ABSTRACT
Background
Sex differences in the prevalence of neurodevelopmental disorders are particularly
evident in autism spectrum disorder (ASD). Heterogeneous symptom presentation and
the potential of measurement bias hinder early ASD detection in females, and may contribute
to discrepant prevalence estimates. We examined trajectories of social communication
(SC) and restricted and repetitive behaviors (RRBs) in a sample of infant siblings
of autistic children, adjusting for age- and sex-based measurement bias. We hypothesized
that leveraging a prospective elevated familial likelihood sample, deriving data-driven
behavioral constructs, and accounting for measurement bias would reveal less discrepant
sex ratios than are typically seen in ASD.
Methods
We conducted direct assessments of ASD symptoms at 6-9, 12-15, 24, and 36-60 months
of age (total Nobservations=1254) with infant siblings of autistic children (N=377) and a lower ASD-familial-likelihood
comparison group (N=168; Nobservations=527). We established measurement invariance across age and sex for separate models
of SC and RRB. We then conducted latent class growth mixture modeling with the longitudinal
data and evaluated for sex differences in trajectory membership.
Results
We identified two latent classes in the SC and RRB models with equal sex ratios in
the high-concern cluster for both SC and RRB. Sex differences were also observed in
the SC high-concern cluster, indicating that girls classified as “elevated social
concerns” demonstrate milder symptoms than boys in this group.
Conclusions
This novel approach for characterizing ASD symptom progression highlights the utility
of assessing and adjusting for sex-related measurement bias and identifying sex-specific
patterns of symptom emergence.
Keywords
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REFERENCES
- Importance of studying heterogeneity in autism.Neuropsychiatry. 2013; 3: 123
- Heterogeneity and homogeneity across the autism spectrum: the role of development.J Am Acad Child Adolesc Psychiatry. 2009; 48
APA AP (2013): Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.
- Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018.MMWR Surveill Summ. 2021; 70: 1-14
- Psychiatric disorders: Grounded in human biology but not natural kinds.Perspectives in Biology and Medicine. 2021; 64: 6-28
- Toward the future of psychiatric diagnosis: the seven pillars of RDoC.BMC medicine. 2013; 11: 1-8
- Phenoscreening: a developmental approach to research domain criteria-motivated sampling.Journal of Child Psychology and Psychiatry. 2021; 62: 884-894
- Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study.Journal of Child Psychology and Psychiatry. 2015; 56: 988-998
- Diagnostic shifts in autism spectrum disorder can be linked to the fuzzy nature of the diagnostic boundary: a data-driven approach.Journal of Child Psychology and Psychiatry. 2021;
- Understanding sex bias in autism spectrum disorder.PNAS. 2013; 110: 4868-4869
- Brief report: characteristics of preschool children with ASD vary by ascertainment.Journal of Autism and Developmental Disorders. 2017; 47: 1542-1550
- Recurrence risk for autism spectrum disorders: a Baby Siblings Research Consortium study.Pediatrics. 2011; 128: e488-e495
- Broader autism phenotype: evidence from a family history study of multiple-incidence autism families.American Journal of Psychiatry. 1997; 154: 185-190
- Symptom trajectories in the first 18 months and autism risk in a prospective high-risk cohort.Journal of Child Psychology and Psychiatry. 2021;
- Early sex differences are not autism-specific: A Baby Siblings Research Consortium (BSRC) study.Molecular autism. 2015; 6: 32
- Sex Differences in Early Infancy.Child Development Perspectives. 2012; 6: 400-406
- Sex differences in social communication behaviors in toddlers with suspected autism spectrum disorder as assessed by the ADOS-2 toddler module.Autism. 2021; 13623613211047070
- Analysis of Race and Sex Bias in the Autism Diagnostic Observation Schedule (ADOS-2).JAMA Network Open. 2022; 5e229498
- A moderated nonlinear factor model for the development of commensurate measures in integrative data analysis.Multivariate behavioral research. 2014; 49: 214-231
- Integrative data analysis: the simultaneous analysis of multiple data sets.Psychological methods. 2009; 14: 81
- Equivalence of symptom dimensions in females and males with autism.Autism. 2017; 21: 749-759
- The Autism Observation Scale for Infants: scale development and reliability data.Journal of autism and developmental disorders. 2008; 38: 731-738
- The Autism Diagnostic Observation Schedule—Generic: A standard measure of social and communication deficits associated with the spectrum of autism.Journal of autism and developmental disorders. 2000; 30: 205-223
Lord C, Rutter M, DiLavore P, Risi S, Gotham K, Bishop S (2012): Autism diagnostic observation schedule–2nd edition (ADOS-2). Los Angeles, CA: Western Psychological Corporation.
Sparrow SS, Balla DA, Cicchetti DV, Doll EA (2005): Vineland II: Vineland Adaptive Behavior Scales. American Guidance Service.
- Simplifying the implementation of modern scale scoring methods with an automated R package: Automated moderated nonlinear factor analysis (aMNLFA).Addictive behaviors. 2019; 94: 65-73
Team RC (2013): R: A language and environment for statistical computing.
- Latent variable mixture modeling.New developments and techniques in structural equation modeling. 2001; 2: 1-33
- Estimation of Extended Mixed Models Using Latent Classes and Latent Processes: The R Package lcmm.Journal of Statistical Software. 2017; 78: 1-56
- Assessment of autism symptoms from 6 to 18 months of age using the Autism Observation Scale for Infants in a prospective high-risk cohort.Child Development. 2021; 92: 1187-1198
- Towards equitable diagnoses for autism and attention-deficit/hyperactivity disorder across sexes and genders.Current Opinion in Psychiatry. 2022; 35: 90-100
- A Replication of the Autism Diagnostic Observation Schedule (ADOS) Revised Algorithms.Journal of the American Academy of Child & Adolescent Psychiatry. 2008; 47: 642-651
- The Autism Diagnostic Observation Schedule, Toddler Module: Standardized Severity Scores.J Autism Dev Disord. 2015; 45: 2704-2720
- Individual Differences and the Development of Joint Attention in Infancy.Child Development. 2007; 78: 938-954
- Variability in Responding to Joint Attention Cues in the First Year is Associated With Autism Outcome.Journal of the American Academy of Child & Adolescent Psychiatry. 2021; https://doi.org/10.1016/j.jaac.2021.03.023
- Factor Analysis of Restricted and Repetitive Behaviors in Autism Using the Autism Diagnostic Interview-R.Child Psychiatry Hum Dev. 2003; 34: 3-17
- Restricted and repetitive behaviors in young children with autism spectrum disorders.J Autism Dev Disord. 2007; 37: 73-85
- Circumscribed interests in autism: are there sex differences?.Advances in Autism. 2019;
- Behavioral manifestations of autism in the first year of life.International journal of developmental neuroscience. 2005; 23: 143-152
- Gender Bias, Female Resilience, and the Sex Ratio in Autism.Journal of the American Academy of Child & Adolescent Psychiatry. 2012; 51: 756-758
- The emotion dysregulation inventory: Psychometric properties and item response theory calibration in an autism spectrum disorder sample.Autism Research. 2018; 11: 928-941
- An integrative model of control: Implications for understanding emotion regulation and dysregulation in childhood anxiety.Journal of affective disorders. 2006; 91: 113-124
- The Challenge of Modeling Co-Developmental Processes over Time.Child development perspectives. 2021; 15: 67-75
- Annual Research Review: The transdiagnostic revolution in neurodevelopmental disorders.Journal of Child Psychology and Psychiatry. 2021;
Article Info
Publication History
Accepted:
May 30,
2022
Received in revised form:
May 12,
2022
Received:
February 14,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Society of Biological Psychiatry.
