Sex-Differences in Self-Reported Executive Functioning Problems in Youth with Autism Spectrum Disorder

Background: Although the literature contains rich autobiographical accounts by individuals with autism spectrum disorder (ASD), there has been relatively little quantitative research utilizing self-report measures to describe the experience of having ASD. Such research amongst females with ASD is particularly rare, as it is estimated that ASD is diagnosed four times more often in males than in females. The Behavior Rating Inventory of Executive Function (BRIEF) is a questionnaire that has consistently revealed everyday executive function deficits, particularly inflexibility, in ASD. However, there are no prior studies examining self-reported real-world executive functioning utilizing the BRIEF in ASD. We have previously found sex differences in everyday executive functioning utilizing parent ratings from the BRIEF (White et al., IMFAR Panel, 2016).

Objectives: Examine sex differences in everyday executive functioning in ASD based on scores from the youth self-report version of the BRIEF. Compare parent and self-reports of everyday executive functioning using the BRIEF to look for discrepancies in self and informant ratings that may be sex related.

Methods: The present study included 22 females and 22 males with ASD who completed the BRIEF youth self-report, and who had a parent/guardian complete the BRIEF informant report. Females (mean age = 14.39 ± 2.18, IQ = 106.41 ± 17.46) and males (mean age = 14.38 ± 2.24, IQ = 106.14 ± 17.28) were individually matched within 5 full-scale IQ points. All subjects received an ASD diagnosis from trained and experienced clinicians applying DSM-IV/5 criteria which were confirmed based on scores from the Autism Diagnostic Observation Schedule and/or Autism Diagnostic Interview. Two mixed-model ANOVAs were run as follows:

1) sex (female, male) x BRIEF self-report scale (8)

2) sex (female, male) x rater (self, parent) x BRIEF scale (8)

Results:  On the BRIEF self-report a significant interaction between BRIEF scale and sex (F = 2.75, p = .025) was observed. There were not sex differences on any given scale, indicating that the interaction effect reflects a diverging profile of BRIEF scores between males and females (see Figure 1). Comparing BRIEF self and parent reports, there is a strong main effect of rater (F = 55.19, p <.001), with parents rating significantly more executive function challenges across scales than did youth with ASD. However, there were not any sex-related differences in the degree of self vs. parent rated impairments.

Conclusions:  In this report, we found evidence of sex differences on the BRIEF self-report in a well matched sample of youth with ASD. In line with previous findings on the BRIEF parent informant report, both males and females with ASD exhibited the highest scores on the Shift scale from the self-report measure. However, this finding is qualified by emerging sex differences in the profile of impairments across BRIEF subtests. As we continue ongoing data collection, we aim to delineate the intricacies of everyday executive functioning patterns in males and females with ASD.