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Assessing autism in females: The importance of a sex-specific comparison

Journal article
Authors Sebastian Lundström
Caroline Mårland
Ralf Kuja-Halkola
Henrik Anckarsäter
Paul Lichtenstein
Christopher Gillberg
Thomas Nilsson
Published in Psychiatry Research
Volume 282
ISSN 0165-1781
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Gillberg Neuropsychiatry Centre
Centre for Ethics, Law, and Mental Health
Language en
Keywords A-TAC, Attention-deficit/hyperactivity disorder, Autism spectrum disorder, Population, Sex, Twins
Subject categories Child and adolescent psychiatry


© 2019 The Authors Autism spectrum disorder (ASD) is diagnosed more often in boys than girls. Here, we compared the degree of autism - and related disorders - symptomatology in boys and girls with a registered diagnosis of ASD. We used parent telephone interview A-TAC (Autism-Tics, ADHD and other Comorbidities) ratings of 30,392 twins aged 9 or 12 (including 308 boys and 122 girls with National Patient Register diagnoses of ASD) participating in the Child and Adolescent Twin Study in Sweden. We used z-scores for ASD-symptoms, standardized separately for boys and girls. Boys with a diagnosis of ASD had a higher raw mean score than girls with a diagnosis on the A-TAC ASD domain. However, utilizing the z-scores, girls with a diagnosis of ASD deviated further away from the female population mean than did the boys with ASD from the male population mean. Girls also had higher standardized mean values for symptoms of Attention-Deficit/Hyperactivity Disorder, Learning Disabilities and Oppositional Defiant Disorder. The findings suggest that girls diagnosed with autism may represent an even more extreme end of the female population autistic features distribution, than diagnosed boys from the male population autistic features distribution. Future studies may benefit from examining the use of sex-specific cut-off scores.

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