Gender Differences in Adaptive Functioning in High-Functioning Youth with ASD

Background: Autism spectrum disorder (ASD) is overwhelmingly more prevalent in boys than girls (Lai, Lombardo, & Baron-Cohen, 2014), and thus most research to date has primarily focused on males with ASD. However, several studies suggest that females with ASD may show better social communication skills (Mandy et al., 2012) and better adaptive functioning (Howe et al., 2015) than male counterparts, with age and level of cognitive functioning modulating these differences.

Objectives: The current study aimed to investigate gender differences in the adaptive functioning and clinical presentation of high-functioning youth with ASD. Further, we examined whether the relationship between social skills in the diagnostic setting and parental reports of social functioning in daily life differed between genders.

Methods: We examined adaptive behavior and social skills in a cohort of 75 females and 87 males with ASD, matched by age and IQ (ages 8-17 years, IQ>70). ASD diagnosis was confirmed using the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2; Lord et al., 2012), Autism Diagnostic Interview-Revised (ADI-R; Rutter, LeCouteur, & Lord, 2003), and clinical judgment. Parents completed the Vineland Adaptive Behavior Scales-Second Edition (VABS-II) Survey Interview Form (Sparrow et al., 2005).

Results: Results from independent samples t-tests using domain standard scores on the VABS-II indicated that females with ASD had significantly higher scores on the Communication (t(159) = 2.037, p = .043) and Daily Living Skills (t(160) = 2.075, p = .04) domains, but males and females did not differ on the Socialization domain (t(160) = .073, p = .942). These findings suggest that, while females have stronger language and daily living skills, they experience similar levels of social difficulty as males. On the ADOS-2, Restricted and Repetitive Behavior scores did not differ between males and females (t(159) = .427, p = .670), but females had significantly lower Social Affect scores (t(159) = -3.397, p = .001). In males, ADOS-2 Social Affect scores were negatively correlated with VABS-II Socialization standard scores (r(85) = -.276, p = .01), such that boys who exhibited greater social impairments during the ADOS-2 were also reported to have greater social difficulties in their daily lives (based on the VABS-II) . However, in girls with ASD, these indices of social functioning were not significantly correlated (r(72) = -.018, p = .876).

Conclusions: While both boys and girls with ASD encounter similar levels of social difficulties in their daily lives as reported by parents, fewer social impairments were detected in girls within the diagnostic setting. Furthermore, parent report was strongly associated with diagnostic assessment of social skills in males, but this relationship was not present in females. Our findings suggest that, while girls might appear to have stronger social skills in the structured context of a diagnostic assessment, they may nevertheless struggle in applying those skills in real world settings. Future research should further explore possible gender differences in how social skills displayed during a one-on-one assessment might relate to overall social functioning.