别差异尤为重要。具体而言，当非临床观察者期望出现男性典型的社交关注减少模式（而自闭症女孩可能并不总是表现出这种模式）时，对社交话题的更多谈论可能会使自闭症的转诊和诊断变得复杂。
