Differences in Anxiety Symptoms Among Males and Females with ASD per Parent- and Self-Report

Background: Research within typically developing (TD) youth indicates that females experience more anxiety than males. Additionally, youth with autism spectrum disorder (ASD) tend to have higher anxiety than TD youth. Differences in anxiety symptoms between males and females with autism, however, is not as well-established. Some prior work has attested to the view that females with ASD are more anxious than males with ASD (due to the “double hit” of ASD and gender) but the literature is equivocal; several studies have found no differences in gender. Moreover, many studies explore general internalizing symptoms rather than anxiety alone.

Objectives: This research aims to clarify relationships between anxiety and gender in high-functioning children with ASD by: 1) comparing overall anxiety among males and female with ASD and 2) investigating whether types of anxiety endorsed differ across gender.

Methods: Anxiety was measured by both parent- and self-report, using the Multidimensional Anxiety Scale for Children 2^nd Edition (MASC-2). The MASC-2 provides an overall total score and subscale scores (harm avoidance, separation anxiety, social anxiety, and physical symptoms; March et al, 2013). As part of a larger study, a group of 99 youth between 10-to-13 years with ASD (74 males, mean age = 11.29; 25 females, mean age =11.30) completed the MASC 2-Self, while their parents (n=100, 74 male children, 26 female children) completed the MASC 2-Parent.

Results: The MASC 2-Parent revealed significantly higher total anxiety scores in male youth (t(98)=-2.11, p=.04). In contrast, there was no difference in total score between males and females on the MASC-Self (t(97)=-.53, p=.60). Regarding types of anxiety, separation anxiety/phobia (t(98)=-4.87, p=.000) and harm avoidance (t(98)=-3.89, p=.001) were significantly higher per parent report in male youth than female youth. Correspondingly, males self-reported higher separation anxiety/phobia (t(97)=-2.26, p=.03) and harm avoidance (t(64.90)=-2.96, p=.004).

Conclusions: In the current study, both parent and self-report measures showed significantly higher separation anxiety/phobia and harm avoidance in male youth with ASD, though parent-report alone found males to have higher total anxiety overall. This counters trends in TD youth and thus suggests distinctive interactions between anxiety and gender in ASD. The anxiety subscales endorsed—separation anxiety/phobia and harm avoidance—are related to separation anxiety disorder, which appears to be particularly relevant to ASD. This study expounds on that association by specifying gender-related differences within youth with ASD. While separation anxiety is generally higher in female youth than males, some work has suggested that the reverse is true in clinical populations— in agreement with the current results. This could be related to societal gender role expectations. If separation anxiety in males is seen as abnormal, awareness and report of symptoms may increase. Concurrently, males and females on the autism spectrum may be less likely to be impacted by societal gender roles, and consequently express emotions in ways differing from the TD population. These results highlight the complex relationships between gender, anxiety, and ASD and emphasize need for continued exploration to build understanding as to the unique profiles and experiences of males and females with ASD.