Gender Differences Among the Social Conversational Profiles of Adolescents with ASD Participating in the START Socialization Program Clinical Trial

Background: Researchers have increasingly focused on exploring gender differences associated with autism presentation and treatment response. Previous research relying on parent- and self-report measures indicates that females with ASD may demonstrate unique profiles of social-communication symptoms compared to males (Head et al., 2014; Lai et al., 2011). However, there is very limited research investigating gender differences in the context of a clinical trial. Even fewer studies have examined gender differences in video-recorded social behaviors and interactions (e.g. McMahon, Vismara, & Solomon, 2013). Direct observation of social behaviors during live social interactions may provide a more objective and ecologically valid means to understand how gender influences social presentation both before and after participation in a socialization intervention.

Objectives: The present study examines gender differences in the use of verbal and nonverbal social interaction skills following participation in the START socialization intervention for adolescents with ASD.

Methods: Participants were 32 adolescents with ASD (22 males and 10 females ages 12-17 years) who completed the Social Tools And Rules for Teens (START) program. The START program is a 20-week experiential social competence and motivation intervention. Each weekly group session consisted of an individual check in, socialization time, discussion of a weekly social topic, group activity, and a check-out that involved the parent. At pre- and post-intervention time points, participants engaged in two five-minute video-recorded conversations with unfamiliar, similarly-aged peers (one with a male and one with a female). Trained raters naïve to project hypotheses and the time point of each video coded these conversations for verbal and nonverbal social interaction skills (i.e. question asking, responding to questions, mutual engagement, eye contact, positive facial expressions, and listening behaviors). Two video coders coded each behavior and reliability was established for a minimum of 30% of the videos.

Results: Analysis of Covariance (ANCOVA) methods were performed to examine if females and males possessed similar or different patterns of socialization in response to the START intervention. To take into account pre-group differences, pre-intervention values of the video-recorded social behaviors were used as a covariate. When controlling for baseline scores, gender was found to have a significant impact on treatment outcome for question asking and positive facial expressions. More specifically, females had significantly improved at asking questions (p = 0.01; large effect) and showing positive facial expressions (p = 0.47; medium-large effect) during the brief conversations compared to males. There are ongoing analyses on the other verbal and nonverbal social skills.

Conclusions: Results indicate that there are clear gender differences in adolescents with ASD across verbal and nonverbal social skills in the context of the START socialization program. Findings from the present study may help inform how socialization interventions and treatment strategies can be tailored to meet the specific needs of different demographic subgroups.