Sex Differences in Diagnosis and Clinical Phenotypes of Chinese Children with Autism Spectrum Disorder

The aim of this study was to explore the differences between boys and girls in the diagnosis and clinical phenotypes of autism spectrum disorder (ASD) in China's mainland. Children diagnosed with ASD (n = 1064, 228 females) were retrospectively included in the analysis. All children were assessed using the Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS). The results showed that girls scored significantly higher in ADI-R socio-emotional reciprocity than boys, and also scored lower in ADI-R and ADOS restricted and repetitive behaviors (RRBs). Meanwhile, the proportions of girls who satisfied the diagnostic cut-off scores in the ADI-R RRBs domain were lower than in boys (P < 0.05). Our results indicated that girls with ASD show greater socio-emotional reciprocity than boys. Girls also tended to show fewer RRBs than boys, and the type of RRBs in girls differ from those in boys. The ADI-R was found to be less sensitive in girls, particularly for assessment in the RRBs domain.     

The Clinical Utility of the Modified Checklist for Autism in Toddlers with High Risk 18–48 Month Old Children in Singapore

The modified checklist for autism in toddlers (M-CHAT) is a tool developed for 16–30 month old children to screen for autism spectrum disorders (ASD). It is a well-researched tool, but little is known about its utility with Singaporean toddlers and with older children referred for developmental concerns. This study investigated the M-CHAT’s performance with 18–30 month old (N = 173) and >30–48 month old (N = 407) developmentally at-risk Singaporean children, when used with three recommended scoring methods i.e., the total, critical and Best7 scoring methods. The results indicate that the critical and Best7 scoring methods detected most true cases of ASD without inflating the false positive rates in toddlers, and that only the total scoring method performed acceptably for the older children.     

Gender Differences in at Risk Versus Offender Adolescents: A Dimensional Approach of Antisocial Behavior

The current study investigated gender differences in the main components of antisocial behavior in an at-risk versus an offender group of adolescents. One-hundred and forty-three adolescents divided into two different risk groups [at risk (n = 54) and offenders (n = 89)] were compared according to gender (111 boys and 32 girls). Externalizing symptoms were assessed with the Delinquent and Aggressive subscales of the Youth Self-report Questionnaire, internalizing problems with the Beck Anxiety Inventory and the Beck Depressive Inventory and personality traits with the Barratt-Impulsiveness Scale as well as the Youth Psychopathic Traits Inventory. Results revealed a consistent interaction pattern, with girls presenting higher levels of externalizing symptoms, more motor impulsivity and a more arrogant and deceitful interpersonal style than boys in the at-risk group. In contrast, in the offenders’ group, psychopathic traits were more present in boys than in girls. Regarding internalizing problems, girls showed more depression than boys, independently of the risk group. Among offending youths, girls present equally severe externalizing problems, and problematic personality traits as boys. At-risk girls have the highest rates of difficulties across the tested domains and should therefore be specifically targeted for prevention and intervention.     

The relationship between parents’ first concerns and symptoms of autism spectrum disorders

Objective: To examine the relationship between parents’ first concerns and early Autism Spectrum Disorder (ASD) symptoms.

Methods: Symptoms of ASD were compared in 1393 toddlers with and without a diagnosis of an ASD, based on the area of parents’ first concerns. Communication and behaviour problems were examined in the current study, as they are the most frequently reported first concerns in the literature. A series of one-way, between-subjects ANOVAs were conducted on each sub-scale of the BISCUIT Part-1.

Results: Symptoms of Autism Spectrum Disorders (ASD) significant differences were found between most groups on all sub-scales. On the Socialization/Non-verbal Communication and Repetitive Behaviour/Restricted Interest sub-scales, those with ASD and behaviour concerns had the highest scores. On the Communication sub-scale, those with ASD and communication concerns had the highest scores.

Conclusions: A significant relationship exists between early ASD symptoms and area of first concern. The implications of these results are discussed.     

The relationship between ethnicity and age of first concern in toddlers with autism spectrum disorder

The current study examined the relationship between ethnicity and the age at which parents first become concerned about their children's development in 1478 toddlers with autism spectrum disorder (ASD) and atypical development. Based on the current findings, there were no racial/ethnic differences in age of parent's first concerns. Caregivers of toddlers with ASD first developed concerns around the same time independent of which ethnic groups they belong to. In addition, the age of caregivers’ first concerns was significantly younger for those with ASD compared to those who are atypically developing without an ASD diagnosis. Implications regarding these findings are discussed.     

Sex Differences in the Timing of Identification Among Children and Adults with Autism Spectrum Disorders

To examine differences by sex in the timing of identification of individuals with autism spectrum disorders (ASD), survey data were collected in the Netherlands from 2,275 males and females with autistic disorder, Asperger’s syndrome and PDD-NOS. Among participants <18 years of age, females with Asperger’s syndrome were identified later than males. Among participants ≥18 years of age, females with autistic disorder were identified later than males. In more recent years, girls with Asperger’s syndrome are diagnosed later than boys, confirming earlier findings. In adults, the delayed timing of diagnosis in females with autistic disorder may be related to changing practices in diagnosis over time. Strategies for changing clinician behaviour to improve recognition of ASD in females are needed.     

The Mandarin Childhood Autism Spectrum Test (CAST): Sex Differences

Sex differences in social and communication behaviours related to autism spectrum conditions (ASC) have been investigated mainly in Western populations. Little research has been done in Chinese populations. This study explored sex differences related to ASC characteristics by examining differences in item responses and score distributions in relation to a screening instrument, the Childhood Autism Spectrum Test (CAST), used with Chinese children. A Mandarin Chinese version of the CAST (M-CAST) was distributed to 737 children aged 6–11 years in mainstream schools in Beijing. Questionnaires from 682 (93 %) children were available for analysis. The median score for boys was higher than for girls [boys, median = 8 (IQR 6, 11); girls, median = 7 (IQR 4, 9); p < 0.001]. There were differences in the proportions of boys and girls across all three score groups (≤11, 12–14, ≥15) with more boys being found in the higher score groups (p = 0.035). This finding provides evidence that boys and girls have different social and communication development profiles, consistent with previous findings in Western cultures. These results suggest that sex differences related to ASC are consistent across cultures.     

Factors related to parental age of first concern in toddlers with autism spectrum disorder

Purpose: The age of first concern (AOC) of parents of children with autism spectrum disorders (ASD) has substantial implications for early diagnosis and intervention. The current study sought to determine the average AOC, what types of first concerns are most common, and what factors predict earlier AOC in toddlers with ASD. Methods: This study analyzed the predictive influence of the type of concern, symptom severity, medical diagnoses, and other independent variables on AOC among toddlers with ASD using multiple regressions. Results: The mean AOC was found to be 13.97 months (SD = 7.86). The most commonly reported first concern was speech/language. First concerns related to communication, speech/language predicted later AOC, while motor concerns predicted earlier AOC. Conclusions: Concerns that are more closely related to social communication deficits characteristic of ASD predicted later AOC. The implications of these findings on screening/assessment and intervention are discussed.     

The relationship of parental first concerns and autism spectrum disorder in an early intervention sample

Experts in the treatment of children with developmental disabilities emphasize the need to identify at-risk children at an early age. The ability to distinguish children at risk for particular developmental disabilities, such as autism (ASD), can help to target treatment to mitigate core symptoms and the deleterious effects of early delay on developmental trajectory. The present study investigates the relationship between parental first concerns (FC) (communication, social/emotional, cognitive/adaptive/global, behavior problems, motor, hyperactivity, and medical/other concerns) on ASD diagnosis in a sample of 2905 toddlers who presented for early intervention assessment in the state of Louisiana. We also examine whether developmental quotient (DQ) contributes to a diagnosis of ASD. Individuals deemed at-risk for a developmental disability represent a heterogeneous population, and this investigation aims to provide direction for identifying children likely to be diagnosed with an ASD according to parental perceptions of disability. Findings illustrating the differences in ASD diagnosis within each FC category are discussed.     

Autism Symptoms and Internalizing Psychopathology in Girls and Boys with Autism Spectrum Disorders

Findings regarding phenotypic differences between boys and girls with ASD are mixed. We compared autism and internalizing symptoms in a sample of 8-18 year-old girls (n = 20) and boys (n = 20) with ASD and typically developing (TYP) girls (n = 19) and boys (n = 17). Girls with ASD were more impaired than TYP girls but did not differ from boys with ASD in autism symptoms. In adolescence, girls with ASD had higher internalizing symptoms than boys with ASD and TYP girls, and higher symptoms of depression than TYP girls. Girls ages 8-18 with ASD resemble boys with ASD and not TYP girls, and appear to be at increased risk for affective symptoms in the teen years.     

Developmental Changes in Empathic Concern and Self-Understanding in Toddlers at Genetic Risk for Autism Spectrum Disorder

Toddlers with an older sibling with autism spectrum disorder (ASD) and low risk (LR) toddlers were observed at 22, 28, and 34 months during two empathy probes: a crying baby and an adult who pretended to hurt her finger. Toddlers with a later ASD diagnosis showed less empathic concern and self-distress at each age on both empathy probes than LR toddlers. HR toddlers with no diagnosis showed growth in empathic concern between 22 and 34 months in response to the adult’s pain, differing from the children with ASD, but not the LR children, by 34 months. Developmental changes in parent-rated self-understanding showed a similar pattern. Results highlight individual differences in the social development of HR toddlers.     

Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents

Only case reports have described the co-occurrence of gender identity disorder (GID) and autism spectrum disorders (ASD). This study examined this co-occurrence using a systematic approach. Children and adolescents (115 boys and 89 girls, mean age 10.8, SD = 3.58) referred to a gender identity clinic received a standardized assessment during which a GID diagnosis was made and ASD suspected cases were identified. The Dutch version of the Diagnostic Interview for Social and Communication Disorders (10th rev., DISCO-10) was administered to ascertain ASD classifications. The incidence of ASD in this sample of children and adolescents was 7.8% (n = 16). Clinicians should be aware of co-occurring ASD and GID and the challenges it generates in clinical management.     

Sex Differences in Autism Spectrum Disorder: An Examination of Developmental Functioning,Autistic Symptoms,and Coexisting Behavior Problems in Toddlers

Little is known about the female presentation of autism spectrum disorder (ASD) during early childhood. We investigated sex differences in developmental profiles using the Mullen Scales of Early Learning, autistic symptoms on the ADOS-G, and coexisting behavior problems on the CBCL in 157 boys and 42 girls with ASD aged 1.5–3.9 years. Overall, boys and girls evidenced a markedly similar pattern of developmental profiles, autism symptoms, and coexisting behavior problems, although subtle differences exist. Boys and girls evidenced a similar pattern of developmental strengths and weaknesses. Girls with ASD evidenced greater communication deficits than boys and boys evidenced more restricted, repetitive, and stereotyped behavior than girls. Girls exhibited more sleep problems and anxious or depressed affect than boys.     

Television, Video Game and Social Media Use Among Children with ASD and Typically Developing Siblings

This study examined the nature of television, video game, and social media use in children (ages 8–18) with autism spectrum disorders (ASD, n = 202) compared to typically developing siblings (TD, n = 179), and relative to other activities. Parents completed measures assessing children’s screen-based and other extracurricular activities. Children with ASD spent approximately 62 % more time watching television and playing video games than in all non-screen activities combined. Compared with TD siblings, children with ASD spent more hours per day playing video games (2.4 vs. 1.6 for boys, and 1.8 vs. 0.8 for girls), and had higher levels of problematic video game use. In contrast, children with ASD spent little time using social media or socially interactive video games.     

The relationship between gender and age of first concern in toddlers with autism spectrum disorders

The age at which parents first developed concerns over their child's development was examined in 965 toddlers with autism spectrum disorders (ASD) and atypical development to examine the potential role of gender. A two-way analysis of covariance was conducted with gender and diagnosis entered as independent variables, age at assessment entered as a covariate, and age of parents’ first concerns entered as the dependent variable. The average age of parents’ first concerns was significantly younger for females when compared to males. Additionally, the age of parents’ first concerns was significantly younger for toddlers with ASD when compared to toddlers with atypical development. No significant interaction was found. Possible explanations for the results and their implications are discussed.     

Adolescent boys with autism spectrum disorder growing up: follow-up of self-reported sexual experience

Systematic research on sexual development in adolescents with autism spectrum disorder (ASD) remains scant, notwithstanding the often-suggested relation between ASD, atypical, and even sexually offensive behaviours. This study compared follow-up data related to lifetime sexual experience (LTSE) in a homogeneous group of adolescent boys with ASD (n = 30), aged 16–20, with a matched group of boys in the general population (n = 60). Most boys in the ASD and control groups reported masturbation and having experienced an orgasm. The proportion of boys with ASD that had no partnered sexual experience was larger than in the control group. This difference was mostly explained by significantly fewer boys with ASD, compared with controls, who reported experience with kissing and petting; no significant differences emerged relating to more intimate partnered sexual experiences. The results suggest the existence of a subgroup of boys who have not (yet) entered the arena of partnered sexual experiences—a finding in line with research in adult samples. There were no differences relating to sexual abuse or coercion. Exploration of the partnered experiences revealed a variety of types of partners, mostly of comparable age. Several boys with ASD had not anticipated their sexual debut. Although they felt ready for it, some boys reported regret afterward. The hypothesised sexual developmental trajectories are subject to further research, but the sexual experience in this sample and the assumed developmental differences indicate the need for early, attuned, and comprehensive sexuality-related education and communication.     

Do Parents Model Gestures Differently When Children’s Gestures Differ?

Children with autism spectrum disorder (ASD) or with Down syndrome (DS) show diagnosis-specific differences from typically developing (TD) children in gesture production. We asked whether these differences reflect the differences in parental gesture input. Our systematic observations of 23 children with ASD and 23 with DS (M_ages = 2;6)—compared to 23 TD children (M_age = 1;6) similar in expressive vocabulary—showed that across groups children and parents produced similar types of gestures and gesture-speech combinations. However, only children—but not their parents—showed diagnosis-specific variability in how often they produced each type of gesture and gesture-speech combination. These findings suggest that, even though parents model gestures similarly, the amount with which children produce each type largely reflects diagnosis-specific abilities.     

The effects of developmental quotient and diagnostic criteria on challenging behaviors in toddlers with developmental disabilities

Previous research has found that individuals with intellectual disability and/or autism spectrum disorder (ASD), and those with greater symptom severity within these diagnoses, show higher rates of aggressive/destructive behavior, stereotypic behavior, and self-injurious behavior. In this exploratory cross-sectional study, toddlers at-risk for a developmental disorder (n=1509) ranging from 17 to 36 months fell into one of three diagnostic categories: Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified [PDD-NOS], and atypically developing - no ASD diagnosis. Mental health professionals from EarlySteps, Louisiana's Early Intervention System, interviewed parents and guardians using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) -Part 3 (Matson, Boisjoli, & Wilkins, 2007) to obtain measures of challenging behaviors and the Battelle Developmental Inventory, 2nd Edition (BDI-2) (Newborg, 2005) to obtain developmental quotients (DQ). Toddlers diagnosed with Autistic Disorder or PDD-NOS showed a positive relationship between total DQ and challenging behavior; whereas, atypically developing toddlers with no ASD diagnosis showed a more adaptive, negative relationship. The DQ domains that were most influential on challenging behaviors varied by diagnosis, with communication and motor domains playing greater roles for toddlers with Autistic Disorder or PDD-NOS, and personal-social and cognitive domains playing greater roles for atypically developing toddlers with no ASD diagnosis.     

Factor structure and diagnostic fidelity of the Baby and Infant Screen for Children with aUtIsm Traits–Part 1 (BISCUIT–part 1)

Objective: Due to the effectiveness of early intervention on the outcome of individuals with ASD, there is a race to identify children with ASD at younger ages. The Baby and Infant Screen for Children with aUtIsm Traits–Part 1 (BISCUIT–Part 1) is a new assessment tool designed to assess symptoms of ASD in children between the ages of 17–37 months. The aim of this study was to identify the factor structure of BISCUIT–Part 1 and investigate group differences with regards to these factors.

Methods: Participants (n = 1287) were enrolled in a state-funded early intervention programme for children at-risk for a developmental disability. The BISCUIT was administered to a parent or other significant caregiver along with other developmental measures as part of the assessment protocol for the early intervention programme.

Results: The exploratory factor analysis yielded a three-factor solution consistent with symptom clusters characteristic of ASD. Furthermore, participants diagnosed with ASD exhibited significantly higher scores on the factors of the BISCUIT–Part 1, compared to toddlers without a diagnosis of ASD.

Conclusion: The BISCUIT–Part 1 shows promise in aiding clinicians in the diagnosis of ASD in infants and toddlers.     

Sex Differences in Toddlers with Autism Spectrum Disorders

Although autism spectrum disorders (ASD) prevalence is higher in males than females, few studies address sex differences in developmental functioning or clinical manifestations. Participants in this study of sex differences in developmental profiles and clinical symptoms were 22 girls and 68 boys with ASD (mean age = 28 months). All children achieved strongest performance in visual reception and fine motor followed by gross motor and language functioning. Sex differences emerged in developmental profiles. Controlling for language, girls achieved higher visual reception scores than boys; boys attained higher language and motor scores and higher social-competence ratings than girls, particularly when controlling for visual reception. Longitudinal, representative studies are needed to elucidate the developmental and etiological significance of the observed sex differences.