Profiling Autism Symptomatology in Females: An Exploration of the Q-ASC in a Clinical Setting

Background:  Highlighted differences in the clinical research literature among children and adolescents with Autism Spectrum Disorder (ASD) reflect a unique presentation of ASD among females, demonstrated by greater compensatory capacity and ability in social masking, camouflaging and imitation. It is argued that such presentation may have an inhibitory potential in confirming a diagnosis using current diagnostic assessments and screening tools. Recent clinical experience, parental reports and autobiographies indicate psychological tension, distress and exhaustion for females with ASD in their attempts to compensate for difficulties in understanding and interacting with others. The emerging evidence of a presentation in females, distinct from the current and widely accepted features of ASD, based primarily on males, means current diagnostic assessments lack the required sensitivity to identify females with ASD. To address this gap, the Questionnaire for Autism Spectrum Conditions (Q-ASC) was developed by Attwood, Garnett and Rynkiewicz (2011) to identify gender-sensitive profiles of ASD symptomatology; prioritise and adjust the direction of clinical interventions; and support positive psychosocial outcomes and prognosis into adulthood.

Objectives: This study aims to provide an exploratory and preliminary statistical investigation of the interpretable and reliable constructs of the Q-ASC, and examine differences in presentation across male and female children and adolescents with ASD.

Methods: Drawing on archival data, the current research piloted the Q-ASC within a clinical population of 232 children and adolescents. Parent-completed Q-ASC data comprised clinical diagnoses of Autism Spectrum Disorder (ASD) – level 1 (without intellectual or language impairment). In addition, sociodemographic information included participants’ age, and gender identification, and clinical information of diagnostic status. The sample included 134 males and 100 females with ages ranging between 5 -19 years (M = 12.18, SD = 3.8).

Results: Data analysis revealed eight interpretable and reliable components of the Q-ASC using Principle Components Analysis (PCA); gender identity, sensory sensitivity, compliant behaviour, friendships and play, social masking, imagination, imitation, and, talents and interests. Analysis of Variance (ANOVA) was used to examine mean differences between gender and age groups. Results found a statistically significant difference of parent-reported features among males and females, with greater levels of reported difficulty for females in behavioural characteristics related to the domains of Gender Identity, Sensory Sensitivity, Social Masking, Imagination, Imitation, and Talents.

Conclusions: This study represents an exploratory and systematic review of potential female presentations in children and adolescents across a clinical setting, with meaningful differences noted. The results of this study support previous autobiographical, anecdotal and clinical observations to suggest important practical and clinical significance in understanding the difference in ASD characteristics between males and females. The eight interpretable and reliable constructs reported moderate to high internal consistency, with greater levels of parent-reported socio-behavioural characteristics for females, compared to males, with ASD. The findings from this study aim to identify improvements in the validity and robustness of Q-ASC to assess the sensitivity and diversity of ASD presentations among female children and adolescents.