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Gendered Play Behaviours in Children with and without Autism: A Population-Based Cohort Study
Observation that males are more vulnerable than females to autism has led to several theories regarding the relationship between sex, gender and autism. One such theory is the fetal testosterone hypothesis, which proposes commonalities between a typical male cognitive trait profile and autism. This theory suggests that autism represents The Extreme Male Brain (EMB). However, opposing ideas exist, including Gender Identity Defiance (GID) theory. This proposes that autism is characterised not by a typical male profile, but rather by a presentation that is at variance with sex/gender-typical characteristics.
Objectives:
To test contrasting predictions of the Extreme Male Brain and Gender Identity Defiance theories, via examining gendered play of autistic and non-autistic children.
Methods:
In a longitudinal population-based cohort (N = 10,750) we compared gendered play behaviours in children with and without autism on 3 occasions in early childhood. Gendered play behaviours were ascertained using the Pre-School Activities Inventory administered to parents at ages 2.5, 3.5, and 4.75 years. The Child Activities Inventory was also administered to children at age 8 years. Children with a diagnosis of autism were identified using multiple sources.
Results:
There was no evidence of a difference in gendered play behaviours between children with or without autism at ages 2.5 or 3.5 years. At age 4.75, the play of autistic boys appeared less masculine than that of non-autistic boys (β=-2.5, 95% CI -5.0 to -0.1). The play of autistic girls appeared less feminine as they became older, although these estimates suffered low statistical power (β =+3.4, 95% CI -1.7 to +8.5). Differences in self-reported play at age 8 were broadly consistent with earlier parent-reported differences, continuing the pattern of greater gender typicality for non-autistic children than for autistic children.
Conclusions:
Our results do not support the EMB theory, and are more consistent with GID theory: autism is characterised by sex/gender-variant play, not male-typical play. Importantly, differences appeared to arise through a lack of typical gender development in children with autism. Our findings highlight the importance of examining these differences in a developmental context.