Academic Scientific JournalsSex/gender differences in the level and variability of autistic traits: a meta-analysis of the Autism-Spectrum Quotient
Keywords:
autism spectrum quotient, autism, neurodevelopmental disorders, sex/gender differencesAbstract
Background:
The objective of this meta-analysis was to assess the influence of sex/gender on the level and variability of autistic traits in both autistic and neurotypical samples.
Participants and procedure:
A systematic search was conducted in the PubMed and EBSCOhost databases in April and May 2019 as well as September 2020. Studies were included if they contained information about mean (M) and standard deviation (SD) statistics of the Au-tism-Spectrum Quotient in a group with autism and typically developing participants. Calculations were performed using a random-effects model with study subgroups as the unit of analysis.
Results:
A total of 307 articles were chosen for further analysis with 634 786 participants in the studies evaluating the effect of sex/gender on the level of autistic traits and 495 840 individuals in the analyses examining the effect of sex/gender on the variability of autistic traits. Sex/gender moderated mainly the level of total autistic traits score (Q = 22.34, p ≤ .001) in that the level became higher as more males/men were included in the study but only in the neurotypical sample. The variability was higher in males/men than in females/women in the total level of autistic traits, social behaviors/social skills, commu-nication/mindreading, attention to details/patterns, and attention switching/tolerance of change in a clinical and a non-clinical group of women (from variance =1.65, Q = 59, I2 = 61.02, τ2 = 360.20 to variance = 56.69, Q = 47.19, I2 = 59.22, τ2 = 8719.17). Furthermore, the impact of sex/gender on the level and variability of autistic traits was more pronounced in the neurotypical group than in the autism sample.
Conclusions:
These findings suggest that males/men tend to display more pronounced and varied autistic traits than females/women. Further research is necessary to gain a better understanding of the scope and nature of these sex/gender differences.
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References
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). APA Publishing.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.text rev.). APA Publishing.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). APA Publishing.
Auyeung, B., Baron-Cohen, S., Ashwin, E., Knickmeyer, R., Taylor, K., & Hackett, G. (2009). Fetal testosterone and autistic traits. British Journal of Psychology, 100, 1–22. https://doi.org/10.1348/000712608X311731
Auyeung, B., Baron-Cohen, S., Wheelwright, S., & Allison, C. (2008). The Autism Spectrum Quotient: Children’s version (AQ-Child). Journal of Autism and Developmental Disorders, 38, 1230–1240. https://doi.org/10.1007/s10803-007-0504-z
Auyeung, B., Taylor, K., Hackett, G., & Baron-Cohen, S. (2010). Fetal testosterone and autistic traits in 18 to 24-month-old children. Molecular Autism, 1, 11. https://doi.org/10.1186/2040-2392-1-11
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: an investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46, 3281–3294. https://doi.org/10.1007/s10803-016-2872-8
Baron-Cohen, S., Hoekstra, R. A., Knickmeyer, R., & Wheelwright, S. (2006). The Autism-Spectrum Quotient (AQ) – adolescent version. Journal of Autism and Developmental Disorders, 36, 343–350. https://doi.org/10.1007/s10803-006-0073-6
Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The Autism-Spectrum Quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31, 5–17. https://doi.org/10.1023/A:1005653411471
Baye, A., & Monseur, C. (2016). Gender differences in variability and extreme scores in an international context. Large-Scale Assessments in Education, 4, 1. https://doi.org/10.1186/s40536-015-0015-x
Beggiato, A., Peyre, H., Maruani, A., Scheid, I., Rastam, M., Amsellem, F., Gillberg, C., Leboyer, M., Bourgeron, T., Gilbert, C., & Delorme, R. (2017). Gender differences in autism spectrum disorders: Divergence among specific core symptoms. Autism Research, 10, 680–689. https://doi.org/10.1002/aur.1715
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Complex data structures: Overview. In M. Borenstein, L. V. Hedges, J. P. T. Higgins, & H. R. Rothstein (Eds.), Introduction to meta-analysis (pp. 215–216). John Wiley.
Bourson, L., & Prevost, C. (2022). Characteristics of restricted interests in girls with ASD compared to boys: a systematic review of the literature. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-01998
Cochran, W. (1954). The combination of estimates from different experiments. Biometics, 10, 101–129. https://doi.org/10.2307/3001666
Constantino, J. N., & Todd, R. D. (2003). Autistic traits in the general population: a twin study. Archives of General Psychiatry, 60, 524–530. https://doi.org/10.1001/archpsyc.60.5.524
Cook, J., Hull, L., Crane, L., & Mandy, W. (2021). Camouflaging in autism: a systematic review. Clinical Psychology Review, 89, 102080. https://doi.org/10.1016/j.cpr.2021.102080
Duval, S., & Tweedie, R. (2000). Trim and fill: a simple funnel-plot based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463. https://doi.org/10.1111/j.0006- 341x.2000.00455.x
Egger, M., Davey Smith, G., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple graphical test. British Medical Journal, 315, 629–634. https://doi.org/10.1136/bmj.315.7109.629
Ellis, H. (1934/1984). Man and woman: a study of human sexual characters. Heinemann.
Frazier, T. W., Thompson, L., Youngstrom, E. A., Law, P., Hardan, A. Y., Eng, C., & Morris, N. (2014). A twin study of heritable and shared environmental contributions to autism. Journal of Autism and Developmental Disorders, 44, 2013–2025. https://doi.org/10.1007/s10803-014-2081-2
Frazier, T. W., Youngstrom, E. A., Sinclair, L., Kubu, C. S., Law, P., Rezai, A., Constantino, J. N., & Eng, C. (2010). Autism spectrum disorders as a qualitatively distinct category from typical behavior in a large, clinically ascertained sample. Assessment, 17, 308–320. https://doi.org/10.1177/1073191109356534
Frazier, T. W., Youngstrom, E. A., Speer, L., Embacher, R., Law, P., Constantino, J., Findling, R. L., Hardan, A. Y., & Eng, C. (2012). Validation of proposed DSM-5 criteria for autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 28–40.E3. https://doi.org/10.1016/j.jaac.2011.09.021
Goldman, S. (2013). Opinion: Sex, gender and the diagnosis of autism – a biosocial view of the male preponderance. Research in Autism Spectrum Disorders, 7, 675–679. https://doi.org/10.1016/j.rasd.2013.
Greenberg, D. M., Warrier, V., Allison, C., & Baron-Cohen, S. (2018). Testing the empathizing-systemizing theory of sex differences and the extreme male brain theory of autism in half a million people. PNAS, 115, 12152–12157. https://doi.org/10.1073/pnas.1811032115
Hedges, L., & Nowell, A. (1995). Sex differences in mental test scores, variability, and numbers of highscoring individuals. Science, 269, 41–45. https://doi.org/10.1126/science.7604277
Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Academic Press.
Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327, 557–560. https://doi.org/10.1136/bmj.327.7414.557
Hunter, J. E., & Schmidt, F. L. (2004). Methods of metaanalysis: Correcting error and bias in research findings. Sage.
Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: a narrative review. Review Journal of Autism and Developmental Disorder, 7, 306–317. https://doi.org/10.1007/s40489-020-00197
Ingersoll, B., & Wainer, A. (2014). The broader autism phenotype. In F. R. Volkmar, S. J. Rogers, R. Paul, & K. A. Pelphrey (Eds.), Handbook of autism and pervasive developmental disorders: Diagnosis, development, and brain mechanisms (pp. 28–56). John Wiley & Sons. https://doi.org/10.1002/9781118911389.hautc02
Karwowski, M., Jankowska, D. M., Gajda, A., Marczak, M., Groyecka, A., & Sorokowski, P. (2016). Greater male variability in creativity outside the WEIRD World. Creativity Research Journal, 28, 467–470. https://doi.org/10.1080/10400419.2016.1229978
Kim, Y. S., Leventhal, B. L, Koh, Y. J., Fombonne, E., Laska, E., Lim, E. C., Cheon, K. A., Kim, S. J., Kim, Y. K., Lee, H. K., Song, D. H., & Grinker, R. R. (2011). Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry, 168, 904–912. https://doi.org/10.1176/appi.ajp.2011.10101532
Lehre, A. C., Lehre, K. P., Laake, P., & Danbolt, N. C. (2009). Greater intrasex phenotype variability in males than in females is a fundamental aspect of the gender differences in humans. Developmental Psychobiology, 51, 198–206. https://doi.org/10.1002/dev.20358
Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 56, 466–474. https://doi.org/10.1016/j.jaac.2017.03.013
López-López, J. A., Page, M. J., Lipsey, M. W., & Higgins, J. (2018). Dealing with effect size multiplicity in systematic reviews and meta-analyses. Research Synthesis Methods, 9, 336–351. https://doi.org/10.1002/jrsm.1310
Lundström, S., Chang, Z., Råstam, M., Gillberg, C., Larsson, H., Anckarsäter, H., & Lichtenstein, P. (2012). Autism spectrum disorders and autistic like traits: Similar etiology in the extreme end and the normal variation. Archives of General Psychiatry, 69, 46–52. https://doi.org/10.1001/archgenpsychiatry.2011.144
Maenner, M. J., Shaw, K. A., Bakian, A. V., Bilder, D. A., Durkin, M. S., Esler, A., Furnier, S. M., Hallas, L., Hall-Lande, J., Hudson, A., Hughes, M. M., Patrick, M., Pierce, K., Poynter, J. N., Salinas, A., Shenouda, J., Vehorn, A., Warren, Z., Constantino, J. N., DiRienzo, M., … Cogswell, M. E. (2021). Prevalence and characteristics of autism spectrum disorder among children aged 8 years – autism and developmental disabilities monitoring network, 11 sites, United States, 2018. Morbidity and Mortality Weekly Report, 70, 1–16. https://doi.org/10.15585/mmwr.ss7011a1
Omelańczuk, I., & Pisula, E. (2020). Correlations between temperament and autistic trait measures – quantitative or qualitative differences between children with and without autism spectrum disorders? Research in Autism Spectrum Disorders, 76, 101602. https://doi.org/10.1016/j.rasd.2020.101602
Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., … McKenzie, J. E. (2021). PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ, 372, n160. https://doi.org/10.1136/bmj.n160
Rivet, T. T., & Matson, J. L (2011). Review of gender differences in core symptomatology in autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 957–976. https://doi.org/10.1016/j.rasd.2010.12.003
Ronald, A., Happé, F., Bolton, P., Butcher, L. M., Price, T. S., Wheelwright, S., & Plomin, R. (2006). Genetic heterogeneity between the three components of the autism spectrum: a twin study. Journal of American Academy of Child & Adolescent Psychiatry, 45, 691–699. https://doi.org/10.1097/01.chi.0000215325.130
Ronald, A., & Hoekstra, R. A. (2011). Autism spectrum disorders and autistic traits: a decade of new twin studies. American Journal of Medical Genetics. Part B, 156, 255–274. https://doi.org/10.1002/ajmg.b.31159
Rosenthal, R. (1979). The “file drawer problem” and tolerance for null results. Psychological Bulletin, 86, 638−641. https://doi.org/10.1037/0033-2909.86.3.638
Rosenthal, R. (1995). Writing meta-analytic reviews. Psychological Bulletin, 118, 183–192. https://doi.org/10.1037/0033-2909.118.2.183
Ruzich, E., Allison, C., Smith, P., Watson, P., Auyeung, B., Ring, H., & Baron-Cohen, S. (2015). Measuring autistic traits in the general population: a systematic review of the Autism-Spectrum Quotient (AQ) in a nonclinical population sample of 6,900 typical adult males and females. Molecular Autism, 6, 1–12. https://doi.org/10.1186/2040-2392-6-2
Scammacca, N., Roberts, G., & Stuebing, K. K. (2014). Meta-analysis with complex research designs: Dealing with dependence from multiple measures and multiple group comparisons. Review of Educational Research, 84, 328–364. https://doi.org/10.3102/0034654313500826
Sterne, J. A., Gavaghan, D., & Egger, M. (2000). Publication and related bias in meta-analysis: Power of statistical tests and prevalence in the literature. Journal of Clinical Epidemiology, 53, 1119–1129. https://doi.org/10.1016/s0895-4356(00)00242-0
Taylor, C. L., & Barbot, B. (2021). Gender differences in creativity: Examining the greater male variability hypothesis in different domains and tasks. Personality and Individual Differences, 174, 110661. https://doi.org/10.1016/j.paid.2021.110661
Thompson, S. G., & Sharp, S. J. (1999). Explaining heterogeneity in meta-analysis: a comparison of methods. Statistics in Medicine, 18, 2693–2708. https://doi.org/10.1016/S0197-2456(97)91051-5
Torske, T., Nærland, T., Quintana, D. S., Hypher, R. E., Kaale, A., Høyland, A. L., Hope, S., Johannessen, J., Øie, M. G., & Andreassen, O. A. (2023). Sex as a moderator between parent ratings of executive dysfunction and social difficulties in children and adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders, 53, 3847–3859. https://doi.org/10.1007/s10803-022-05629-5
Van Wijngaarden-Cremers, P. J., van Eeten, E., Groen, W. B., Van Deurzen, P. A., Oosterling, I. J., & Van der Gaag, R. J. (2014). Gender and age differences in the core triad of impairments in autism spectrum disorders: a systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 44, 627–635. https://doi.org/10.1007/s10803-013-1913-9
Wierenga, L. M., Doucet, G. E., Dima, D., Agartz, I., Aghajani, M., Akudjedu, T. N., Albajes-Eizagirre, A., Alnaes, D., Alpert, K. I., Andreassen, O. A., Anticevic, A., Asherson, P., Banaschewski, T., Bargallo, N., Baumeister, S., Baur-Streubel, R., Bertolino, A., Bonvino, A., Boomsma, D. I., Borgwardt, S., … Tamnes, C. K. (2022). Greater male than female variability in regional brain structure across the lifespan. Human Brain Mapping, 43, 470–499. https://doi.org/10.1002/hbm.25204
Wierenga, L. M., Sexton, J. A., Laake, P., Giedd, J. N., Tamnes, C. K., & the Pediatric Imaging, Neurocognition and Genetics Study. (2018). A key characteristic of sex differences in the developing brain: Greater variability in brain structure of boys than girls. Cerebral Cortex, 28, 2741–2751. https://doi.org/10.1093/cercor/bhx154
Wood-Downie, H., Wong, B., Kovshoff, H., Mandy, W., Hull, L., & Hadwin, J. A. (2021). Sex/gender differences in camouflaging in children and adolescents with autism. Journal of Autism and Developmental Disorders, 51, 1353–1364. https://doi.org/10.1007/s10803-020-04615-z
World Health Organization (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. WHO.
Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M. S., Saxena, S., Yusuf, A., Shih, A., & Elsabbagh, M. (2022). Global prevalence of autism: a systematic review update. Autism Research, 15, 778–790. https://doi.org/10.1002/aur.2696
