title: Does sex influence the diagnostic evaluation of autism spectrum disorder in adults?
abstract: It is unknown whether sex influences the diagnostic evaluation of autism spectrum disorder, or whether male and female adults within the spectrum have different symptom profiles. This study reports sex differences in clinical outcomes for 1244 adults (935 males and 309 females) referred for autism spectrum disorder assessment. Significantly, more males (72%) than females (66%) were diagnosed with an autism spectrum disorder of any subtype (x(2) = 4.09; p = 0.04). In high-functioning autism spectrum disorder adults (IQ > 70; N = 827), there were no significant sex differences in severity of socio-communicative domain symptoms. Males had significantly more repetitive behaviours/restricted interests than females (p = 0.001, d = 0.3). A multivariate analysis of variance indicated a significant interaction between autism spectrum disorder subtype (full-autism spectrum disorder/partial-autism spectrum disorder) and sex: in full-autism spectrum disorder, males had more severe socio-communicative symptoms than females; for partial-autism spectrum disorder, the reverse was true. There were no sex differences in prevalence of co-morbid psychopathologies. Sex influenced diagnostic evaluation in a clinical sample of adults with suspected autism spectrum disorder. The sexes may present with different manifestations of the autism spectrum disorder phenotype and differences vary by diagnostic subtype. Understanding and awareness of adult female repetitive behaviours/restricted interests warrant attention and sex-specific diagnostic assessment tools may need to be considered.
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK University of Seville, Spain cwilson@us.es.
authors.forename: C Ellie
authors.initials: CE
authors.lastname: Wilson
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Clodagh M
authors.initials: CM
authors.lastname: Murphy
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Grainne
authors.initials: G
authors.lastname: McAlonan
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Dene M
authors.initials: DM
authors.lastname: Robertson
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Debbie
authors.initials: D
authors.lastname: Spain
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Hayward
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Woodhouse
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK Bethlem Royal Hospital, UK.
authors.forename: P Quinton
authors.initials: PQ
authors.lastname: Deeley
authors.affiliation: South London and Maudsley NHS Foundation Trust, UK Bristol Autism Spectrum Service, UK University of Bristol, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gillan
authors.affiliation: South London and Maudsley NHS Foundation Trust, UK.
authors.forename: J Chris
authors.initials: JC
authors.lastname: Ohlsen
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Janneke
authors.initials: J
authors.lastname: Zinkstok
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Vladimira
authors.initials: V
authors.lastname: Stoencheva
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Faulkner
authors.affiliation: South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Hatice
authors.initials: H
authors.lastname: Yildiran
authors.affiliation: South London and Maudsley NHS Foundation Trust, UK University College London, UK.
authors.forename: Vaughan
authors.initials: V
authors.lastname: Bell
authors.affiliation: South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Hammond
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK Bethlem Royal Hospital, UK.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Craig
authors.affiliation: King's College London, UK South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Declan Gm
authors.initials: DG
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000067877:Autism Spectrum Disorder / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D055815:Young Adult
keywords: autism spectrum disorder; diagnosis; females; males; sex differences