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 children with ASD, 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 to 9, 12 to 15, 24, and 36 to
60 months of age (total nobservations = 1254) with infant siblings of children with ASD (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 2 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 having elevated social
concerns demonstrated 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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Article Info
Publication History
Published online: June 07, 2022
Accepted:
May 30,
2022
Received in revised form:
May 12,
2022
Received:
February 14,
2022
Footnotes
JPi and JTE contributed equally to this work as joint senior authors.
Identification
Copyright
© 2022 Society of Biological Psychiatry.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Balanced Sex Ratios and the Autism ContinuumBiological PsychiatryVol. 92Issue 8
- PreviewAutism is a heterogeneous neurodevelopmental condition that is diagnosed more frequently in males than females (note that in this commentary, the use of “female” and “male” refers to sex assigned at birth). The ratio of male to female diagnosis is about 3.25 to 1 when evaluated using ascertainment methods that actively screen a population-based sample, compared with the 4.56 to 1 ratio in individuals who have already had a diagnosis of autism (1). In many cases, females tend to not receive a diagnosis of autism until later in life when they have increased difficulties navigating a more complex social environment, or they tend to receive co-occurring diagnoses early in life that overshadow their autism.
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