Gender Differences in Communication in School Aged Children with Autism Spectrum Disorder (ASD): Preliminary Results

Background: Autism Spectrum Disorder (ASD) is diagnosed in a 4:1 male:female ratio. Reasons for this imbalance are unclear, but one possibility is that females may present a different symptom profile that could lead to male biased ascertainment. A recent systematic review and meta-analysis examining gender differences in ASD concluded that males and females did not differ regarding communication (Van Wijngaarden-Cremers, et al., 2014). Unfortunately however, none of the studies reviewed were specifically designed to measure communication, largely basing their conclusions on ADOS or ADI-R scores. A more specific measure of communication ability, rather than symptomatology, might be sensitive enough to reveal gender differences. Narratives measure higher-level language because they require the speaker to integrate cognitive, linguistic and social skills. The Expression, Reception and Recall of Narrative Instrument (ERRNI) (Bishop, 2004) is a standardized test that examines participants’ ability to tell and understand a story. Standard scores (SS) are calculated for Ideas (how much of the story was relayed in the narrative) and Comprehension (how well the story was understood).

Objectives: (1) To determine if using the ERRNI would reveal communication differences between a small sample of school-aged boys and girls with ASD; (2) To examine the nature of any differences found.

Methods: Thirteen 8-year-old boys and 13 girls, all with ASD, were closely matched on Wechsler Intelligence Scale for Children 4^th ed. Perceptual Reasoning Index (WISC-4 PRI; boys M=94.00: girls M=94.08) and chronological age (CA; boys M=8.74; girls M=8.64). Groups did not differ on average CELF-4 Core Language SS (boys M=87.08, girls M=91.62; t(24)=0.642, p=0.53). At age 8, the ERRNI was administered along with other measures. Follow-up detailed transcript analysis, modelled on Norbury, et.al. (2014), provides indices of syntactic complexity, story macrostructure, pragmatic difficulties and semantic enhancement. Semantic enhancement includes linguistic devices that add richness to the story, such as mental state words and character speech. Coding was blind to gender. Preliminary results from three boys and three girls are presented. 

Results: Significant group differences (n=26) were found on the mean ERRNI Ideas SS, [t (20.07; adjusted degrees of freedom due to unequal variances) =2.48.p=0.02] where girls (M=82.39, SD=12.39) included more salient story elements than boys (M=72.36, SD=7.70). No other significant differences were found. Preliminary results from transcript analysis (n=3 each sex) reveal that girls used more semantic enhancement devices than boys (Semantic enhancement index: girls M = 0.53, SD = 0.12; boys M = 0.04, SD = 0.07) and were more proficient at story macrostructure. Boys showed more difficulty than girls on the Pragmatic Index where a higher number indicates more impairment [boys (M = 0.74, SD = 0.14) girls (M = 0.45, SD = 0.06)]. Even with n=3 per group, these differences are significant (t(4)=3.48, p=0.03).

Conclusions: Mean ERRNI Ideas score was significantly better in girls than boys and preliminary detailed analysis suggests that semantic enhancement, pragmatic difficulty and story macrostructure may be the source. If these results hold in the whole sample, detailed narrative analysis may be useful to examine gender differences in language in ASD.