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Brief Report: Examination of Sex-Based Differences in ASD Symptom Severity among High-Functioning Children with ASD Using the SRS-2

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Title: Brief Report: Examination of Sex-Based Differences in ASD Symptom Severity among High-Functioning Children with ASD Using the SRS-2
Language: English
Authors: Rodgers, Jonathan D., Lodi-Smith, Jennifer, Donnelly, James P., Lopata, Christopher, McDonald, Christin A., Thomeer, Marcus L., Lipinski, Alanna M., Nasca, Brian C., Booth, Adam J.
Source: Journal of Autism and Developmental Disorders. Feb 2019 49(2):781-787.
Availability: Springer. Available from: Springer Nature. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 7
Publication Date: 2019
Sponsoring Agency: Institute of Education Sciences (ED)
US Department of Defense
Contract Number: R324A130216
R324A080136
W81XWH1510195
Document Type: Journal Articles
Reports - Research
Descriptors: Gender Differences, Autism, Pervasive Developmental Disorders, Symptoms (Individual Disorders), Severity (of Disability), Children, Interpersonal Competence, Measures (Individuals), Scores, Intelligence Quotient, Language Proficiency, Motivation, Receptive Language
DOI: 10.1007/s10803-018-3733-4
ISSN: 0162-3257
Abstract: Prior studies of sex-based differences in autism spectrum disorder (ASD) have yielded mixed findings. This study examined ASD symptom severity and functional correlates in a sample of 34 high-functioning females with ASD (HFASD; M age = 8.93; M IQ = 104.64) compared to 34 matched males (M age = 8.96; M IQ = 104.44) using the Social Responsiveness Scale-Second Edition (SRS-2). Results identified non-significant and minimal differences (negligible-to-small) on the SRS-2 total, DSM-5 symptom subscale, and treatment subscale scores. Significant negative (moderate) correlations were found between the SRS-2 Social Cognition subscale and IQ and language scores and between the SRS-2 Social Motivation subscale and receptive language scores for females only; no significant correlations were found for males.
Abstractor: As Provided
IES Funded: Yes
Entry Date: 2019
Accession Number: EJ1205037
Database: ERIC
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  Value: <anid>AN0134562374;aut01feb.19;2019Feb08.10:50;v2.2.500</anid> <title id="AN0134562374-1">Brief Report: Examination of Sex-Based Differences in ASD Symptom Severity Among High-Functioning Children with ASD Using the SRS-2 </title> <p>Prior studies of sex-based differences in autism spectrum disorder (ASD) have yielded mixed findings. This study examined ASD symptom severity and functional correlates in a sample of 34 high-functioning females with ASD (HFASD; M age = 8.93; M IQ = 104.64) compared to 34 matched males (M age = 8.96; M IQ = 104.44) using the Social Responsiveness Scale-Second Edition (SRS-2). Results identified non-significant and minimal differences (negligible-to-small) on the SRS-2 total, DSM-5 symptom subscale, and treatment subscale scores. Significant negative (moderate) correlations were found between the SRS-2 Social Cognition subscale and IQ and language scores and between the SRS-2 Social Motivation subscale and receptive language scores for females only; no significant correlations were found for males.</p> <p>Keywords: Autism spectrum disorder; High-functioning; Sex-based differences; Social Communication and Interaction; Social Responsiveness Scale-Second Edition</p> <p>Autism spectrum disorder (ASD) is defined by two symptom dimensions (deficits in social interaction/communication and restricted and repetitive behaviors, interests, and activities; American Psychiatric Association 2013). According to the most recent CDC estimates, high-functioning children with ASD (HFASD, i.e., without cognitive impairment) now account for a majority of those diagnosed (Christensen et al. 2016). For children with HFASD, the ratio of males-to-females in epidemiological research ranges from 5-to-1 to 16-to-1 (Baird et al. 2006; Christensen et al. 2016). This substantial discrepancy in prevalence makes studies of sex-based differences of clinical phenomenon/presentation difficult due to challenges in securing a sufficient number of comparable female participants (Hull et al. 2017; Kirkovski et al. 2013; Van Wijngaarden-Cremers et al. 2014).</p> <p>Differences in ASD symptom severity between female and male children is a significant area of research interest. A difference in the severity of core symptoms could indicate sex-based variability in the manifestation of ASD in females versus males and a differential need for supportive services and resources. However, research specifically on individuals with HFASD is very limited. Most past research has focused on broad samples of individuals with ASD across the range of IQ. In this broader literature, past reviews (including meta-analyses) have not identified a consistent difference in the area of social impairment/communication across studies, but do frequently identify differences in the restricted and repetitive behaviors and interests of females versus males (see Kreiser and White 2014; Van Wijngaarden-Cremers et al. 2014), with females showing less identified characteristics in this area. Additionally, much of the past research included in these reviews has not controlled (by design or statistically) for age or IQ, despite these being important considerations in exploring variability in ASD symptoms (Hull et al. 2017; Hus et al. 2013).</p> <p>In studies specifically about children with HFASD current results are mixed. The available research tends to compare groups using the gold-standard diagnostic measures (the Autism Diagnostic Interview-Revised [ADI-R; Rutter et al. 2003] or Autism Diagnostic Observation Schedule [ADOS; Lord et al. 2000]) which are comprised of symptom counts versus scaled ratings. For example, research using the ADI-R found no sex-based differences in a sample of 23 age and IQ matched pairs of children and adolescents with HFASD (Holtmann et al. 2007). However, this same study identified a higher degree of severity in social problems for females using the Child Behavior Checklist (Achenbach 1991), though this rating form is not specific to the social interaction and communication problems of ASD. Research on the ADOS in a sample of IQ equivalent groups (52 females, 273 males) reported a higher degree of restricted and repetitive behaviors, interests, and activities in males than females but no sex-based difference in social interaction/social communication problems (Mandy et al. 2012). Two studies in HFASD have used a measure indicative of symptom severity specifically for ASD (the Social Responsiveness Scale [Constantino and Gruber 2005]) and in these studies a more consistent lack of sex-based differences has been found. In samples of 28 and 20 age and IQ matched pairs no differences on overall ASD symptom severity were identified (May et al. 2014; Solomon et al. 2012). The scarcity and limitations of the previous studies in sex-based symptom differences in children with HFASD support a need for continued examination of this topic.</p> <hd id="AN0134562374-2">Current Study</hd> <p>This study was conducted to provide additional information on sex-based differences in ASD symptom severity for children with HFASD. Specifically, this study examines differences in ASD symptom severity for a sample of age- and IQ-matched children with HFASD using the Social Responsiveness Scale-Second Edition (SRS-2; Constantino and Gruber 2012). It also conceptually replicated past work on sex-based differences in ASD symptom severity, a critical need in the social sciences (Tackett et al. 2017). In addition, the association between IQ and language levels and ASD symptom severity were examined within each group. Further, we examined the correlates of the SRS-2 total, DSM-5 and treatment subscale scores with demographic (age and parent education) and functional (cognitive and language) characteristics in order to further explore possible factors related to sex-based differences.</p> <hd id="AN0134562374-3">Methods</hd> <p></p> <hd id="AN0134562374-4">Participants</hd> <p>A total of 68 children (34 females and 34 males), ages 6-12 years with HFASD comprised the sample. The children were participants in one of several prior psychosocial intervention studies for children with HFASD. Inclusion criteria for those studies were: a prior clinical diagnosis of ASD (with diagnostic confirmation using the ADI-R [Rutter et al. 2003]), Wechsler Intelligence Scales for Children-Fourth Edition (WISC-IV; Wechsler 2003) short-form IQ > 70 (with a verbal comprehension or perceptual reasoning index composite ≥ 80), and Comprehensive Assessment of Spoken Language (CASL; Carrow-Woolfolk 1999) short-form receptive or expressive language composite ≥ 80. The WISC-IV short-form consisted of the Block Design, Similarities, Vocabulary, and Matrix Reasoning subtests and the CASL short-form consisted of the Antonyms, Synonyms, Syntax Construction, and Paragraph Comprehension subtests. The only exclusion criterion for the prior studies was severe physical aggression because the psychosocial interventions being examined target primarily social interaction and social-communication skills.</p> <p>The sample was 92.65% Caucasian with an average parent education of 15.12 years. Some participants had comorbid diagnoses of or received pharmacological treatment for anxiety, depression, or attention-deficit/hyperactivity disorder (ADHD), based on parent report. See Table 1 for a summary of the sample characteristics by group.</p> <p></p> <hd id="AN0134562374-5">Procedures</hd> <p>The study was conducted using screening and pre-test scores from children participating in multiple clinical intervention trials at a university research center. The intervention studies from which the data were drawn were approved by an Institutional Review Board and completed according to the approved protocol. Parent informed consent and child assent were obtained. Recruitment for these trials was through public advertisements including announcements from community partners and school districts. All female participants meeting inclusion criteria from these trials were included in the current sample (<emph>n</emph> = 34). Matching was then conducted individually using the available pool of males (<emph>n</emph> = 307) who had also met inclusion criteria as part of their participation in the prior intervention studies. Participants were matched on age and IQ, as these are critical considerations in the interaction of sex and ASD characteristics (Hull et al. 2017; Hus et al. 2013). Male-matches were identified within 12 months of age and 10 short-form IQ points for each female. These criteria were selected because 12 months of age is a specific yet feasible (for matching purposes) developmental window and 10 standard score points of IQ is the basis for clinical ranges on the WISC-IV. If multiple matches were identified, an individual male match was randomly selected using the randomized list generator available from <ulink href="http://www.random.org">http://www.random.org</ulink> (Haahr 1998). Matching was also attempted for majority (Caucasian) and minority (non-Caucasian or mixed-race) status however one minority female could not be matched to a minority male on age and cognitive function. In this case, a Caucasian male was matched with the minority female.</p> <hd id="AN0134562374-6">Measure</hd> <p></p> <hd id="AN0134562374-7">Social Responsiveness Scale, Second Edition, School Age Form (SRS-2)</hd> <p>The SRS-2 (Constantino and Gruber 2012) was completed by a parent or caregiver and was used to assess ASD symptom severity. The SRS-2 is a 65-item measure of ASD-related behaviors to assist in diagnosis, treatment planning, and progress monitoring. The SRS-2 items use a Likert scale with item values of 1 = Not True, 2 = Sometimes True, 3 = Often True, and 4 = Almost Always True. Item values are combined into subscales to provide a gradient of continuous values to measure symptom severity and frequency.</p> <p>The current study used the raw scores from the total, DSM-5 symptom scales, and treatment subscales. Constantino and Gruber (2012) recommended that raw scores be used when examining group characteristics and differences in research studies. This is especially warranted in studies of sex-based differences because SRS-2 standard scores are derived based on sex-specific norm-reference groups (i.e., separate normative samples and standard scores for females and for males). The use of sex-specific normative samples and derivation of standard scores based on sex does not allow for the use of standard scores to compare sex-based differences in symptom severity; the use of untransformed raw scores allows for a direct comparison of ASD symptom severity using the SRS-2. The total score includes all 65 items with a raw score range of 0-195. The two DSM-5 symptom subscales measure the primary symptom dimensions of ASD including Social Communication and Interaction (SCI; 53 items) and Restricted Interests and Repetitive Behavior (RIRB; 12 items). The SRS-2 also yields five treatment subscale scores including Social Awareness (8 items; representing the ability to pick up social cues), Social Cognition (12 items; representing the interpretation of social cues), Social Communication (22 items; representing the expressive aspects of social interaction), Social Motivation (11 items; representing the willingness to engage in social interaction), and Restricted Interests and Repetitive Behavior (12 items; representing stereotyped and/or repetitive interests and behaviors). The first four treatment subscales combined comprise the DSM-5 SCI symptom subscale and the RIRB treatment subscale is identical to the DSM-5 RIRB symptom scale.</p> <p>Validation studies reported in the test manual have indicated that the SRS-2 total score accurately detects ASD characteristics and discriminates ASD from other clinical disorders (see Constantino and Gruber 2012). Internal consistency of the total raw score reportedly ranges from 0.91 to 0.97 across a range of studies and samples (see Constantino and Gruber 2012). While independent reliability and validity on the DSM-5 and treatment subscales of the SRS-2 have not been established, we use these scales for exploratory purposes.</p> <hd id="AN0134562374-8">Analyses</hd> <p>There were no missing data. The studies that generated the data instituted specific protocols for data processing and quality checks. All SRS-2 protocols were reviewed for completeness upon return and any errors in completion (e.g., omitted items) were immediately reviewed with the respondent and corrected. Each protocol was scored independently by two research assistants using the SRS-2 computer scoring software program and the resulting scores (along with other study data) were entered into the study database and independently checked by another research assistant. Any scoring or entry discrepancies were resolved by a third team member. Analyses were conducted in SPSS and R. Between-group comparability based on demographic and screening data was tested using independent samples <emph>t</emph> tests for continuous variables and Fisher's exact tests for categorical variables. Between-group differences in ASD symptom severity (SRS-2 scores) were tested using independent samples <emph>t</emph> tests and effect size estimates (Cohen's <emph>d</emph>) were provided. Levene's test confirmed homogeneity of variance for all study variables. Tukey's test was used to identify outliers outside the 1.5 interquartile range. Three potential outliers were identified in the SRS-2 subscales. These were confirmed as valid data points and retained for analyses. Anderson-Darling tests of normality confirmed that all SRS-2 variables were normally distributed. The associations between IQ and language scores and ASD symptom severity scores were calculated using Pearson's <emph>r</emph> for each group separately. The sample of 68 has sufficient power to detect an effect size (<emph>d</emph>) of 0.69 with power of 0.80 (two-tailed alpha set to 0.05). Within the female and male subgroups, a correlation of 0.33 can be detected in each group of 34 cases with power of 0.80 (two-tailed alpha = 0.05). Significance levels are reported alongside effect sizes for all analyses.</p> <hd id="AN0134562374-9">Results</hd> <p>Initial tests supported the comparability of the male and female samples on major demographic characteristics and screening measures scores (see Table 1). Overall, the male and female samples did not significantly differ on age, IQ, ethnicity, parent education, ADI-R scores, language level, or proportion of comorbid diagnoses. Given the high level of comparability on these variables, statistical adjustment was not warranted for the comparison of symptom severity between groups.</p> <p>Between-group tests of ASD symptom severity yielded no statistically significant differences between female and male children with HFASD (Table 2). The lack of difference in symptom severity between groups was also evident in the effect sizes which were negligible for the total, DSM-5 symptom scales, and all but one of the treatment subscales (<emph>d</emph>s from 0.07 to 0.10); only the Social Motivation subscale had an effect size that reached the small range (<emph>d</emph> = 0.28).</p> <p></p> <p>SRS-2 scales by sex</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" /><th align="left" colspan="2">Females (<italic>n</italic> = 34)</th><th align="left" colspan="2">Males (<italic>n</italic> = 34)</th><th align="left" colspan="3">Sex-based contrast</th></tr><tr><th align="left">Mean</th><th align="left">SD</th><th align="left">Mean</th><th align="left">SD</th><th align="left"><italic>t</italic> (66)</th><th align="left"><italic>p</italic></th><th align="left">Cohen's <italic>d</italic></th></tr></thead><tbody><tr><td align="left">SRS-2 total</td><td align="char" char=".">99.44</td><td align="char" char=".">26.51</td><td align="char" char=".">97.56</td><td align="char" char=".">29.34</td><td align="char" char=".">0.28</td><td align="char" char=".">0.782</td><td align="char" char=".">0.067</td></tr><tr><td align="left"> SCI</td><td align="char" char=".">81.12</td><td align="char" char=".">22.76</td><td align="char" char=".">78.74</td><td align="char" char=".">23.34</td><td align="char" char=".">0.43</td><td align="char" char=".">0.671</td><td align="char" char=".">0.103</td></tr><tr><td align="left">  SA</td><td align="char" char=".">12.68</td><td align="char" char=".">4.04</td><td align="char" char=".">12.32</td><td align="char" char=".">3.14</td><td align="char" char=".">0.40</td><td align="char" char=".">0.689</td><td align="char" char=".">0.098</td></tr><tr><td align="left">  SCOG</td><td align="char" char=".">18.18</td><td align="char" char=".">5.98</td><td align="char" char=".">18.65</td><td align="char" char=".">6.89</td><td align="char" char=".">− 0.30</td><td align="char" char=".">0.765</td><td align="char" char=".">− 0.073</td></tr><tr><td align="left">  SCOM</td><td align="char" char=".">34.15</td><td align="char" char=".">10.68</td><td align="char" char=".">33.21</td><td align="char" char=".">11.04</td><td align="char" char=".">0.36</td><td align="char" char=".">0.722</td><td align="char" char=".">0.087</td></tr><tr><td align="left">  SMOT</td><td align="char" char=".">16.12</td><td align="char" char=".">5.80</td><td align="char" char=".">14.56</td><td align="char" char=".">5.54</td><td align="char" char=".">1.13</td><td align="char" char=".">0.262</td><td align="char" char=".">0.275</td></tr><tr><td align="left"> RIRB</td><td align="char" char=".">18.32</td><td align="char" char=".">6.13</td><td align="char" char=".">18.82</td><td align="char" char=".">6.63</td><td align="char" char=".">− 0.32</td><td align="char" char=".">0.748</td><td align="char" char=".">− 0.078</td></tr></tbody></table> </ephtml> </p> <p> <emph>SRS-2</emph> Social Responsiveness Scale-2nd Edition, <emph>SCI</emph> Social Communication and Interaction, <emph>SA</emph> Social Awareness, <emph>SCOG</emph> Social Cognition, <emph>SCOM</emph> Social Communication, <emph>SMOT</emph> Social Motivation, <emph>RIRB</emph> Restricted Interests and Repetitive Behaviors</p> <p>Correlations between the children's demographic and functional variables and SRS-2 total, DSM-5 subscales, and treatment subscales scores were also examined (Table 3). No significant correlations were found for males between any of the WISC-IV scores and CASL language scores and ASD symptom severity scores, and the magnitudes of the correlations were negligible (<emph>r</emph> ≤ 0.19) for all but one scale. For females, significant negative correlations were found between the SRS-2 Social Cognition treatment subscale and WISC-IV full-scale and verbal comprehension IQ scores and CASL receptive and expressive language scores; these correlations were of moderate magnitude (<emph>r</emph>s ranging from − 0.36 to − 0.49). A significant negative correlation of moderate magnitude (<emph>r</emph> = − 0.35) was also observed between the SRS-2 Social Motivation treatment subscale scores and CASL receptive language scores for females. All other correlations were non-significant and generally of weak/negligible strength for the female sample. Figure 1 illustrates the differential relationships in females and males using the strongest of these differences, receptive language to Social Cognition.</p> <p></p> <p>Correlations of sample characteristics with SRS-2 raw scores by sex</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="2" /><th align="left" colspan="2">Total</th><th align="left" colspan="2">SCI</th><th align="left" colspan="2">SA</th><th align="left" colspan="2">SCOG</th><th align="left" colspan="2">SCOM</th><th align="left" colspan="2">SMOT</th><th align="left" colspan="2">RIRB</th></tr><tr><th align="left"><italic>r</italic></th><th align="left"><italic>p</italic></th><th align="left"><italic>r</italic></th><th align="left"><italic>p</italic></th><th align="left"><italic>r</italic></th><th align="left"><italic>p</italic></th><th align="left"><italic>r</italic></th><th align="left"><italic>p</italic></th><th align="left"><italic>r</italic></th><th align="left"><italic>p</italic></th><th align="left"><italic>r</italic></th><th align="left"><italic>p</italic></th><th align="left"><italic>r</italic></th><th align="left"><italic>p</italic></th></tr></thead><tbody><tr><td align="left" colspan="15">Females (<italic>n</italic> = 34)</td></tr><tr><td align="left"> Age</td><td align="char" char=".">0.13</td><td align="char" char=".">0.464</td><td align="char" char=".">0.10</td><td align="char" char=".">0.574</td><td align="char" char=".">0.01</td><td align="char" char=".">0.955</td><td align="char" char=".">− 0.12</td><td align="char" char=".">0.499</td><td align="char" char=".">0.19</td><td align="char" char=".">0.282</td><td align="char" char=".">0.15</td><td align="char" char=".">0.397</td><td align="char" char=".">0.18</td><td align="char" char=".">0.308</td></tr><tr><td align="left"> Parent education</td><td align="char" char=".">− 0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">− 0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">− 0.02</td><td align="char" char=".">0.911</td><td align="char" char=".">− 0.26</td><td align="char" char=".">0.138</td><td align="char" char=".">0.07</td><td align="char" char=".">0.694</td><td align="char" char=".">0.02</td><td align="char" char=".">0.911</td><td align="char" char=".">− 0.03</td><td align="char" char=".">0.866</td></tr><tr><td align="left"> WISC-IV</td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left">  Short-form IQ</td><td align="char" char=".">− 0.18</td><td align="char" char=".">0.308</td><td align="char" char=".">− 0.23</td><td align="char" char=".">0.191</td><td align="char" char=".">− 0.04</td><td align="char" char=".">0.822</td><td align="char" char=".">− 0.36</td><td align="char" char=".">0.036</td><td align="char" char=".">− 0.16</td><td align="char" char=".">0.366</td><td align="char" char=".">− 0.23</td><td align="char" char=".">0.191</td><td align="char" char=".">0.09</td><td align="char" char=".">0.613</td></tr><tr><td align="left">  Short-form VCI</td><td align="char" char=".">− 0.16</td><td align="char" char=".">0.366</td><td align="char" char=".">− 0.21</td><td align="char" char=".">0.233</td><td align="char" char=".">− 0.12</td><td align="char" char=".">0.499</td><td align="char" char=".">− 0.38</td><td align="char" char=".">0.027</td><td align="char" char=".">− 0.08</td><td align="char" char=".">0.653</td><td align="char" char=".">− 0.21</td><td align="char" char=".">0.233</td><td align="char" char=".">0.09</td><td align="char" char=".">0.613</td></tr><tr><td align="left">  Short-form PRI</td><td align="char" char=".">− 0.15</td><td align="char" char=".">0.397</td><td align="char" char=".">− 0.18</td><td align="char" char=".">0.308</td><td align="char" char=".">0.05</td><td align="char" char=".">0.779</td><td align="char" char=".">− 0.23</td><td align="char" char=".">0.191</td><td align="char" char=".">− 0.18</td><td align="char" char=".">0.308</td><td align="char" char=".">− 0.19</td><td align="char" char=".">0.282</td><td align="char" char=".">0.05</td><td align="char" char=".">0.779</td></tr><tr><td align="left"> CASL</td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left">  Expressive</td><td align="char" char=".">− 0.17</td><td align="char" char=".">0.336</td><td align="char" char=".">− 0.22</td><td align="char" char=".">0.211</td><td align="char" char=".">− 0.10</td><td align="char" char=".">0.573</td><td align="char" char=".">− 0.36</td><td align="char" char=".">0.036</td><td align="char" char=".">− 0.08</td><td align="char" char=".">0.653</td><td align="char" char=".">− 0.25</td><td align="char" char=".">0.154</td><td align="char" char=".">0.05</td><td align="char" char=".">0.779</td></tr><tr><td align="left">  Receptive</td><td align="char" char=".">− 0.29</td><td align="char" char=".">0.096</td><td align="char" char=".">− 0.34</td><td align="char" char=".">0.049</td><td align="char" char=".">− 0.11</td><td align="char" char=".">0.536</td><td align="char" char=".">− 0.49</td><td align="char" char=".">0.003</td><td align="char" char=".">− 0.22</td><td align="char" char=".">0.211</td><td align="char" char=".">− 0.35</td><td align="char" char=".">0.042</td><td align="char" char=".">0.00</td><td align="char" char=".">0.999</td></tr><tr><td align="left" colspan="15">Males (<italic>n</italic> = 34)</td></tr><tr><td align="left"> Age</td><td align="char" char=".">0.02</td><td align="char" char=".">0.911</td><td align="char" char=".">0.00</td><td align="char" char=".">0.999</td><td align="char" char=".">− 0.11</td><td align="char" char=".">0.536</td><td align="char" char=".">− 0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">0.08</td><td align="char" char=".">0.653</td></tr><tr><td align="left"> Parent education</td><td align="char" char=".">0.20</td><td align="char" char=".">0.257</td><td align="char" char=".">0.23</td><td align="char" char=".">0.191</td><td align="char" char=".">0.10</td><td align="char" char=".">0.574</td><td align="char" char=".">0.33</td><td align="char" char=".">0.057</td><td align="char" char=".">0.18</td><td align="char" char=".">0.308</td><td align="char" char=".">0.14</td><td align="char" char=".">0.430</td><td align="char" char=".">0.09</td><td align="char" char=".">0.613</td></tr><tr><td align="left"> WISC-IV</td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left">  Short-form IQ</td><td align="char" char=".">− 0.07</td><td align="char" char=".">0.694</td><td align="char" char=".">− 0.06</td><td align="char" char=".">0.736</td><td align="char" char=".">0.09</td><td align="char" char=".">0.613</td><td align="char" char=".">− 0.09</td><td align="char" char=".">0.613</td><td align="char" char=".">− 0.08</td><td align="char" char=".">0.653</td><td align="char" char=".">− 0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">− 0.10</td><td align="char" char=".">0.574</td></tr><tr><td align="left">  Short-form VCI</td><td align="char" char=".">− 0.04</td><td align="char" char=".">0.822</td><td align="char" char=".">− 0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">0.16</td><td align="char" char=".">0.366</td><td align="char" char=".">− 0.02</td><td align="char" char=".">0.911</td><td align="char" char=".">− 0.11</td><td align="char" char=".">0.536</td><td align="char" char=".">0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">− 0.08</td><td align="char" char=".">0.653</td></tr><tr><td align="left">  Short-form PRI</td><td align="char" char=".">− 0.07</td><td align="char" char=".">0.694</td><td align="char" char=".">− 0.07</td><td align="char" char=".">0.694</td><td align="char" char=".">− 0.01</td><td align="char" char=".">0.955</td><td align="char" char=".">− 0.12</td><td align="char" char=".">0.499</td><td align="char" char=".">− 0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">− 0.07</td><td align="char" char=".">0.694</td><td align="char" char=".">− 0.09</td><td align="char" char=".">0.613</td></tr><tr><td align="left"> CASL</td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left">  Expressive</td><td align="char" char=".">− 0.19</td><td align="char" char=".">0.282</td><td align="char" char=".">− 0.15</td><td align="char" char=".">0.397</td><td align="char" char=".">0.12</td><td align="char" char=".">0.499</td><td align="char" char=".">− 0.15</td><td align="char" char=".">0.397</td><td align="char" char=".">− 0.19</td><td align="char" char=".">0.282</td><td align="char" char=".">− 0.16</td><td align="char" char=".">0.366</td><td align="char" char=".">− 0.28</td><td align="char" char=".">0.109</td></tr><tr><td align="left">  Receptive</td><td align="char" char=".">0.00</td><td align="char" char=".">0.999</td><td align="char" char=".">0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">0.18</td><td align="char" char=".">0.308</td><td align="char" char=".">− 0.04</td><td align="char" char=".">0.822</td><td align="char" char=".">0.01</td><td align="char" char=".">0.955</td><td align="char" char=".">0.03</td><td align="char" char=".">0.866</td><td align="char" char=".">− 0.11</td><td align="char" char=".">0.536</td></tr></tbody></table> </ephtml> </p> <p> <emph>SRS-</emph>2 Social Responsiveness Scale-2nd Edition, <emph>SCI</emph> Social Communication and Interaction, <emph>SA</emph> Social Awareness, <emph>SCOG</emph> Social Cognition, <emph>SCOM</emph> Social Communication, <emph>SMOT</emph> Social Motivation, <emph>RIRB</emph> Restricted Interests and Repetitive Behaviors, <emph>WISC-IV</emph> Wechsler Intelligence Scale for Children-4th Edition, <emph>VCI</emph> Verbal Comprehension Index, <emph>PRI</emph> Perceptual Reasoning Index, <emph>CASL</emph> comprehensive assessment of spoken language</p> <p>Correlation of SRS-2 Social Cognition Raw Score with CASL receptive language skills by sex</p> <p>PHOTO (COLOR)</p> <hd id="AN0134562374-10">Discussion</hd> <p>The current study compared ASD symptom severity (i.e., SRS-2 total, DSM-5 symptom scales, and treatment subscales) scores for a well-characterized sample of females with HFASD to a sample of males with HFASD matched on age and IQ. Findings suggested no meaningful differences between female and male children with HFASD on the severity of symptoms or on the DSM-V symptom subscales/treatment subscales. Thus, the overall pattern of results suggests equivalence of female and male children with HFASD for the severity of the core symptom areas of ASD. This is generally consistent with past research exploring sex-based differences in symptom severity for children with HFASD, and thus conceptually replicates and extends previous findings (May et al. 2014; Solomon et al. 2012). Of particular note is the lack of differences in restricted, repetitive and stereotyped behaviors between male and female children with HFASD. This null finding is consistent with some (Solomon et al. 2012) but not all literature in this area (Kreiser and White 2014; Mandy et al. 2012; Van Wijngaarden-Cremers et al. 2014). Future research in a well-characterized and matched sample should consider this area using a more detailed measure of these behaviors. The current findings also do not specifically support the presence of a female-specific autism phenotype that may differ from the more commonly understood male phenotype (see Van Wijngaarden-Cremers et al. 2014), as expressed in symptom severity on the SRS-2. It is important to note that, while absolute severity of symptoms do not appear to be different, there is the possibility that male and female individuals respond differently to interventions and services and thus future studies should consider this point.</p> <p>A unique finding of the current study was the differential relationships found between functional level variables (IQ and language) and ASD symptom severity for females with HFASD compared to males with HFASD. For male children with HFASD, IQ and receptive and expressive language levels were not associated with parent rated overall ASD symptom severity or with the DSM-5 symptom scales or treatment subscales. For female children with HFASD, IQ and receptive and expressive language were also unrelated to symptom severity, the DSM-5 symptom scales, and the Social Awareness and Social Communication treatment subscales. However, correlations on four of the five cognitive/language measures and the Social Cognition subscale were statistically significant and moderate in magnitude and receptive language and Social Motivation were significantly and moderately associated. More specifically, higher verbal ability and/or language skills were associated with lower Social Cognition and Social Motivation symptom severity. These results suggest that language abilities and receptive language skills in particular may play a unique role in the understanding and interpretation of social cues in females. However, further work is needed to explore these relationships and identify if this relationship is specific to HFASD, replicates in more nuanced symptom measures, and is present in the general population or unique to HFASD.</p> <hd id="AN0134562374-11">Strengths and Limitations</hd> <p>This is the largest study to date to examine sex-based differences in ASD symptom severity for matched children with HFASD using a continuous measure, and the only to use the SRS-2, a common and well-validated measure of ASD symptom severity. It included a relatively large and well-characterized sample of female children with HFASD that was individually and carefully matched to male children with HFASD. Another strength was the examination of sex-based differences using a measure that employs continuous scaling; this allows for a better assessment of the severity of ASD symptoms/impairments (vs a categorical or symptom count metric; Achenbach 2011; Constantino and Gruber 2012).</p> <p>Despite the study's relatively large sample and contribution to the research on sex-based differences in ASD symptom severity for children with HFASD, the sample was none-the-less limited in both representativeness and size. Specifically, the sample was predominantly Caucasian, from well-educated families, and all of the children were high-functioning (IQ and language) and excluded if they showed severe physical aggression; this limits the generalizability of the findings to the broader ASD population. The present sample only had sufficient power to detect large but not small effects and thus may have been underpowered to identify more subtle group differences. In addition, the number of analyses conducted was large for the sample size, particularly without correction for multiple comparisons. Because of this attention should be paid to effect size estimates rather than significance values and, in particular, the findings related to the correlations between functional variables and Social Cognition and Social Motivation should be considered tentative.</p> <hd id="AN0134562374-12">Acknowledgments</hd> <p>The research reported in this article was supported by Department of Education, Institute of Education Sciences Grants R324A130216 and R324A080136, United States Department of Defense Grant W81XWH-15-1-0195, and a research grant from the Peter and Elizabeth C. Tower Foundation. Findings and conclusions are those of the authors and do not necessarily reflect the views of the funding agencies.</p> <hd id="AN0134562374-13">Author Contributions</hd> <p>JDR conceived of the study, participated in its design, collected and coordinated the data, and drafted the manuscript; JLS contributed to the study design, conducted the statistical analyses, assisted in interpretation of the data, and contributed to manuscript preparation; JPD participated in the design, conducted the statistical analyses, and assisted in the interpretation of the data and preparation of the manuscript; CL participated in the study design and contributed to manuscript preparation; CAM participated in the study design, assisted with data coordination, and contributed to manuscript preparation; MLT participated in the study design and manuscript preparation; AML assisted in data collection, data management, and manuscript preparation; BCN assisted in data collection, data management, and manuscript preparation; AJB assisted in data collection, data management, and manuscript preparation. All authors read and approved the final manuscript.</p> <hd id="AN0134562374-14">Compliance with Ethical Standards</hd> <p></p> <hd id="AN0134562374-15">Ethical Approval</hd> <p>All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.</p> <hd id="AN0134562374-16">References</hd> <ref id="AN0134562374-17"> <title> References </title> <blist> <bibl id="bib1" type="bt">1</bibl> <bibtext> Achenbach TM, Manual for the Child Behavior Checklist/4-18 and 1991 profile, 1991, Burlington, VT, University of Vermont</bibtext> </blist> <blist> <bibl id="bib2" type="bt">2</bibl> <bibtext> Achenbach TM, Commentary: Definitely more than measurement error: But how should we understand and deal with informant discrepancies?, Journal of Child and Adolescent Psychology, 2011, 40, 1, 80, 86, 10.1080/15374416.2011.533416</bibtext> </blist> <blist> <bibl id="bib3" type="bt">3</bibl> <bibtext> Diagnostic and statistical manual of mental disorders, 2013, 5, Arlington, American Psychiatric</bibtext> </blist> <blist> <bibl id="bib4" type="bt">4</bibl> <bibtext> Baird G, Simonoff E, Pickles A, Chandler S, Loucas T, Meldrum D, Charman T, Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The Special Needs and Autism Project (SNAP), Lancet, 2006, 368, 210, 215, 10.1016/S0140-6736(06)69041-7</bibtext> </blist> <blist> <bibl id="bib5" type="bt">5</bibl> <bibtext> Carrow-Woolfolk E, Comprehensive assessment of spoken language, 1999, Circle Pines, American Guidance Services</bibtext> </blist> <blist> <bibl id="bib6" type="bt">6</bibl> <bibtext> Christensen DL, Baio J, Braun KVN, Bilder D, Charles J, Constantino JN, Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 Sites, United States, 2012, MMWR, 2016, 65, No. SS-3, 1, 23</bibtext> </blist> <blist> <bibl id="bib7" type="bt">7</bibl> <bibtext> Constantino JN, Gruber CP, Social Responsiveness Scale (SRS), 2005, Los Angeles, Western Psychological Services</bibtext> </blist> <blist> <bibl id="bib8" type="bt">8</bibl> <bibtext> Constantino JN, Gruber CP, Social Responsiveness Scale, Second Edition (SRS-2), 2012, Torrance, Western Psychological Services</bibtext> </blist> <blist> <bibl id="bib9" type="bt">9</bibl> <bibtext> Haahr, M. (1998)., List randomiser. Retrieved July 15, 2017, from, <ulink href="http://www.random.org/lists/">http://www.random.org/lists/</ulink>.</bibtext> </blist> <blist> <bibtext> Holtmann M, Bölte S, Poustka F, Autism spectrum disorders: Sex differences in autistic behavior domains and coexisting psychopathology, Developmental Medicine & Child Neurology, 2007, 49, 361, 366, 10.1111/j.1469-8749.2007.00361.x</bibtext> </blist> <blist> <bibtext> Hull L, Mandy W, Petrides KV, Behavioural and cognitive sex/gender differences in autism spectrum condition and typically developing males and females, Autism, 2017, 21, 706, 727, 10.1177/1362361316669087</bibtext> </blist> <blist> <bibtext> Hus V, Bishop S, Gotham K, Huerta M, Lord C, Factors influencing scores on the social responsiveness scale, Journal of Child Psychology and Psychiatry, 2013, 54, 216, 224, 10.1111/j.1469-7610.2012.02589.x</bibtext> </blist> <blist> <bibtext> Kirkovski M, Enticott PG, Fitzgerald PB, A review of the role of female gender in autism spectrum disorders, Journal of Autism and Developmental Disorders, 2013, 43, 2584, 2603, 10.1007/s10803-013-1811-1</bibtext> </blist> <blist> <bibtext> Kreiser NL, White SW, ASD in females: Are we overstating the gender difference in diagnosis?, Clinical Child and Family Psychology Review, 2014, 17, 67, 84, 10.1007/s10567-013-0148-9</bibtext> </blist> <blist> <bibtext> Lord C, Risi S, Lambrecht L, Cook EH, Jr., Leventhal BL, DiLavore PC, 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, 10.1023/A:1005592401947</bibtext> </blist> <blist> <bibtext> Mandy W, Chilvers R, Chowdhury U, Salter G, Seigal A, Skuse D, Sex differences in autism spectrum disorder: Evidence from a large sample of children and adolescents, Journal of Autism and Developmental Disorders, 2012, 42, 1304, 1313, 10.1007/s10803-011-1356-0</bibtext> </blist> <blist> <bibtext> May T, Cornish K, Rinehart N, 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, 2014, 44, 1077, 1086, 10.1007/s10803-013-1964-y</bibtext> </blist> <blist> <bibtext> Rutter M, LeCouteur A, Lord C, Autism diagnostic interview-revised, 2003, Los Angeles, Western Psychological Services</bibtext> </blist> <blist> <bibtext> Solomon M, Miller M, Taylor SL, Hinshaw SP, Carter CS, Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders, Journal of Autism and Developmental Disorders, 2012, 42, 48, 59, 10.1007/s10803-011-1215-z</bibtext> </blist> <blist> <bibtext> Tackett JL, Lilienfeld SO, Patrick CJ, Johnson SL, Krueger RF, Miller JD, Oltmanns TF, Shrout PE, It's time to broaden the replicability conversation: Thoughts for and from clinical psychological science, Perspectives on Psychological Science, 2017, 12, 742, 756, 10.1177/1745691617690042</bibtext> </blist> <blist> <bibtext> Van Wijngaarden-Cremers PJ, van Eeten E, Groen WB, Van Deurzen PA, Oosterling IJ, Van der Gaag RJ, 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, 2014, 44, 627, 635, 10.1007/s10803-013-1913-9</bibtext> </blist> <blist> <bibtext> Wechsler D, Wechsler Intelligence Scale for Children, 2003, 4, San Antonio, The Psychological Corporation</bibtext> </blist> </ref> <aug> <p>By Jonathan D. Rodgers; Jennifer Lodi-Smith; James P. Donnelly; Christopher Lopata; Christin A. McDonald; Marcus L. Thomeer; Alanna M. Lipinski; Brian C. Nasca and Adam J. Booth</p> </aug>
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  Data: Brief Report: Examination of Sex-Based Differences in ASD Symptom Severity among High-Functioning Children with ASD Using the SRS-2
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. Feb 2019 49(2):781-787.
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  Data: Springer. Available from: Springer Nature. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
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  Data: R324A130216<br />R324A080136<br />W81XWH1510195
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  Data: <searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Autism%22">Autism</searchLink><br /><searchLink fieldCode="DE" term="%22Pervasive+Developmental+Disorders%22">Pervasive Developmental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Severity+%28of+Disability%29%22">Severity (of Disability)</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Competence%22">Interpersonal Competence</searchLink><br /><searchLink fieldCode="DE" term="%22Measures+%28Individuals%29%22">Measures (Individuals)</searchLink><br /><searchLink fieldCode="DE" term="%22Scores%22">Scores</searchLink><br /><searchLink fieldCode="DE" term="%22Intelligence+Quotient%22">Intelligence Quotient</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Proficiency%22">Language Proficiency</searchLink><br /><searchLink fieldCode="DE" term="%22Motivation%22">Motivation</searchLink><br /><searchLink fieldCode="DE" term="%22Receptive+Language%22">Receptive Language</searchLink>
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  Data: 10.1007/s10803-018-3733-4
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  Data: 0162-3257
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  Data: Prior studies of sex-based differences in autism spectrum disorder (ASD) have yielded mixed findings. This study examined ASD symptom severity and functional correlates in a sample of 34 high-functioning females with ASD (HFASD; M age = 8.93; M IQ = 104.64) compared to 34 matched males (M age = 8.96; M IQ = 104.44) using the Social Responsiveness Scale-Second Edition (SRS-2). Results identified non-significant and minimal differences (negligible-to-small) on the SRS-2 total, DSM-5 symptom subscale, and treatment subscale scores. Significant negative (moderate) correlations were found between the SRS-2 Social Cognition subscale and IQ and language scores and between the SRS-2 Social Motivation subscale and receptive language scores for females only; no significant correlations were found for males.
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  Data: 2019
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        Value: 10.1007/s10803-018-3733-4
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      – Text: English
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    Subjects:
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Autism
        Type: general
      – SubjectFull: Pervasive Developmental Disorders
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Severity (of Disability)
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Interpersonal Competence
        Type: general
      – SubjectFull: Measures (Individuals)
        Type: general
      – SubjectFull: Scores
        Type: general
      – SubjectFull: Intelligence Quotient
        Type: general
      – SubjectFull: Language Proficiency
        Type: general
      – SubjectFull: Motivation
        Type: general
      – SubjectFull: Receptive Language
        Type: general
    Titles:
      – TitleFull: Brief Report: Examination of Sex-Based Differences in ASD Symptom Severity among High-Functioning Children with ASD Using the SRS-2
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Rodgers, Jonathan D.
      – PersonEntity:
          Name:
            NameFull: Lodi-Smith, Jennifer
      – PersonEntity:
          Name:
            NameFull: Donnelly, James P.
      – PersonEntity:
          Name:
            NameFull: Lopata, Christopher
      – PersonEntity:
          Name:
            NameFull: McDonald, Christin A.
      – PersonEntity:
          Name:
            NameFull: Thomeer, Marcus L.
      – PersonEntity:
          Name:
            NameFull: Lipinski, Alanna M.
      – PersonEntity:
          Name:
            NameFull: Nasca, Brian C.
      – PersonEntity:
          Name:
            NameFull: Booth, Adam J.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 02
              Type: published
              Y: 2019
          Identifiers:
            – Type: issn-print
              Value: 0162-3257
          Numbering:
            – Type: volume
              Value: 49
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Journal of Autism and Developmental Disorders
              Type: main
ResultId 1