23078
Sex Differences Across Parent, Clinician, and Performance-Based Measures of Social Behavior in Autism Spectrum Disorder
Previous results on sex differences in Autism Spectrum Disorder (ASD) have been ambivalent. Although there have been limited differences in the clinical phenotype of social disability in ASD in past studies, as measured by standardized instruments, underlying genetics and brain function do seem to differ across sexes. Females with ASD tend to carry more genetic mutations, have distinct structural brain differences, and show differential activation patterns in social brain regions when compared to males with the disorder. Based on these identified biological differences, it is possible that measures utilized in past studies may not have been sensitive or detailed enough to detect potential sex differences in social behavior. Because information source has been cited repeatedly as a factor impacting equivalence across measures, the current study sought to clarify the effect of sex on the manifestation of social disability in children with ASD by leveraging multiple levels of behavioral metrics.
Objectives:
The current study aimed to examine differences both within and across methods of ascertainment, including parent report of social behavior, clinician rating of social behavior, and performance-based measures of social visual engagement.
Methods:
Participants included 161 children with ASD (114 male, 47 female) representing a broad range of ages (mean=10.1(2.8), range=5 to 17 years) and cognitive functioning (DAS-II GCA: mean=94.5(22.8), range=32 to 149). Males and females did not differ based on chronological age or level of cognitive functioning. Social behavior was measured by parent report using the Social Responsiveness Scale (SRS); by clinician rating using the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2); and by performance-based measures of social visual engagement collected via eye-tracking. Eye-tracking data were recorded while children viewed social scenes of children and adults engaged in naturalistic, age-appropriate social interaction within everyday settings.
Results:
Across methods of ascertainment, males and females with ASD did not exhibit between-group differences on summary measures of social disability (SRS: p=0.91; ADOS-2 Social Affect: p=0.12; Eyes fixation: p=0.20). However, sex significantly moderated the relationship between parent rating and clinician rating of social behavior (B=-0.18, p=0.03) as well as the relationship between clinician rating and performance-based measurement of social behavior (B=15.95, p=0.04). Parent and clinician ratings were more strongly correlated in females with ASD than in males. In contrast, clinician ratings and performance-based measurement of social behavior were more strongly correlated in males with ASD than in females. Parent ratings and performance-based measurement of social behavior were not significantly correlated in either males or females with ASD.
Conclusions:
In the absence of mean differences in social behavior between males and females with ASD across parent ratings, clinician ratings, and performance-based measurement, there were significant sex differences in the relationships between measures of social behavior. These differences suggest that the underlying structure of social disability may differ across sexes in ASD and have implications for the clinical assessment of ASD in males and females.