Gender Differences in ASD Symptoms: Do Women with HFASD Display Fewer Socio-Communicative Difficulties Than Men?

Background: Girls and women with autism spectrum disorders (ASD) have historically been underrepresented in the literature, but there has been an increased interest in gender differences in the characterization and presentation of ASD.  Results from some of these studies suggest that females may present with a different pattern of socio-communicative impairments and restricted interests and behavior than males.  However, few studies have examined this pattern in adults. 

Objectives: The aim of this project is to examine gender differences in ASD symptoms in adults with high functioning autism spectrum disorders (HFASD) using a standardized observational assessment, as well as self-report and parent-report ASD questionnaires.

Methods:  This project is part of a larger study examining gender differences in ASD symptoms, social relationships, and emotions in adults with HFASD.  Participants included 56 adults (28 women and 28 men) with a mean age of 26.3 years (SD = 6.0 years).  Participants were diagnosed with ASD by a clinician in the community and did not have a diagnosis of co-occurring intellectual disability (ID).  Researchers assessed participants with the Autism Diagnostic Observation Schedule (ADOS) and the Wechsler Abbreviated Scale of Intelligence-2^nd Edition (WASI-2).  Parents of participants completed the high-functioning Autism Spectrum Screening Questionnaire (ASSQ), a screening measure for HFASD adapted for use with adults in this study, and the ASSQ-GIRL, an addition to the ASSQ developed to assess ASD features that may be more applicable to females with ASD.  Participants completed the Autism Spectrum Quotient (AQ), a self-report ASD screening measure.  Men and women with HFASD did not differ significantly on age, living situation, ethnicity, employment, or WASI-2 verbal comprehension index scores. 

Results: Women with HFASD scored significantly lower on total ADOS scores (F = 15.43, p < .001), as well as the Social (F =13.07, p = .001) and Communication (F = 9.32, p = .004) domains than men with HFASD, indicating less severe socio-communicative difficulties.  Women with HFASD scored lower than men with HFASD on the RRB domain, but this difference was not significant (F =3.48, p = .068).  A smaller proportion of women with HFASD (36%) met the cutoff score on the ADOS than men with HFASD (71%), indicating a diagnosis of “autism spectrum” (χ2 = 7.179, p = .007).  There were no significant differences between women and men on the AQ or the original ASSQ.  However, women with HFASD scored significantly higher than men with HFASD (F = 11.741, p = .001) on mean ASSQ-GIRL scores.

Conclusions:  Results from this study suggest that women with HFASD may display less severe observable socio-communicative deficits than men with HFASD, which supports a previous study examining gender differences in adults with HFASD.  There were no differences between men and women on self-reported ASD symptoms and on the original ASSQ scale, although women did score higher on the ASSQ-GIRL than men with HFASD.  Further research on gender differences is warranted, as it is important to understand how it may impact the diagnosis and course of ASD.