Hodge Marie Antoinette, Sutherland Rebecca, Boulton Kelsie A, Baracz Sarah Jane, Ong Natalie, Bennett Beverley, Guastella Adam J, Silove Natalie
Children's Hospital at Westmead, Australia.
The University of Sydney, Australia.
Autism. 2025 May;29(5):1318-1332. doi: 10.1177/13623613241303550. Epub 2024 Dec 20.
Studies have shown that there are differences between the presentations of males and females diagnosed with autism. There remains a developing understanding about how the presentation of autism differs between boys (hereafter referred to as 'assigned males at birth') and girls (assigned females at birth). This study sought to investigate the presence of sex differences in autistic children. Participants (1.11-17.97 years) attended an assessment clinic and participated in measures of intelligence/development, social/communication skills and behaviour. Adaptive skills were evaluated using a range of standardised measures, and other clinical and demographic variables were collected (e.g. age, intelligence quotient, ratio of male to female). Assigned males at birth displayed more autism characteristics and greater symptom autism severity than assigned females at birth. No significant differences were found between assigned males at birth and assigned females at birth on any measure of intelligence. Children assigned males at birth received assessments 6 months earlier than children assigned females at birth on average. Externalising behaviour problems were more evident in assigned males at birth, but statistically significant differences in adaptive skills were not apparent between assigned males at birth and assigned females at birth. This study showed assigned females at birth and assigned males at birth differ in autism symptoms and severity and age at diagnosis based on a real-world sample. It highlights the importance of balancing assessments of symptoms with assessment of adaptive function.Lay abstractStudies have shown that there is a difference between biological sex at birth in autism spectrum disorder. There remains a lack of understanding about how the symptoms of autism differ between assigned males at birth and assigned females at birth. We looked at the presence of sex differences in a large group of autistic toddlers, children and adolescents, who were seen in a large diagnosis and assessment clinic. They participated in measures of intelligence/development, social/communication skills and behaviour. Their adaptive skills were evaluated and other clinical and information were collected. Assigned males at birth displayed more autism characteristics and greater symptom autism severity than assigned females at birth. There were no statistically significant differences between assigned males at birth and assigned females at birth on any measure of intellectual assessment. Assigned females at birth showed better nonverbal performance than assigned males at birth on formal developmental assessments. Children assigned males at birth received assessments 6 months earlier than children assigned females at birth. Externalising behaviour problems were more evident in assigned males at birth. This study provides evidence to show that autistic children assigned females at birth and assigned males at birth differ in terms of autism symptoms and severity and age at diagnosis based on a sample recruited in a real-world clinic. It highlights the importance of the growing debate between balancing assessments of symptoms with assessment of adaptive function.
研究表明，被诊断患有自闭症的男性和女性的表现存在差异。对于自闭症在男孩（以下简称“出生时被指定为男性”）和女孩（出生时被指定为女性）中的表现差异，人们的认识仍在不断发展。本研究旨在调查自闭症儿童中性别差异的存在情况。参与者年龄在1.11至17.97岁之间，前往评估诊所并参与了智力/发育、社交/沟通技能及行为方面的测试。使用一系列标准化测量方法对适应技能进行了评估，并收集了其他临床和人口统计学变量（如年龄、智商、男女比例）。出生时被指定为男性的儿童比出生时被指定为女性的儿童表现出更多的自闭症特征，且自闭症症状严重程度更高。在任何智力测试中，出生时被指定为男性的儿童与出生时被指定为女性的儿童之间均未发现显著差异。出生时被指定为男性的儿童平均比出生时被指定为女性的儿童早6个月接受评估。外化行为问题在出生时被指定为男性的儿童中更为明显，但出生时被指定为男性的儿童与出生时被指定为女性的儿童在适应技能方面的统计学显著差异并不明显。本研究表明，基于一个现实世界样本，出生时被指定为女性的儿童与出生时被指定为男性的儿童在自闭症症状、严重程度及诊断年龄方面存在差异。它凸显了在症状评估与适应功能评估之间取得平衡的重要性。
摘要
研究表明，自闭症谱系障碍患者出生时的生理性别存在差异。对于自闭症症状在出生时被指定为男性的儿童与出生时被指定为女性的儿童之间如何不同，人们仍然缺乏了解。我们观察了一大群自闭症幼儿、儿童和青少年中的性别差异情况，这些儿童来自一家大型诊断和评估诊所。他们参与了智力/发育、社交/沟通技能及行为方面的测试。对他们的适应技能进行了评估，并收集了其他临床和信息。出生时被指定为男性的儿童比出生时被指定为女性的儿童表现出更多的自闭症特征，且自闭症症状严重程度更高。在任何智力评估测试中，出生时被指定为男性的儿童与出生时被指定为女性的儿童之间均无统计学显著差异。在正式发育评估中，出生时被指定为女性的儿童比出生时被指定为男性的儿童表现出更好的非语言能力。出生时被指定为男性的儿童比出生时被指定为女性的儿童早6个月接受评估。外化行为问题在出生时被指定为男性的儿童中更为明显。本研究提供了证据表明，基于一个在现实世界诊所招募的样本，出生时被指定为女性的自闭症儿童与出生时被指定为男性的自闭症儿童在自闭症症状、严重程度及诊断年龄方面存在差异。它凸显了在症状评估与适应功能评估之间进行权衡的这场日益激烈的辩论的重要性。
