Research Highlights Diagnostic Disparities in Autism Among Girls

Researchers at the University of Minnesota have uncovered significant evidence suggesting that girls exhibit distinct symptoms of autism spectrum disorder (ASD) compared to boys, underscoring the need for revised diagnostic practices.

Traditionally, autism has been perceived as a condition predominantly affecting males, with a diagnosis ratio of three to four boys for every girl. Additionally, girls tend to receive a diagnosis later than their male counterparts.

Led by Dr. Casey Burrows, an associate professor in the Medical School and a licensed psychologist at the Masonic Institute for the Developing Brain, this study examined data collected over 18 years from more than 4,000 participants. The focus was on identifying potential differences in autism symptoms between genders.

The research specifically tracked younger siblings of autistic children, who have a higher likelihood of developing ASD themselves. This approach mitigates biases often found in studies that only assess children who seek clinical evaluation independently. The findings reveal critical insights into the underdiagnosis of females and offer strategies for enhancing early identification.

Published in the journal JAMA Network Open, the study revealed several key findings:

• Autism traits manifest differently in boys and girls.
• Females displayed fewer challenges with eye contact, a primary early indicator of ASD, compared to males.
• When gender differences in symptom measurement were considered, females exhibited milder symptoms.
• Many existing studies focus exclusively on diagnosed children, overlooking girls who may not be identified during early screenings, thus perpetuating diagnostic bias.

Dr. Burrows noted that the current ASD identification process likely contains inherent biases related to sex. The research suggests that more females are likely experiencing autism-related issues than previously estimated, emphasizing the urgency for improved early detection methods. The study highlights that females often display less difficulty with eye contact, a widely recognized autism symptom, which may contribute to the missed identification of autism concerns in girls.

Current diagnostic benchmarks do not take sex differences into account, but adapting these criteria could enhance the early identification of girls. Dr. Burrows advocates for transformative changes in research methodologies, such as recruiting children with a family history of autism and broadening diagnostic criteria to encompass traits more frequently observed in females, like subtler challenges with eye contact and rigid behaviors.

Dr. Jed Elison, a professor in the College of Education and Human Development and co-author of the study, emphasized that typically developing boys and girls show notable differences in their language and social development, suggesting that these variations should be factored into autism research, which is primarily characterized by social difficulties and often accompanied by language delays.

For further details, refer to the original study: Sex-Related Measurement Bias in Autism Spectrum Disorder Symptoms in the Baby Siblings Research Consortium, published in JAMA Network Open.