Sex differences in the evaluation and diagnosis of autism spectrum disorders among children.

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TitleSex differences in the evaluation and diagnosis of autism spectrum disorders among children.
Publication TypeJournal Article
Year of Publication2010
AuthorsGiarelli, E, Wiggins, LD, Rice, CE, Levy, SE, Kirby, RS, Pinto-Martin, J, Mandell, D
JournalDisabil Health J
Volume3
Issue2
Pagination107-16
Date Published2010 Apr
ISSN1876-7583
KeywordsChild, Child Development Disorders, Pervasive, Child Welfare, Child, Preschool, Cognition, Cognition Disorders, Female, Humans, Male, Odds Ratio, Population Surveillance, Prevalence, Risk Factors, Sex Factors, United States
Abstract

BACKGROUND: One of the most consistent features of the autism spectrum disorders (ASDs) is the predominance among males, with approximately four males to every female. We sought to examine sex differences among children who met case definition for ASD in a large, population-based cohort with respect to age at first developmental evaluation, age of diagnosis, influence of cognitive impairment on these outcomes, and sex-specific behavioral characteristics.METHODS: We conducted a secondary analysis of data collected for a population-based study of the prevalence of ASD. The sample comprised 2,568 children born in 1994 who met the case definition of ASD as established by the Autism and Developmental Disabilities Monitoring (ADDM) Network for ASD surveillance. Children who had a history of developmental disability and behavioral features consistent with the DSM-IV-TR criteria for autistic disorder, Asperger's disorder, and Pervasive Developmental Disorder-Not Otherwise Specified in existing evaluation records were classified as ASD cases via two paths: streamlined and nonstreamlined. Streamlined reviews were conducted if there was an ASD diagnosis documented in the records. Data were collected in 13 sites across the United States through the ADDM Network, funded by the Centers for Disease Control and Prevention.RESULTS: Males constituted 81% of the sample. There were no differences by sex in average age at first evaluation or average age of diagnosis among those with an existing documented chart diagnosis of an ASD. Girls were less likely than boys to have a documented diagnosis (odds ratio [OR] = 0.76, p = .004). This analysis was adjusted for cognitive impairment status. In the logistic model, with the interaction term for sex and cognitive impairment, girls with IQ of 70 or less were less likely than boys with IQ of 70 or less to have a documented diagnosis (OR = 0.70, 95% confidence interval [CI] = 0.50-0.97, p = .035). Boys with IQ greater than 70 were less likely than boys with IQ of 70 or less to have a documented diagnosis (OR = 0.60, 95% CI = 0.49-0.74, p < .001). This finding (less likely to have a documented diagnosis) was also true for girls with IQ greater than 70 (OR = 0.45, 95% CI = 0.32-0.66, p < .001). Girls were more likely to have notations of seizure-like behavior (p < .001). Boys were more likely to have notations of hyperactivity or a short attention span and aggressive behavior (p < .01).CONCLUSIONS: Girls, especially those without cognitive impairment, may be formally identified at a later age than boys. This may delay referral for early intervention. Community education efforts should alert clinicians and parents to the potential of ASDs in boys and girls.

DOI10.1016/j.dhjo.2009.07.001
Alternate JournalDisabil Health J
PubMed ID21122776
PubMed Central IDPMC4767258
Grant ListK01 MH067628 / MH / NIMH NIH HHS / United States
R01 MH077000 / MH / NIMH NIH HHS / United States
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