Influence of gender bias in the diagnosis of autism spectrum disorder: a review
Keywords:
ASD, gender differences, gender bias, womenAbstract
The prevalence of autistic spectrum disorder (ASD) has increased in recent years, partly due to improvements in detection methods and partly to the modifications in the definition that have been incorporated into diagnostic manuals. This increase has caused the prevalence rate by gender to be currently of 1.4 / 1, according to some authors, or up to 15.7 / 1 according to others, with a much higher number of barons who receive the diagnosis compared to the number of women who receive it. The different explanations that have been given to this question point to certain gender differences in the symptomatic manifestations of the disorder, together with the fact that the evaluation techniques that have been used have been mostly designed with a sample of barons in mind and, therefore, with a greater precision for the detection in the case of them. Likewise, a phenomenon of camouflage has been argued to occur among women with the disorder, especially in cases of high cognitive capacity, who tend to have greater abilities to compensate for communication and social interaction difficulties typical of ASD. All this could be leading to the occurrence of false negative cases among women who may have ASD and who are not diagnosed. The objective of this research is to explore these gender differences in relation to the expression of the symptoms of ASD and to verify if this is faithfully transferred to the gender differences in the diagnosis, as well as to investigate the possible causes that could be behind this phenomenon. To this end, a theoretical review of the scientific literature published from 2009 to the present has been carried out and its most important conclusions which could help to clarify these issues have been selected and presented.
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References
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5. Baron-Cohen, S., Lombardo, M. V., Auyeung, B., Ashwin, E., Chakrabarti, B., & Knickmeyer, R. (2011). Why are autism spectrum conditions more prevalent in males? PLoS Biol, 9, e1001081. https://doi.org/10.1371/journal.pbio.1001081
6. *Begger, S., Mandell, D., Wijnker-Holmes, B., Venderbosch, S., Rem, D., Stekelenburg, F., & Koot, H. M. (2013). Sex differences in the timing of identification among children and adults with autism spectrum disorders. Journal of autism and developmental disorders, 43, 1151-1156. https://doi.org/10.1007/s10803-012-1656-z
7. Broekhof, E., Ketelaar, L., Stockmann, L., van Zijp, A., Bos, M. G., & Rieffe, C. (2015). The understanding of intentions, desires and beliefs in young children with autism spectrum disorder. Journal of autism and developmental disorders, 45, 2035-2045.
8. Brugha, T. S., McManus, S., Bankart, J., Scott, F., Purdon, S., Smith, J., ... & Meltzer, H. (2011). Epidemiology of autism spectrum disorders in adults in the community in England. Archives of general psychiatry, 68, 459-465.
9. Cheslack-Postava, K., & Jordan-Young, R. M. (2012). Autism spectrum disorders: toward a gendered embodiment model. Social science & medicine, 74, 1667-1674.
10. Chistol, L. T., Bandini, L. G., Must, A., Phillips, S., Cermak, S. A., & Curtin, C. (2018). Sensory sensitivity and food selectivity in children with autism spectrum disorder. Journal of autism and developmental disorders, 48, 583-591.
11. *Cridland, E, Jones, S., Caputi, P., & Magee, C. (2014). Being a girl in a boys’ world: investigating the experiences of girls with autism spectrum disorders during adolescence. Journal of autism and developmental disorders, 44, 1261-1274. https://doi.org/10.1007/s10803-013-1985-6
12. *Dean, M., Harwood, R., & Kasari, C. (2017). The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder. Autism, 21, 678-689.
13. *Dean, M., Kasari, C., Shih, W., Frankel, F., Whitney, R., Landa, R., & Harwood, R. (2014). The peer relationships of girls with ASD at school: comparison to boys and girls with and without ASD. Journal of Child Psychology and Psychiatry, 55, 1218-1225. https://doi.org/10.1111/jcpp.12242
14. *Dworzynski, K., Ronald, A., Bolton, P., & Happé, F. (2012). How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? Journal of the American Academy of Child & Adolescent Psychiatry, 51, 788-797. https://doi.org/10.1016/j.jaac.2012.05.018
15. *Giarelli, E., Wiggins, L. D., Rice, C. E., Levy, S. E., Kirby, R. S., Pinto-Martin, J., & Mandell, D. (2010). Sex differences in the evaluation and diagnosis of autism spectrum disorders among children. Disability and health journal, 3, 107-116. https://doi.org/10.1016/j.dhjo.2009.07.001
16. Gillberg, C., Cederlund, M., Lamberg, K., & Zeijlon, L. (2006). Brief report:“the autism epidemic”. The registered prevalence of autism in a Swedish urban area. Journal of autism and developmental disorders, 36, 429.
17. Gomes, E., Rotta, N. T., Pedroso, F. S., Sleifer, P., & Danesi, M. C. (2004). Auditory hypersensitivity in children and teenagers with autistic spectrum disorder. Arquivos de Neuro-psiquiatria, 62, 797-801.
18. Goodman, R., (1997). The strengths and difficulties Questionnaire. Journal of child Psychology and Psychiatry; 38, 581-586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x
19. Gould, J., & Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice (GAP), 12(1), 34-41.
20. *Harrop, C., Gulsrud, A., & Kasari, C. (2015). Does gender moderate core deficits in ASD? An investigation into restricted and repetitive behaviors in girls and boys with ASD. Journal of autism and developmental disorders, 45, 3644-3655. https://doi.org/10.1007/s10803-015-2511-9
21. *Head, A., McGillivray, J., & Stokes, M. (2014). Gender differences in emotionality and sociability in children with autism spectrum disorders. Molecular autism, 5, 19. https://doi.org/10.1186/2040-2392-5-19
22. Hervás, A. (2016). Un autismo, varios autismos. Variabilidad fenotípica en los trastornos del espectro autista. Rev Neurol, 62 (Supl 1): S9-14.
23. *Hiller, R., Young, R., & Weber, N. (2014). Sex differences in autism spectrum disorder based on DSM-5 criteria: evidence from clinician and teacher reporting. Journal of abnormal child psychology, 42, 1381-1393. https://doi.org/10.1007/s10802-014-9881-x
24. *Horiuchi, F., Oka, Y., Uno, H., Kawabe, K., Okada, F., Saito, I., & Ueno, S. (2014). Age-and sex-related emotional and behavioral problems in children with autism spectrum disorders: Comparison with control children. Psychiatry and clinical neurosciences, 68, 542-550. https://doi.org/10.1111/pcn.12164
25. Hubbard, K. L., Anderson, S. E., Curtin, C., Must, A., & Bandini, L. G. (2014). A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children. Journal of the Academy of Nutrition and Dietetics, 114, 1981–1987.
26. *Hull, L., Mandy, W., & Petrides, K. V. (2017). Behavioural and cognitive sex/gender differences in autism spectrum condition and typically developing males and females. Autism, 2, 706-727.
27. *Kauschke, C., van der Beek, B., & Kamp-Becker, I. (2016). Narratives of girls and boys with autism spectrum disorders: gender differences in narrative competence and internal state language. Journal of autism and developmental disorders, 46, 840-852. https://doi.org/10.1007/s10803-015-2620-5
28. Kim, E. S., Berkovits, L. D., Bernier, E. P., Leyzberg, D., Shic, F., Paul, R., & Scassellati, B. (2013). Social robots as embedded reinforcers of social behavior in children with autism. Journal of autism and developmental disorders, 43, 1038-1049.
29. Klin, A. (2006). Autism and Asperger syndrome: an overview. Revista brasileira de psiquiatria, 28, s3-s11.
30. *Kopp, S., & Gillberg, C. (2011). The Autism Spectrum Screening Questionnaire (ASSQ)-Revised Extended Version (ASSQ-REV): An instrument for better capturing the autism phenotype in girls? A preliminary study involving 191 clinical cases and community controls. Research in developmental disabilities, 32, 2875-2888. https://doi.org/10.1016/j.ridd.2011.05.017
31. Kreiser, N., & White, S. (2014). ASD in females: are we overstating the gender difference in diagnosis? Clinical child and family psychology review, 17, 67-84. https://doi.org/10.1007/s10567-013-0148-9
32. *Kumazaki, H., Muramatsu, T., Kosaka, H., Fujisawa, T. X., Iwata, K., Tomoda, A. & Mimura, M. (2015). Sex differences in cognitive and symptom profiles in children with high functioning autism spectrum disorders. Research in Autism Spectrum Disorders, 13, 1-7. https://doi.org/10.1016/j.rasd.2014.12.011
33. Lai, M. C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11-24.
34. Lai, M. C., Lombardo, M. V., Ruigrok, A. N., Chakrabarti, B., Auyeung, B., Szatmari, P., ... & MRC AIMS Consortium. (2017). Quantifying and exploring camouflaging in men and women with autism. Autism, 21(6), 690-702.
35. 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 & Adolescent Psychiatry, 56(6), 466-474.
36. *Mandy, W., Chilvers, R., Chowdhury, U., Salter, G., Seigal, A., & Skuse, D. (2012). Sex differences in autism spectrum disorder: evidence from a large sample of children and adolescents. Journal of autism and developmental disorders, 42, 1304-1313. https://doi.org/10.1007/s10803-011-1356-0
37. *Mandy, W., Pellicano, L., St Pourcain, B., Skuse, D., & Heron, J. (2018). The development of autistic social traits across childhood and adolescence in males and females. Journal of Child Psychology and Psychiatry.
38. *May, T., Cornish, K., & Rinehart, N. (2014). Does gender matter? A one-year follow-up of autistic, attention and anxiety symptoms in high-functioning children with autism spectrum disorder. Journal of autism and developmental disorders, 44, 1077. https://doi.org/10.1007/s10803-013-1964-y
39. *May, T., Cornish, K., & Rinehart, N. J. (2016). Gender profiles of behavioral attention in children with autism spectrum disorder. Journal of attention disorders, 20, 627-635. https://doi.org/10.1177/1087054712455502
40. Mayes, S. D., Calhoun, S. L., Waschbusch, D. A., & Baweja, R. (2017). Autism and reactive attachment/disinhibited social engagement disorders: Co-occurrence and differentiation. Clinical child psychology and psychiatry, 22, 620-631.
41. *Memari, A., Ziaee, V., Shayestehfar, M., Ghanouni, P., Mansournia, M. & Moshayedi, P. (2013). Cognitive flexibility impairments in children with autism spectrum disorders: links to age, gender and child outcomes. Research in Developmental Disabilities, 34, 3218-3225. https://doi.org/10.1016/j.ridd.2013.06.033
42. Organización Mundial de la Salud (2017) OMS: Organización Mundial de la Salud. Ginebra, Suiza.: WHO Media centre. Recuperado de http://www.who.int/mediacentre/factsheets/autism-spectrum-disorders/es/
43. *Ormond, S., Brownlow, C., Garnett, M. S., Rynkiewicz, A., & Attwood, T. (2018). Profiling autism symptomatology: An exploration of the Q-ASC parental report scale in capturing sex differences in autism. Journal of autism and developmental disorders, 48, 389-403.
44. *Ratto, A. B., Kenworthy, L., Yerys, B. E., Bascom, J., Wieckowski, A. T., White, S. W., ... & Scarpa, A. (2018). What about the girls? Sex-based differences in autistic traits and adaptive skills. Journal of autism and developmental disorders, 48, 1698-1711.
45. *Rutherford, M., McKenzie, K., Johnson, T., Catchpole, C., O’Hare, A., McClure, I., & Murray, A. (2016). Gender ratio in a clinical population sample, age of diagnosis and duration of assessment in children and adults with autism spectrum disorder. Autism, 20, 628-634. https://doi.org/10.1177/1362361315617879
46. Ruggieri, V., & Arberas, C. (2016). Autismo en las mujeres: aspectos clínicos, neurobiológicos y genéticos. Rev Neurol, 62 (supl 1): S21-26.
47. *Sipes, M., Matson, J. L., Worley, J. A., & Kozlowski, A. M. (2011). Gender differences in symptoms of autism spectrum disorders in toddlers. Research in Autism Spectrum Disorders, 5, 1465-1470. https://doi.org/10.1016/j.rasd.2011.02.007
48. *Solomon, M., Miller, M., Taylor, S. L., Hinshaw, S., & Carter, C. (2012). Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of autism and developmental disorders, 42, 48-59. https://doi.org/10.1007/s10803-011-1215-z
49. *Stacy, M., Zablotsky, B., Yarger, H. A., Zimmerman, A., Makia, B., & Lee, L. C. (2014). Sex differences in co-occurring conditions of children with autism spectrum disorders. Autism, 18, 965-974. https://doi.org/10.1177/1362361313505719
50. Tager-Flusberg, H. (2007). Evaluating the theory-of-mind hypothesis of autism. Current Directions in Psychological Science, 16, 311–315. https://doi.org/10.1111/j.1467-8721.2007.00527.x
51. Wing, L. (1981). Sex ratios in early childhood autism and related conditions. Psychiatry research, 5, 129-137.
52. *Worley, J., & Matson, J. (2011). Psychiatric symptoms in children diagnosed with an autism spectrum disorder: An examination of gender differences. Research in Autism Spectrum Disorders, 5, 1086-1091.
2. Artigas-Pallarés, J., & Narbona-García, J. (2011). Trastornos del neurodesarrollo, Barcelona. Viguera Ed.
3. Attwood, T., Garnett, M. S., Rynkiewiez, A. (2011). Questionnaire for Autism Spectrum Conditions (Q-ASC) [Measurement instrument].
4. Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in cognitive sciences, 6, 248-254. https://doi.org/10.1016/S1364-6613(02)01904-6
5. Baron-Cohen, S., Lombardo, M. V., Auyeung, B., Ashwin, E., Chakrabarti, B., & Knickmeyer, R. (2011). Why are autism spectrum conditions more prevalent in males? PLoS Biol, 9, e1001081. https://doi.org/10.1371/journal.pbio.1001081
6. *Begger, S., Mandell, D., Wijnker-Holmes, B., Venderbosch, S., Rem, D., Stekelenburg, F., & Koot, H. M. (2013). Sex differences in the timing of identification among children and adults with autism spectrum disorders. Journal of autism and developmental disorders, 43, 1151-1156. https://doi.org/10.1007/s10803-012-1656-z
7. Broekhof, E., Ketelaar, L., Stockmann, L., van Zijp, A., Bos, M. G., & Rieffe, C. (2015). The understanding of intentions, desires and beliefs in young children with autism spectrum disorder. Journal of autism and developmental disorders, 45, 2035-2045.
8. Brugha, T. S., McManus, S., Bankart, J., Scott, F., Purdon, S., Smith, J., ... & Meltzer, H. (2011). Epidemiology of autism spectrum disorders in adults in the community in England. Archives of general psychiatry, 68, 459-465.
9. Cheslack-Postava, K., & Jordan-Young, R. M. (2012). Autism spectrum disorders: toward a gendered embodiment model. Social science & medicine, 74, 1667-1674.
10. Chistol, L. T., Bandini, L. G., Must, A., Phillips, S., Cermak, S. A., & Curtin, C. (2018). Sensory sensitivity and food selectivity in children with autism spectrum disorder. Journal of autism and developmental disorders, 48, 583-591.
11. *Cridland, E, Jones, S., Caputi, P., & Magee, C. (2014). Being a girl in a boys’ world: investigating the experiences of girls with autism spectrum disorders during adolescence. Journal of autism and developmental disorders, 44, 1261-1274. https://doi.org/10.1007/s10803-013-1985-6
12. *Dean, M., Harwood, R., & Kasari, C. (2017). The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder. Autism, 21, 678-689.
13. *Dean, M., Kasari, C., Shih, W., Frankel, F., Whitney, R., Landa, R., & Harwood, R. (2014). The peer relationships of girls with ASD at school: comparison to boys and girls with and without ASD. Journal of Child Psychology and Psychiatry, 55, 1218-1225. https://doi.org/10.1111/jcpp.12242
14. *Dworzynski, K., Ronald, A., Bolton, P., & Happé, F. (2012). How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? Journal of the American Academy of Child & Adolescent Psychiatry, 51, 788-797. https://doi.org/10.1016/j.jaac.2012.05.018
15. *Giarelli, E., Wiggins, L. D., Rice, C. E., Levy, S. E., Kirby, R. S., Pinto-Martin, J., & Mandell, D. (2010). Sex differences in the evaluation and diagnosis of autism spectrum disorders among children. Disability and health journal, 3, 107-116. https://doi.org/10.1016/j.dhjo.2009.07.001
16. Gillberg, C., Cederlund, M., Lamberg, K., & Zeijlon, L. (2006). Brief report:“the autism epidemic”. The registered prevalence of autism in a Swedish urban area. Journal of autism and developmental disorders, 36, 429.
17. Gomes, E., Rotta, N. T., Pedroso, F. S., Sleifer, P., & Danesi, M. C. (2004). Auditory hypersensitivity in children and teenagers with autistic spectrum disorder. Arquivos de Neuro-psiquiatria, 62, 797-801.
18. Goodman, R., (1997). The strengths and difficulties Questionnaire. Journal of child Psychology and Psychiatry; 38, 581-586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x
19. Gould, J., & Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice (GAP), 12(1), 34-41.
20. *Harrop, C., Gulsrud, A., & Kasari, C. (2015). Does gender moderate core deficits in ASD? An investigation into restricted and repetitive behaviors in girls and boys with ASD. Journal of autism and developmental disorders, 45, 3644-3655. https://doi.org/10.1007/s10803-015-2511-9
21. *Head, A., McGillivray, J., & Stokes, M. (2014). Gender differences in emotionality and sociability in children with autism spectrum disorders. Molecular autism, 5, 19. https://doi.org/10.1186/2040-2392-5-19
22. Hervás, A. (2016). Un autismo, varios autismos. Variabilidad fenotípica en los trastornos del espectro autista. Rev Neurol, 62 (Supl 1): S9-14.
23. *Hiller, R., Young, R., & Weber, N. (2014). Sex differences in autism spectrum disorder based on DSM-5 criteria: evidence from clinician and teacher reporting. Journal of abnormal child psychology, 42, 1381-1393. https://doi.org/10.1007/s10802-014-9881-x
24. *Horiuchi, F., Oka, Y., Uno, H., Kawabe, K., Okada, F., Saito, I., & Ueno, S. (2014). Age-and sex-related emotional and behavioral problems in children with autism spectrum disorders: Comparison with control children. Psychiatry and clinical neurosciences, 68, 542-550. https://doi.org/10.1111/pcn.12164
25. Hubbard, K. L., Anderson, S. E., Curtin, C., Must, A., & Bandini, L. G. (2014). A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children. Journal of the Academy of Nutrition and Dietetics, 114, 1981–1987.
26. *Hull, L., Mandy, W., & Petrides, K. V. (2017). Behavioural and cognitive sex/gender differences in autism spectrum condition and typically developing males and females. Autism, 2, 706-727.
27. *Kauschke, C., van der Beek, B., & Kamp-Becker, I. (2016). Narratives of girls and boys with autism spectrum disorders: gender differences in narrative competence and internal state language. Journal of autism and developmental disorders, 46, 840-852. https://doi.org/10.1007/s10803-015-2620-5
28. Kim, E. S., Berkovits, L. D., Bernier, E. P., Leyzberg, D., Shic, F., Paul, R., & Scassellati, B. (2013). Social robots as embedded reinforcers of social behavior in children with autism. Journal of autism and developmental disorders, 43, 1038-1049.
29. Klin, A. (2006). Autism and Asperger syndrome: an overview. Revista brasileira de psiquiatria, 28, s3-s11.
30. *Kopp, S., & Gillberg, C. (2011). The Autism Spectrum Screening Questionnaire (ASSQ)-Revised Extended Version (ASSQ-REV): An instrument for better capturing the autism phenotype in girls? A preliminary study involving 191 clinical cases and community controls. Research in developmental disabilities, 32, 2875-2888. https://doi.org/10.1016/j.ridd.2011.05.017
31. Kreiser, N., & White, S. (2014). ASD in females: are we overstating the gender difference in diagnosis? Clinical child and family psychology review, 17, 67-84. https://doi.org/10.1007/s10567-013-0148-9
32. *Kumazaki, H., Muramatsu, T., Kosaka, H., Fujisawa, T. X., Iwata, K., Tomoda, A. & Mimura, M. (2015). Sex differences in cognitive and symptom profiles in children with high functioning autism spectrum disorders. Research in Autism Spectrum Disorders, 13, 1-7. https://doi.org/10.1016/j.rasd.2014.12.011
33. Lai, M. C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11-24.
34. Lai, M. C., Lombardo, M. V., Ruigrok, A. N., Chakrabarti, B., Auyeung, B., Szatmari, P., ... & MRC AIMS Consortium. (2017). Quantifying and exploring camouflaging in men and women with autism. Autism, 21(6), 690-702.
35. 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 & Adolescent Psychiatry, 56(6), 466-474.
36. *Mandy, W., Chilvers, R., Chowdhury, U., Salter, G., Seigal, A., & Skuse, D. (2012). Sex differences in autism spectrum disorder: evidence from a large sample of children and adolescents. Journal of autism and developmental disorders, 42, 1304-1313. https://doi.org/10.1007/s10803-011-1356-0
37. *Mandy, W., Pellicano, L., St Pourcain, B., Skuse, D., & Heron, J. (2018). The development of autistic social traits across childhood and adolescence in males and females. Journal of Child Psychology and Psychiatry.
38. *May, T., Cornish, K., & Rinehart, N. (2014). Does gender matter? A one-year follow-up of autistic, attention and anxiety symptoms in high-functioning children with autism spectrum disorder. Journal of autism and developmental disorders, 44, 1077. https://doi.org/10.1007/s10803-013-1964-y
39. *May, T., Cornish, K., & Rinehart, N. J. (2016). Gender profiles of behavioral attention in children with autism spectrum disorder. Journal of attention disorders, 20, 627-635. https://doi.org/10.1177/1087054712455502
40. Mayes, S. D., Calhoun, S. L., Waschbusch, D. A., & Baweja, R. (2017). Autism and reactive attachment/disinhibited social engagement disorders: Co-occurrence and differentiation. Clinical child psychology and psychiatry, 22, 620-631.
41. *Memari, A., Ziaee, V., Shayestehfar, M., Ghanouni, P., Mansournia, M. & Moshayedi, P. (2013). Cognitive flexibility impairments in children with autism spectrum disorders: links to age, gender and child outcomes. Research in Developmental Disabilities, 34, 3218-3225. https://doi.org/10.1016/j.ridd.2013.06.033
42. Organización Mundial de la Salud (2017) OMS: Organización Mundial de la Salud. Ginebra, Suiza.: WHO Media centre. Recuperado de http://www.who.int/mediacentre/factsheets/autism-spectrum-disorders/es/
43. *Ormond, S., Brownlow, C., Garnett, M. S., Rynkiewicz, A., & Attwood, T. (2018). Profiling autism symptomatology: An exploration of the Q-ASC parental report scale in capturing sex differences in autism. Journal of autism and developmental disorders, 48, 389-403.
44. *Ratto, A. B., Kenworthy, L., Yerys, B. E., Bascom, J., Wieckowski, A. T., White, S. W., ... & Scarpa, A. (2018). What about the girls? Sex-based differences in autistic traits and adaptive skills. Journal of autism and developmental disorders, 48, 1698-1711.
45. *Rutherford, M., McKenzie, K., Johnson, T., Catchpole, C., O’Hare, A., McClure, I., & Murray, A. (2016). Gender ratio in a clinical population sample, age of diagnosis and duration of assessment in children and adults with autism spectrum disorder. Autism, 20, 628-634. https://doi.org/10.1177/1362361315617879
46. Ruggieri, V., & Arberas, C. (2016). Autismo en las mujeres: aspectos clínicos, neurobiológicos y genéticos. Rev Neurol, 62 (supl 1): S21-26.
47. *Sipes, M., Matson, J. L., Worley, J. A., & Kozlowski, A. M. (2011). Gender differences in symptoms of autism spectrum disorders in toddlers. Research in Autism Spectrum Disorders, 5, 1465-1470. https://doi.org/10.1016/j.rasd.2011.02.007
48. *Solomon, M., Miller, M., Taylor, S. L., Hinshaw, S., & Carter, C. (2012). Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of autism and developmental disorders, 42, 48-59. https://doi.org/10.1007/s10803-011-1215-z
49. *Stacy, M., Zablotsky, B., Yarger, H. A., Zimmerman, A., Makia, B., & Lee, L. C. (2014). Sex differences in co-occurring conditions of children with autism spectrum disorders. Autism, 18, 965-974. https://doi.org/10.1177/1362361313505719
50. Tager-Flusberg, H. (2007). Evaluating the theory-of-mind hypothesis of autism. Current Directions in Psychological Science, 16, 311–315. https://doi.org/10.1111/j.1467-8721.2007.00527.x
51. Wing, L. (1981). Sex ratios in early childhood autism and related conditions. Psychiatry research, 5, 129-137.
52. *Worley, J., & Matson, J. (2011). Psychiatric symptoms in children diagnosed with an autism spectrum disorder: An examination of gender differences. Research in Autism Spectrum Disorders, 5, 1086-1091.
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2018-05-01
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Montagut Asunción, M. ., Mas Romero, R. M. ., Fernández Andrés, M. I. ., & Pastor Cerezuela, G. . (2018). Influence of gender bias in the diagnosis of autism spectrum disorder: a review. Escritos De Psicología - Psychological Writings, 11(1), 42–54. Retrieved from https://revistas.uma.es/index.php/espsi/article/view/9426
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