Intellectual disabilities moderate sex/gender differences in autism spectrum disorder: a systematic review and meta-analysis

E. Saure*, M. Castrén, K. Mikkola, J. Salmi

*Corresponding author for this work

Research output: Contribution to journalReview Articlepeer-review

14 Citations (Scopus)

Abstract

Background: Girls/women with autism spectrum disorder (ASD) are suggested to exhibit different symptom profiles than boys/men with ASD. Accumulating evidence suggests that intellectual disability (ID) may affect sex/gender differences in ASD. However, a systematic review and meta-analysis on this topic is missing. Methods: Two databases (MEDLINE and PsycINFO) were used to search for studies reporting sex/gender differences (girls/women versus boys/men) in social communication and interaction, restrictive and repetitive behaviour and interests (RRBIs), sensory processing, and linguistic and motor abilities in ASD. The final sample consisted of 79 studies. The meta-analysis was performed with Review Manager using a random-effects model. Participants with ASD without and with ID were analysed as separate subgroups, and the effects in these two subgroups were also compared with each other. Results: Girls/women with ASD without ID displayed fewer RRBIs, more sensory symptoms and less problems in linguistic abilities than their boys/men counterparts. In contrast, girls/women with ASD with ID displayed more social difficulties and RRBIs, poorer linguistic abilities and more motor problems than boys/men with ASD with ID. Comparisons of groups of participants with ASD without ID versus participants with ASD with ID confirmed differences in sex/gender effects on social difficulties, sensory processing, linguistic abilities and motor abilities. Conclusions: Our results clearly suggest that the female phenotype of ASD is moderated by ID. Among individuals with ASD with ID, girls/women seem to be more severely affected than boys/men, whereas among individuals with ASD without ID, girls/women with ASD may have less symptoms than boys/men. Such phenotypic differences could be a potential cause of underrecognition of girls/women with ASD, and it is also possible that observed phenotypic differences may reflect underdiagnosing of girls/women with ASD.

Original languageEnglish
Pages (from-to)1-34
Number of pages34
JournalJournal of Intellectual Disability Research
Volume67
Issue number1
Early online date29 Nov 2022
DOIs
Publication statusPublished - Jan 2023
MoE publication typeA2 Review article, Literature review, Systematic review

Keywords

  • autism spectrum disorder
  • gender differences
  • intellectual disability
  • sex differences

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