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Sex-Typical Toy, Activity, and Playmate Preferences in Autistic and Non-Autistic Children

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Title: Sex-Typical Toy, Activity, and Playmate Preferences in Autistic and Non-Autistic Children
Language: English
Authors: Jacqueline C. S. To (ORCID 0009-0007-3505-6249), Karson T. F. Kung (ORCID 0000-0002-1598-1513)
Source: Autism: The International Journal of Research and Practice. 2025 29(7):1727-1739.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 13
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Autism Spectrum Disorders, Play, Toys, Gender Differences, Children, Preadolescents, Vocabulary, Abstract Reasoning, Age Differences, Foreign Countries
Geographic Terms: Hong Kong
DOI: 10.1177/13623613251321207
ISSN: 1362-3613
1461-7005
Abstract: Play, in particular sex-typical play, is important for affective, cognitive, and social development. There is limited research on sex-typical play in autistic children. The few prior studies on this topic relied heavily on reports or involvement of caregivers/parents, did not assess cognitive abilities, and examined a limited number of sex-typical play outcomes. The present study examined sex-typical play in 120 children without intellectual disability (30 autistic boys, 35 non-autistic boys, 20 autistic girls, 35 non-autistic girls) aged 4-11 years. Vocabulary and abstract reasoning were also assessed. Consistently across all five play measures (parent-reported composite play, self-reported activity preferences, self-reported toy preferences, self-reported playmate preferences, and observed toy play), there were medium or large, and mostly significant, differences between autistic and non-autistic boys, suggesting less male-typical/more female-typical play in autistic boys. Autistic and non-autistic boys did not differ in vocabulary, abstract reasoning, or age. No consistent, clear, or significant patterns emerged in comparisons of autistic and non-autistic girls. The more non-conforming play in autistic boys concurs with certain prior findings suggesting that the autistic community is not confined to social norms and shows increased gender diversity. The potential link between the unaltered play in autistic girls and camouflaging is considered.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1474624
Database: ERIC
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  Value: <anid>AN0185859362;f9d01jul.25;2025Jun13.01:17;v2.2.500</anid> <title id="AN0185859362-1">Sex-typical toy, activity, and playmate preferences in autistic and non-autistic children </title> <p>Play, in particular sex-typical play, is important for affective, cognitive, and social development. There is limited research on sex-typical play in autistic children. The few prior studies on this topic relied heavily on reports or involvement of caregivers/parents, did not assess cognitive abilities, and examined a limited number of sex-typical play outcomes. The present study examined sex-typical play in 120 children without intellectual disability (30 autistic boys, 35 non-autistic boys, 20 autistic girls, 35 non-autistic girls) aged 4–11 years. Vocabulary and abstract reasoning were also assessed. Consistently across all five play measures (parent-reported composite play, self-reported activity preferences, self-reported toy preferences, self-reported playmate preferences, and observed toy play), there were medium or large, and mostly significant, differences between autistic and non-autistic boys, suggesting less male-typical/more female-typical play in autistic boys. Autistic and non-autistic boys did not differ in vocabulary, abstract reasoning, or age. No consistent, clear, or significant patterns emerged in comparisons of autistic and non-autistic girls. The more non-conforming play in autistic boys concurs with certain prior findings suggesting that the autistic community is not confined to social norms and shows increased gender diversity. The potential link between the unaltered play in autistic girls and camouflaging is considered. In the non-autistic community, boys and girls tend to play differently, although these average differences do not apply to all the boys and girls. Little is known about similarities and differences in sex-typical play (e.g. playing with cars, playing with dolls, rough-and-tumble play, playing house) between autistic and non-autistic children. We looked at different aspects of sex-typical play such as toy, activity, and playmate preferences in autistic and non-autistic children without intellectual disability. Different methods including parent reports, self-reports, and play observation were used. We found some average differences between autistic and non-autistic boys. On average, compared with non-autistic boys, autistic boys played in a more non-conforming manner (less male-typical/more female-typical toy, activity, and playmate preferences). These findings are consistent with observations from other research studies suggesting that autistic individuals may defy social norms and express themselves in diverse ways. There were no differences between autistic and non-autistic girls. One possibility is that autistic girls may camouflage, or mask, their non-conforming play preferences, but further research is needed to test this possibility. The findings from this study can help families, professionals, and schools better understand how autistic boys and girls develop.</p> <p>Keywords: autism; gender; play; sex</p> <p>Throughout childhood, developing individuals spend a substantial amount of time playing. Classic developmental theories highlighted the interconnections between play and cognitive development ([<reflink idref="bib67" id="ref1">67</reflink>]; [<reflink idref="bib80" id="ref2">80</reflink>]), while recent perspectives pay increasing attention to the importance of play in affective and social development ([<reflink idref="bib85" id="ref3">85</reflink>]). Meta-analytic research focusing on non-autistic children has found positive associations between symbolic play and domains of language development ([<reflink idref="bib69" id="ref4">69</reflink>]). Links between social play dynamics and aspects of theory of mind development in non-autistic children have been reported ([<reflink idref="bib81" id="ref5">81</reflink>]). Increased engagement in adventurous play has been associated with less-emotional distress in non-autistic children ([<reflink idref="bib30" id="ref6">30</reflink>]). Regarding play in autistic children, historically, research had a strong focus on symbolic play ([<reflink idref="bib38" id="ref7">38</reflink>]), the role of play in assessment ([<reflink idref="bib68" id="ref8">68</reflink>]), and play interventions ([<reflink idref="bib44" id="ref9">44</reflink>]). Much less research has examined sex-typical play in autistic children, despite a surge in research studies on the intersection of autism and gender diversity in recent years ([<reflink idref="bib63" id="ref10">63</reflink>]; [<reflink idref="bib71" id="ref11">71</reflink>]).</p> <hd id="AN0185859362-2">Sex-typical play: patterns and importance</hd> <p>Meta-analyses of studies focusing on non-autistic children have shown that there are large average sex differences in aspects of play, including toy, activity, and playmate preferences ([<reflink idref="bib17" id="ref12">17</reflink>]; [<reflink idref="bib48" id="ref13">48</reflink>]). Sex-typical play refers to aspects of play that on average differ between boys and girls according to prior empirical research; male-typical play refers to play that is relatively common in boys, and female-typical play refers to play that is relatively common in girls. The term "sex[<reflink idref="bib7" id="ref14">7</reflink>]" does not necessarily imply that differences in play are "hardwired." Indeed, different types of influences concerning genetic, hormonal, cognitive, and socio-cultural factors have been related to sex-typical play ([<reflink idref="bib46" id="ref15">46</reflink>]; [<reflink idref="bib84" id="ref16">84</reflink>]). Sex-typical play emerges between 12 and 24 months of age and shows longitudinal stability across childhood ([<reflink idref="bib2" id="ref17">2</reflink>]; [<reflink idref="bib25" id="ref18">25</reflink>]; [<reflink idref="bib54" id="ref19">54</reflink>]). In non-autistic children, research studies have documented that boys tend to prefer certain toys and activities, like toy cars, tool sets, and rough-and-tumble play, whereas girls tend to prefer some other toys and activities, like dolls, kitchen sets, and playing house ([<reflink idref="bib2" id="ref20">2</reflink>]; [<reflink idref="bib17" id="ref21">17</reflink>]; [<reflink idref="bib23" id="ref22">23</reflink>], [<reflink idref="bib25" id="ref23">25</reflink>]; [<reflink idref="bib37" id="ref24">37</reflink>]; [<reflink idref="bib48" id="ref25">48</reflink>]; [<reflink idref="bib54" id="ref26">54</reflink>]; [<reflink idref="bib88" id="ref27">88</reflink>]). Non-autistic children also tend to prefer playmates of their own sex ([<reflink idref="bib48" id="ref28">48</reflink>]; [<reflink idref="bib52" id="ref29">52</reflink>]; [<reflink idref="bib58" id="ref30">58</reflink>]).</p> <p>Sex-typical play is a behavioral domain of particular importance. In research focusing on non-autistic individuals, sex-typical play has been related to nurturing and visuo-spatial skills ([<reflink idref="bib46" id="ref31">46</reflink>]; [<reflink idref="bib84" id="ref32">84</reflink>]) and is predictive of sex-related differences in occupational interests in adolescence and adulthood ([<reflink idref="bib50" id="ref33">50</reflink>], [<reflink idref="bib47" id="ref34">47</reflink>]). Furthermore, in non-autistic individuals, non-conformity in sex-typical play has been associated with increased gender identity diversity ([<reflink idref="bib39" id="ref35">39</reflink>]; [<reflink idref="bib90" id="ref36">90</reflink>]), increased social rejection ([<reflink idref="bib82" id="ref37">82</reflink>]), and increased mental health difficulties ([<reflink idref="bib64" id="ref38">64</reflink>]). Hence, sex-typical play may form an important foundation for different aspects of affective, cognitive, and social development.</p> <hd id="AN0185859362-3">Prior studies on sex-typical play in autistic children</hd> <p>It has been suggested that autistic children may show different patterns of sex-typical play and may not conform to sex-typical norms ([<reflink idref="bib28" id="ref39">28</reflink>]; [<reflink idref="bib33" id="ref40">33</reflink>]; [<reflink idref="bib42" id="ref41">42</reflink>]). Although there have been numerous studies examining sex-typical play in non-autistic children ([<reflink idref="bib17" id="ref42">17</reflink>]; [<reflink idref="bib48" id="ref43">48</reflink>]), much less is known about the link between autism and sex-typical play. A number of studies have investigated sex differences in autism-related symptoms and other neural, cognitive, and behavioral traits in autistic individuals ([<reflink idref="bib10" id="ref44">10</reflink>]; [<reflink idref="bib35" id="ref45">35</reflink>]), and systematic reviews have reported increased gender identity diversity in autistic individuals ([<reflink idref="bib41" id="ref46">41</reflink>]; [<reflink idref="bib62" id="ref47">62</reflink>]), but much less research has looked at sex-typical play in autistic children. A prior study examined friendship or social preferences in autistic and non-autistic children, reporting that the groups did not differ in their preferences for same-sex friends ([<reflink idref="bib19" id="ref48">19</reflink>]), but the study did not specifically assess playmate preferences.</p> <p>To date, only three studies have investigated specifically sex-typical play in autistic children. [<reflink idref="bib42" id="ref49">42</reflink>] conducted the first study by investigating parent-reported sex-typical play in autistic and non-autistic children. They included a total of 121 participants aged 4–14 years, with 46 autistic boys, 31 non-autistic boys, 20 autistic girls, and 24 non-autistic girls. Parents were asked to report/recall their child's play behavior at age 5 years on the Children's Play Questionnaire ([<reflink idref="bib43" id="ref50">43</reflink>]), a composite play measure assessing various aspects of pretend and non-pretend play involving different sex-typical toys and activities. According to these parent reports, autistic boys showed decreased interest in male-typical pretend play, whereas autistic girls showed decreased interest in female-typical non-pretend play.</p> <p>Subsequently, [<reflink idref="bib28" id="ref51">28</reflink>] conducted the second study by observing sex-typical toy play behavior in autistic and non-autistic children during caregiver-child play interaction. They included a total of 54 participants aged 1–4 years, with 14 autistic boys, 14 non-autistic boys, 14 autistic girls, and 12 non-autistic girls. In these caregiver-child play sessions, autistic boys spent less time playing with male-typical toys such as garage and car toys than did non-autistic boys. By contrast, there were no differences in sex-typical toy play between autistic girls and non-autistic girls.</p> <p>More recently, [<reflink idref="bib33" id="ref52">33</reflink>] conducted the third study by analyzing secondary data collected in a longitudinal population study which measured parent-reported and child-reported sex-typical play in autistic and non-autistic children. They included a total of 11,251 participants assessed at ages 2.5, 3.5, 4.75, and 8 years, with 119 autistic boys, 5709 non-autistic boys, 28 autistic girls, and 5395 non-autistic girls. At ages 2.5, 3.5, and 4.75 years, sex-typical play was assessed using the Pre-School Activities Inventory (PSAI; [<reflink idref="bib23" id="ref53">23</reflink>], [<reflink idref="bib24" id="ref54">24</reflink>]), a parent-reported questionnaire. At age 8 years, sex-typical play was assessed using the Child Activities Inventory ([<reflink idref="bib25" id="ref55">25</reflink>]), a child-reported measure. Both measures offer a composite assessment of sex-typical play, covering and combining various aspects of play to generate an overall score for each child. There were no differences between autistic boys and non-autistic boys at age 2.5 years, but autistic boys showed less male-typical/more female-typical play than did non-autistic boys at ages 3.5, 4.75, and 8 years. Conversely, there were no differences between autistic girls and non-autistic girls at any of the time points. Taken together, mixed results have been reported in the three prior studies, although findings from both [<reflink idref="bib28" id="ref56">28</reflink>] and [<reflink idref="bib33" id="ref57">33</reflink>] suggest that autistic boys exhibit more non-conforming play than do non-autistic boys.</p> <hd id="AN0185859362-4">Theoretical implications</hd> <p>No theories have been developed specifically to predict or explain autistic children's sex-typical play behavior. Two of the three prior studies ([<reflink idref="bib28" id="ref58">28</reflink>]; [<reflink idref="bib42" id="ref59">42</reflink>]) referred to the "extreme male brain" theory of autism (EMB; [<reflink idref="bib4" id="ref60">4</reflink>]) when formulating hypotheses. Although the present study was not designed to test the EMB and one of the three prior studies ([<reflink idref="bib33" id="ref61">33</reflink>]) also did not employ the EMB, the relevant work is reviewed in this report to reflect the development of the research field. The EMB proposes that autism is characterized by an "extreme male brain," with increased systemizing (a male-typical trait) and decreased empathizing (a female-typical trait) ([<reflink idref="bib4" id="ref62">4</reflink>]). An extended hypothesis based on the EMB further argues that heightened prenatal exposure to androgens, or sex steroids more broadly, is the key neurobiological mechanism underlying the development of an "extreme male brain" ([<reflink idref="bib6" id="ref63">6</reflink>], [<reflink idref="bib7" id="ref64">7</reflink>]). While a large-scale population study provided robust evidence supporting predictions concerning systemizing and empathizing ([<reflink idref="bib27" id="ref65">27</reflink>]), critiques have challenged the related conceptualization and measurement tools ([<reflink idref="bib66" id="ref66">66</reflink>]; [<reflink idref="bib72" id="ref67">72</reflink>]). In addition, inconsistent findings have been reported in studies assessing the influences of early androgen exposure on the development of autism ([<reflink idref="bib3" id="ref68">3</reflink>]; [<reflink idref="bib5" id="ref69">5</reflink>]; [<reflink idref="bib26" id="ref70">26</reflink>]; [<reflink idref="bib49" id="ref71">49</reflink>], [<reflink idref="bib50" id="ref72">50</reflink>]).</p> <p>Even though the EMB framework was not originally developed to explain sex-related phenomena more generally, the theory has been widely employed in numerous autism research studies investigating sex-related issues. These studies based on the EMB generally predict more male-typical/less female-typical development in autistic individuals and have examined various sex-related outcomes ranging from psychological traits, such as gender identity ([<reflink idref="bib8" id="ref73">8</reflink>]) and visuo-spatial skills ([<reflink idref="bib21" id="ref74">21</reflink>]), to physical traits, such as facial features ([<reflink idref="bib75" id="ref75">75</reflink>]) and pubertal development ([<reflink idref="bib60" id="ref76">60</reflink>]). Of the two studies linking the EMB to sex-typical play in autistic children, one interpreted their findings as evidence supporting the EMB ([<reflink idref="bib42" id="ref77">42</reflink>]), and the other study concluded that their findings did not support the EMB ([<reflink idref="bib28" id="ref78">28</reflink>]). There is very limited research evidence on sex-typical play in autistic children, which may hinder theory development. Additional empirical research may contribute to the development of a more specific theoretical framework for sex-typical play in autistic children.</p> <hd id="AN0185859362-5">Limitations of prior studies</hd> <p>The three prior studies have built an important foundation in this area of research, but they are not without limitations. First, some of the observed group similarities or differences may have been driven by variation in age or cognitive abilities. In the studies by [<reflink idref="bib42" id="ref79">42</reflink>] and [<reflink idref="bib28" id="ref80">28</reflink>], the autistic groups were older than the non-autistic groups. [<reflink idref="bib42" id="ref81">42</reflink>] and [<reflink idref="bib33" id="ref82">33</reflink>] were not able to assess cognitive abilities, and [<reflink idref="bib28" id="ref83">28</reflink>] reported that many of the autistic girls in their study had language difficulties. Although research focusing on non-autistic populations without intellectual disability has shown that general intelligence is not related to sex-typical play ([<reflink idref="bib65" id="ref84">65</reflink>]; [<reflink idref="bib90" id="ref85">90</reflink>]), it would be useful for further research including autistic and non-autistic children to consider potential group differences in cognitive abilities, especially verbal ability, which may affect how children respond to self-reported measures in research settings. Second, all the prior studies focused on limited aspects of sex-typical play. For instance, [<reflink idref="bib33" id="ref86">33</reflink>] focused only on composite play behavior, while [<reflink idref="bib28" id="ref87">28</reflink>] focused mainly on toy play. Third, most of the previously employed play measures may be biased by parents or caregivers. In the study by [<reflink idref="bib42" id="ref88">42</reflink>], the play assessment involved asking parents to recall their child's sex-typical play behavior, which is subject to recall bias. In the study by [<reflink idref="bib28" id="ref89">28</reflink>], sex-typical play was assessed in caregiver-child play sessions, where children's play behavior may be influenced by their caregivers. Even though [<reflink idref="bib33" id="ref90">33</reflink>] included a measure that directly and exclusively obtained data from the child at one time point, a parent-reported measure was employed for most of the time points in the longitudinal study.</p> <hd id="AN0185859362-6">Present study</hd> <p>Prior research in this area, albeit small in terms of the number of studies, has provided some valuable information about sex-typical play in autistic children. While there are no major research gaps in this area, the aforementioned limitations of the prior studies need to be addressed. The present study was designed to extend the prior studies by assessing various sex-typical play outcomes using parent-reported, child-reported, and observational measures, with a strong focus on direct assessment of the child. In addition, the present study assessed cognitive abilities and attempted to recruit groups of children of similar age. In the present study, a parent-reported questionnaire was used to assess composite play behavior; self-reports were used to assess toy, activity, and playmate preferences; and a child-only free play observation session was used to assess toy play. Little is known about sex-typical play in children with an intellectual disability, and sex-typical play measures have been developed based on behavior and preferences of children without intellectual disability ([<reflink idref="bib46" id="ref91">46</reflink>]; [<reflink idref="bib84" id="ref92">84</reflink>]). To rule out potential confounding influences of intellectual disability and to ensure the same set of sex-typical play measures is developmentally appropriate for the entire sample, the present study recruited only children without intellectual disability. Following prior research that employed similar methods to assess sex-typical play ([<reflink idref="bib48" id="ref93">48</reflink>]; [<reflink idref="bib74" id="ref94">74</reflink>]), the present study recruited children aged 4–11 years. Regarding cognitive abilities, although the use of the IQ test in understanding autistic individuals is not without limitations ([<reflink idref="bib12" id="ref95">12</reflink>]), the IQ test and its relevant subtests have been widely employed in autism research studies ([<reflink idref="bib78" id="ref96">78</reflink>]). Because the present study did not have any predictions on links between specific cognitive domains and sex-typical play, cognitive abilities in the present study were assessed by general proxy measures of IQ. Verbal ability was assessed by vocabulary items, and non-verbal ability was assessed by progressive matrix items. Vocabulary and abstract/matrix reasoning mirror the two constructs assessed by the abbreviated, two-subtest form of the IQ test ([<reflink idref="bib83" id="ref97">83</reflink>]). Considering the mixed prior findings and the lack of a specific theoretical framework, no hypotheses were formulated. Instead, the present study explored similarities and differences in sex-typical play between autistic and non-autistic children.</p> <hd id="AN0185859362-7">Method</hd> <p></p> <hd id="AN0185859362-8">Participants and procedures</hd> <p>A total of 120 participants, aged 4–11 years (<emph>M</emph> = 6.03, <emph>SD</emph> = 1.54), were recruited in Hong Kong via mainstream schools, non-governmental organizations (NGOs), and social media. There were 30 autistic boys, 35 non-autistic boys, 20 autistic girls, and 35 non-autistic girls. All participants were of Chinese descent. Specific data on socioeconomic status were not recorded. For all autistic participants, the diagnosis of autism was verified through written documentation by a qualified professional or through official records on a governmental information system (see Supplemental Material). None of the participants had an intellectual disability. All participants were attending mainstream coeducational kindergartens or primary schools. Issues related to gender dysphoria or gender identity were not mentioned in any of the diagnostic documentation, by any professional workers at recruitment sources, or by any parents in post-study individual feedback sessions. The study was advertised as a study on play without mentioning sex or gender.</p> <p>Participants were assessed individually in a quiet room at school, NGO, or the researchers' university. Participants were first invited to play on their own with a set of toys on a playmat. Next, participants completed abstract reasoning and vocabulary tasks. Finally, participants answered questions about playmate, activity, and toy preferences. All data-collection sessions were led and conducted by a female experimenter. In addition to collecting data from child participants, data were collected from parents through a parent-reported questionnaire assessing their children's sex-typical play behavior. Parent respondents completed an online or printed questionnaire. Almost all respondents were mothers (only five father respondents; three in the non-autistic group and two in the autistic group).</p> <hd id="AN0185859362-9">Data source</hd> <p>This report presents primary data collected by the authors' team, which is a developmental psychology research group. The participants were recruited by the authors' team and were specifically recruited for the present study (i.e. not from a larger study or clinical database).</p> <hd id="AN0185859362-10">Key measures: assessing sex-typical play</hd> <p></p> <hd id="AN0185859362-11">Composite play</hd> <p>The PSAI developed by [<reflink idref="bib23" id="ref98">23</reflink>], [<reflink idref="bib24" id="ref99">24</reflink>]) was used to measure parent-reported composite sex-typical play behavior. The measure assesses various aspects of play and consists of 12 male-typical items (e.g. playing with toy swords, playing with tool set, enjoys rough-and-tumble play) and 12 female-typical items assessing a range of play behavior (e.g. playing with dolls, playing house, playing with girls). Each item is answered on a five-point Likert-type scale indicating the frequency of the behavior, with response options ranging from 1 (never) to 5 (very often). The PSAI was used in the prior longitudinal population study on sex-typical play in autistic and non-autistic children ([<reflink idref="bib33" id="ref100">33</reflink>]). Following prior studies using the PSAI (e.g. [<reflink idref="bib23" id="ref101">23</reflink>], [<reflink idref="bib24" id="ref102">24</reflink>], [<reflink idref="bib25" id="ref103">25</reflink>]; [<reflink idref="bib33" id="ref104">33</reflink>]; [<reflink idref="bib47" id="ref105">47</reflink>]), the standard PSAI scoring formula was used in the present study to calculate an overall score for each participant:</p> <p> <ephtml> <math display="block" xmlns="http://www.w3.org/1998/Math/MathML"><mrow><mi>S</mi><mi>c</mi><mi>o</mi><mi>r</mi><mi>e</mi><mo>=</mo><mn>48</mn><mo>.</mo><mn>25</mn><mo>+</mo><mn>1</mn><mo>.</mo><mn>1</mn><mo>×</mo><mrow><mo>(</mo><mtable columnalign="left"><mtr><mtd><mi>s</mi><mi>u</mi><mi>m</mi><mspace width="0.25em" /><mi>o</mi><mi>f</mi><mspace width="0.25em" /><mi>m</mi><mi>a</mi><mi>l</mi><mi>e</mi><mo>-</mo><mi>t</mi><mi>y</mi><mi>p</mi><mi>i</mi><mi>c</mi><mi>a</mi><mi>l</mi><mspace width="0.25em" /><mi>i</mi><mi>t</mi><mi>e</mi><mi>m</mi><mi>s</mi><mo>−</mo></mtd></mtr><mtr><mtd><mi>s</mi><mi>u</mi><mi>m</mi><mspace width="0.25em" /><mi>o</mi><mi>f</mi><mspace width="0.25em" /><mi>f</mi><mi>e</mi><mi>m</mi><mi>a</mi><mi>l</mi><mi>e</mi><mo>-</mo><mi>t</mi><mi>y</mi><mi>p</mi><mi>i</mi><mi>c</mi><mi>a</mi><mi>l</mi><mspace width="0.25em" /><mi>i</mi><mi>t</mi><mi>e</mi><mi>m</mi><mi>s</mi></mtd></mtr></mtable><mo>)</mo></mrow></mrow></math> </ephtml> </p> <p>Graph</p> <p>Higher scores indicate more male-typical/less female-typical play behavior, whereas lower scores indicate less male-typical/more female-typical play behavior. In the present study, internal consistency was high (<emph>α</emph> = 0.81).</p> <hd id="AN0185859362-12">Activity preferences</hd> <p>Children were asked to report their preferences for sex-typical activities. Items were adapted from the Child Play Behavior and Activity Questionnaire ([<reflink idref="bib88" id="ref106">88</reflink>]). There were a total of six male-typical items (pretending to be a male character, play fighting, model building, video and computer gaming, sports competition, reading and watching things about dinosaurs and space) and six female-typical items (pretending to be a female character, makeup and dress-up games, playing house, arts and crafts, dancing, reading and watching things about princesses and fairy tales). All items were paired with pictures portraying the activities. The pictures either did not include any people or included cartoons of both boys and girls engaging in the activity. Items were presented in an alternating sequence, with male-typical activities and female-typical activities appearing in an ABAB pattern (i.e. female-typical, male-typical, female-typical, male-typical, etc.). Each item was presented individually, and children were prompted to respond using one of four options on an emoji scale, ranging from a downturned sad face (a score of 1) to an upturned happy face (a score of 4), supplemented with verbal explanations of "really dislike it," "dislike it," "like it," and "really like it." To ensure consistency across measures and to concur with the PSAI scoring, the female-typical items were reverse-scored, and a mean score based on both male-typical and female-typical items was calculated. Higher scores indicate more male-typical/less female-typical activity preferences. In the present study, internal consistency was high (<emph>α</emph> = 0.77).</p> <hd id="AN0185859362-13">Toy preferences</hd> <p>Children were asked to report their preferences for sex-typical toys. Items on this toy preferences measure were chosen based on prior meta-analytic research ([<reflink idref="bib17" id="ref107">17</reflink>]). There were six male-typical items (toy gun, sword, car, train, toolset, blocks) and six female-typical items (baby doll, Barbie doll, kitchen set, tea set, makeup set, princess accessories). Like the activity preferences measure, all toy items were paired and presented with pictures. The same emoji scale, presentation sequence, and scoring method from the activity preferences measure were used for the toy preferences measure. Higher scores indicate more male-typical/less female-typical toy preferences. In the present study, internal consistency was high (<emph>α</emph> = 0.81).</p> <hd id="AN0185859362-14">Toy play</hd> <p>A child-only free play session was used to observe children's toy play. The session was video recorded for coding. The 12 toys used in this task mirrored the 12 items on the self-reported toy preferences measure. It is noteworthy that, as previously outlined under the "Participants and procedures" section, the testing session started with this toy play observation task, and after other tasks and play preferences questions were completed, the toy preferences measure was then administered. The two toy measures were spaced far apart to reduce children's self-consciousness when answering the toy preferences questions. In addition, the 12 toys used in the observation task had drastically different designs from those in the pictures presented to children on the self-reported toy preferences measure to reduce generalization. The toys were arranged in a half-circle on a playmat in an alternating sequence (i.e. female-typical, male-typical, female-typical, male-typical, etc.). There were four possible arrangements for the toys, one of which was chosen at random for each participant to minimize any effects of toy placement. The child was brought to the center of the playmat and told, "You can play with any toy you want." The child was then left to play with the toys independently for up to 10 min. To adjust for any variation in total play time, the proportion of time spent playing with male-typical versus female-typical toys was calculated. In line with scoring of other play measures in the present study, higher scores on this task indicate more male-typical/less female-typical toy play. One non-autistic girl who did not play with any toys was excluded from analysis. Further details of procedures, including scoring and coding, are provided in the Supplemental Material.</p> <hd id="AN0185859362-15">Playmate preferences</hd> <p>The playmate preferences measure from the study by [<reflink idref="bib74" id="ref108">74</reflink>] was used. Children were asked, "Who are your three favorite playmates?" and subsequently asked, "Is [playmate name] a boy or a girl?" for each of the named playmates. Based on their responses, children were then assigned to one of two categories: "prefers boys as playmates" or "prefers girls as playmates." Further details of this measure are provided in the Supplemental Material.</p> <hd id="AN0185859362-16">Measures of cognitive abilities</hd> <p></p> <hd id="AN0185859362-17">Abstract reasoning</hd> <p>Items from Sets A and B of Raven's Colored Progressive Matrices were used ([<reflink idref="bib70" id="ref109">70</reflink>]). There are 12 test items on this measure. Each item consists of a visual puzzle with one missing component and requires the child to choose the part that best fits the puzzle from six options. Higher scores indicate more advanced abstract reasoning skills.</p> <hd id="AN0185859362-18">Vocabulary</hd> <p>The vocabulary knowledge task developed by [<reflink idref="bib87" id="ref110">87</reflink>] was used. The task was validated in a sample of Chinese children ([<reflink idref="bib87" id="ref111">87</reflink>]). The measure includes 10 items of receptive vocabulary and 12 items of expressive vocabulary. This vocabulary task generates an overall score, with higher scores indicating more advanced vocabulary knowledge.</p> <hd id="AN0185859362-19">Analytical approach</hd> <p>Reviews of psychological studies have concluded that interaction effects, especially the most replicable ones, tend to be quite small ([<reflink idref="bib1" id="ref112">1</reflink>]; [<reflink idref="bib79" id="ref113">79</reflink>]). With a small sample, the present study had very limited ability to detect subtle interaction effects. All the prior studies on this topic ([<reflink idref="bib28" id="ref114">28</reflink>]; [<reflink idref="bib33" id="ref115">33</reflink>]; [<reflink idref="bib42" id="ref116">42</reflink>]) found some sex-specific effects. In this context, subgroup analyses conducted separately for boys and girls would allow a more direct comparison of findings across the present study and the prior studies. In addition, it is common for research studies on sex-typical play behavior in both typically developing and special populations to focus on within-sex analyses ([<reflink idref="bib25" id="ref117">25</reflink>]; [<reflink idref="bib33" id="ref118">33</reflink>]; [<reflink idref="bib48" id="ref119">48</reflink>]). Hence, in line with prior research, to provide a fuller picture and to document potentially meaningful subgroup differences, the present study focused on within-sex analyses.</p> <p>First, analyses were conducted to confirm that scores on the play measures indeed differed substantially between non-autistic boys and girls, establishing that these measures provide valid assessment of sex-typical play. After that, within each sex, analyses were conducted to examine group differences between autistic and non-autistic children. Within each sex, if the autistic and non-autistic groups differed significantly in age, vocabulary, and/or abstract reasoning, additional analyses would be conducted with the variable(s) entered as covariate(s) to examine group differences in sex-typical play outcomes. All tests were two-tailed with alpha set at 0.05.</p> <hd id="AN0185859362-20">Community involvement</hd> <p>There was no community involvement in the reported study.</p> <hd id="AN0185859362-21">Results</hd> <p>A brief summary of initial data inspection and preliminary analyses, as well as effect size evaluation criteria ([<reflink idref="bib13" id="ref120">13</reflink>]), can be found in the Supplemental Material. Descriptive statistics are summarized in Table 1.</p> <p>Table 1. Descriptive statistics.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">Autistic boys(<italic>n</italic> = 30)</th><th align="left">Non-autistic boys(<italic>n</italic> = 35)</th><th align="left">Autistic girls(<italic>n</italic> = 20)</th><th align="left">Non-autistic girls(<italic>n</italic> = 35)<xref ref-type="table-fn" rid="tfn2">a</xref></th></tr><tr><th /><th align="left" colspan="4"><italic>M (SD)</italic></th></tr></thead><tbody><tr><td>Age</td><td>6.0 (1.8)</td><td>5.7 (1.0)</td><td>6.9 (1.9)</td><td>5.9 (1.4)</td></tr><tr><td>Vocabulary</td><td>11.6 (4.7)</td><td>13.2 (3.6)</td><td>13.9 (4.5)</td><td>13.1 (4.1)</td></tr><tr><td>Abstract reasoning</td><td>10.0 (2.5)</td><td>10.3 (2.1)</td><td>10.9 (1.5)</td><td>10.6 (1.6)</td></tr><tr><td>Composite play</td><td>55.9 (5.6)</td><td>62.2 (7.4)</td><td>34.7 (7.1)</td><td>31.4 (13.0)</td></tr><tr><td>Activity preferences</td><td>33.4 (4.0)</td><td>38.1 (4.6)</td><td>25.9 (5.7)</td><td>26.5 (5.1)</td></tr><tr><td>Toy preferences</td><td>36.9 (5.9)</td><td>39.5 (4.4)</td><td>27.5 (5.9)</td><td>28.5 (6.8)</td></tr><tr><td>Toy play</td><td>0.70 (0.28)</td><td>0.80 (0.20)</td><td>0.31 (0.30)</td><td>0.42 (0.33)</td></tr><tr><th /><th align="left" colspan="4"><italic>n</italic> (%)</th></tr><tr><td>Playmate preferences</td><td>14 (47%)</td><td>26 (74%)</td><td>6 (30%)</td><td>7 (20%)</td></tr></tbody></table> </ephtml> </p> <p>1 Higher scores or percentages on play measures indicate more male-typical/less female-typical play behavior.</p> <p>2 One non-autistic girl did not play with any toys on the toy play task and was excluded from toy play analysis.</p> <p>Comparing non-autistic boys and girls, independent samples <emph>t</emph>-tests revealed significant and very large sex differences in composite play behavior, activity preferences, toy preferences, and toy play, with higher scores in non-autistic boys than in non-autistic girls across all measures, indicating more male-typical/less female-typical play in non-autistic boys (composite play behavior: <emph>t</emph>(<reflink idref="bib68" id="ref121">68</reflink>) = 12.21, <emph>p</emph> < 0.001, <emph>d</emph> = 2.92; activity preferences: <emph>t</emph>(<reflink idref="bib68" id="ref122">68</reflink>) = 10.03, <emph>p</emph> < 0.001, <emph>d</emph> = 2.40; toy preferences: <emph>t</emph>(<reflink idref="bib68" id="ref123">68</reflink>) = 8.05, <emph>p</emph> < 0.001, <emph>d</emph> = 1.92; toy play: <emph>t</emph>(<reflink idref="bib67" id="ref124">67</reflink>) = 5.85, <emph>p</emph> < 0.001, <emph>d</emph> = 1.41). A chi-square test revealed a significant large sex difference indicating that non-autistic boys had more male-typical/less female-typical playmate preferences (i.e. higher percentage of boys as favorite playmates and lower percentage of girls as favorite playmates) than did non-autistic girls, χ<sups>2</sups>(<reflink idref="bib1" id="ref125">1</reflink>, _I_N_i_ = 70) = 20.70, <emph>p</emph> < 0.001, <emph>ϕ</emph> = 0.54. Conversely, there were no significant differences between non-autistic boys and girls in age, vocabulary, or abstract reasoning (age: <emph>t</emph>(<reflink idref="bib68" id="ref126">68</reflink>) = –0.79, <emph>p</emph> = 0.43, <emph>d</emph> = –0.19; vocabulary: <emph>t</emph>(<reflink idref="bib68" id="ref127">68</reflink>) = 0.09, <emph>p</emph> = 0.93, <emph>d</emph> = 0.02; abstract reasoning: <emph>t</emph>(<reflink idref="bib68" id="ref128">68</reflink>) = –0.64, <emph>p</emph> = 0.52, <emph>d</emph> = –0.15).</p> <p>As shown by descriptive statistics, consistently across all the play outcomes, autistic boys scored lower than did non-autistic boys, indicating less male-typical/more female-typical play in autistic boys. These group differences were medium or large (composite play behavior: <emph>d</emph> = –0.95; activity preferences: <emph>d</emph> = –1.08; toy preferences: <emph>d</emph> = –0.51; toy play: <emph>d</emph> = –0.40; playmate preferences: <emph>ϕ</emph> = –0.28). Differences between autistic and non-autistic boys on four of the five play measures were statistically significant (composite play behavior: <emph>t</emph>(<reflink idref="bib63" id="ref129">63</reflink>) = –3.80, <emph>p</emph> < 0.001; activity preferences: <emph>t</emph>(<reflink idref="bib63" id="ref130">63</reflink>) = –4.35, <emph>p</emph> < 0.001; toy preferences: <emph>t</emph>(<reflink idref="bib63" id="ref131">63</reflink>) = –2.05, <emph>p</emph> = 0.04; playmate preferences: χ<sups>2</sups>(<reflink idref="bib1" id="ref132">1</reflink>, _I_N_i_ = 65) = 5.21, <emph>p</emph> = 0.02). For the remaining measure assessing toy play, the group difference was marginally significant, <emph>t</emph>(<reflink idref="bib63" id="ref133">63</reflink>) = –1.61, <emph>p</emph> = 0.11. By contrast, there were no significant differences between autistic and non-autistic boys in age, vocabulary, or abstract reasoning (age: <emph>t</emph>(<reflink idref="bib63" id="ref134">63</reflink>) = 0.80, <emph>p</emph> = 0.43, <emph>d</emph> = 0.20; vocabulary: <emph>t</emph>(<reflink idref="bib63" id="ref135">63</reflink>) = –1.50, <emph>p</emph> = 0.14, <emph>d</emph> = –0.37; abstract reasoning: <emph>t</emph>(<reflink idref="bib63" id="ref136">63</reflink>) = –0.55, <emph>p</emph> = 0.59, <emph>d</emph> = –0.14).</p> <p>No clear patterns emerged for differences between autistic girls and non-autistic girls. Compared with non-autistic girls, there was a trend for autistic girls to show more male-typical/less female-typical play on two of the measures (composite play behavior and playmate preferences) but less male-typical/more female-typical play on the other three measures (activity preferences, toy preferences, toy play). None of these group differences in play were statistically significant (composite play behavior: <emph>t</emph>(<reflink idref="bib53" id="ref137">53</reflink>) = 1.04, <emph>p</emph> = 0.30, <emph>d</emph> = 0.29; activity preferences: <emph>t</emph>(<reflink idref="bib53" id="ref138">53</reflink>) = –0.41, <emph>p</emph> = 0.68, <emph>d</emph> = –0.12; toy preferences: <emph>t</emph>(<reflink idref="bib53" id="ref139">53</reflink>) = –0.57, <emph>p</emph> = 0.57, <emph>d</emph> = –0.16; toy play: <emph>t</emph>(<reflink idref="bib52" id="ref140">52</reflink>) = –1.13, <emph>p</emph> = 0.26, <emph>d</emph> = –0.32; playmate preferences: χ<sups>2</sups>(<reflink idref="bib1" id="ref141">1</reflink>, _I_N_i_ = 55) = 0.71, <emph>p</emph> = 0.40, <emph>ϕ</emph> = 0.11). There were also no significant group differences in vocabulary, <emph>t</emph>(<reflink idref="bib53" id="ref142">53</reflink>) = 0.68, <emph>p</emph> = 0.50, <emph>d</emph> = 0.19, or abstract reasoning, <emph>t</emph>(<reflink idref="bib53" id="ref143">53</reflink>) = 0.58, <emph>p</emph> = 0.56, <emph>d</emph> = 0.16. Although autistic girls were significantly older than non-autistic girls, <emph>t</emph>(<reflink idref="bib53" id="ref144">53</reflink>) = 2.19, <emph>p</emph> = 0.03, <emph>d</emph> = 0.61, analyses adjusting for age yielded highly similar results and did not change the conclusions.</p> <hd id="AN0185859362-22">Discussion</hd> <p>The present study examined different aspects of sex-typical play in autistic and non-autistic children using parent-reported, child-reported, and observational measures. It is noteworthy that all the play measures employed in the present study showed large or very large differences between non-autistic boys and non-autistic girls, suggesting that these measures are suitable for assessing sex-typical play and can reflect sex-typical norms in non-autistic children's play. In the present study, consistently across all play outcomes, autistic boys showed less male-typical/more female-typical play than did non-autistic boys, although there were no significant differences in age, vocabulary, or abstract reasoning between autistic and non-autistic boys. The group differences in sex-typical play in boys were medium or large and mostly significant. In contrast, no clear, consistent, or significant patterns emerged from comparisons of autistic girls and non-autistic girls. The current findings of non-conforming play in autistic boys but not in autistic girls concur with findings in the studies by [<reflink idref="bib28" id="ref145">28</reflink>] and [<reflink idref="bib33" id="ref146">33</reflink>]. The present study extended these prior studies by addressing potential differences in age and cognitive abilities and by including a wider range of sex-typical play measures and outcomes.</p> <hd id="AN0185859362-23">Potential explanations</hd> <p>One possible explanation for the current sex-specific pattern is that autistic children may be particularly drawn to certain sensory input, which is more commonly associated with female-typical toys (e.g. shiny objects, silky objects; [<reflink idref="bib76" id="ref147">76</reflink>]; [<reflink idref="bib77" id="ref148">77</reflink>]; [<reflink idref="bib86" id="ref149">86</reflink>]). This may explain why autistic boys had decreased male-typical/increased female-typical toy preferences and toy play. However, autistic boys also exhibited decreased male-typical/increased female-typical play on other outcome measures (i.e. activities, playmates) that are not necessarily affected by the sensory function of toys.</p> <p>An additional potential explanation for the current findings is that, relative to autistic boys, autistic girls may be more likely to camouflage their non-conforming play. Camouflaging refers to the use of behaviors and strategies to reduce the visibility of autistic traits in social situations to achieve a "less autistic" presentation ([<reflink idref="bib35" id="ref150">35</reflink>]; [<reflink idref="bib53" id="ref151">53</reflink>]). Studies on adults have generally shown that camouflaging is more prevalent and successful in autistic women than in autistic men ([<reflink idref="bib15" id="ref152">15</reflink>]; [<reflink idref="bib34" id="ref153">34</reflink>]; [<reflink idref="bib53" id="ref154">53</reflink>]; [<reflink idref="bib61" id="ref155">61</reflink>]). Other studies have examined camouflaging in older children and adolescents on the autism spectrum ([<reflink idref="bib32" id="ref156">32</reflink>]; [<reflink idref="bib55" id="ref157">55</reflink>]), and it has been reported that some autistic girls can successfully camouflage and see camouflaging as a solution to their problems ([<reflink idref="bib14" id="ref158">14</reflink>]). There is also research showing that autistic girls are more likely to stay in proximity with social groups and copy the social behavior of their peers than are autistic boys ([<reflink idref="bib18" id="ref159">18</reflink>]; [<reflink idref="bib31" id="ref160">31</reflink>]), which might increase similarity in play between autistic and non-autistic girls. In the present study, there was a trend for parents to report increased male-typical/decreased female-typical play in autistic girls, but there was also a trend in the opposite direction for autistic girls to select toys and self-report activity and toy preferences that are relatively less male-typical/more female-typical. This inconsistency may be in part due to differences in types of play (social versus object-oriented play) or types of measures (composite versus specific measures). However, this discrepancy may also imply that in a research setting, autistic girls may camouflage their non-conforming play and express their play as more sex-typical, which could differ from their parents' understanding of how they usually play. Yet, the present study included some young children, and little or no research has examined camouflaging in young children on the autism spectrum. It remains unclear how researchers can effectively capture camouflaging in young children and whether young autistic girls camouflage more than do young autistic boys. Further research may look at the link between camouflaging and sex-typical play in autistic boys and girls.</p> <p>The current findings may also be partly explained by differences in the way autism manifests in boys and girls. Some studies have reported that autistic girls exhibit lower levels of restricted, repetitive behaviors, interests, and activities (RRBs) than do autistic boys ([<reflink idref="bib20" id="ref161">20</reflink>]; [<reflink idref="bib40" id="ref162">40</reflink>]; [<reflink idref="bib59" id="ref163">59</reflink>]). The restricted interests in autistic girls are often deemed as more socially acceptable than those in autistic boys ([<reflink idref="bib9" id="ref164">9</reflink>]). One possibility is that autistic girls' lower RRBs may contribute to their unaltered sex-typical play. Alternatively, the effects may operate in the opposite direction, with autistic girls' unaltered sex-typical play contributing to their lower RRB scores on autism-related assessment tools. Notably, autism diagnosis in girls tends to be delayed ([<reflink idref="bib22" id="ref165">22</reflink>]), which may be related to differences in behavioral manifestation ([<reflink idref="bib56" id="ref166">56</reflink>]). Further research may examine whether autistic girls' unaltered sex-typical play may contribute to the delayed or missed diagnosis of autism in girls.</p> <p>Interaction with female peers and adults may also play a role. Studies have found that autistic children perceive or receive greater social support from female peers than from male peers ([<reflink idref="bib11" id="ref167">11</reflink>]; [<reflink idref="bib51" id="ref168">51</reflink>]). In addition, the vast majority of caregivers of autistic children are female ([<reflink idref="bib29" id="ref169">29</reflink>]), and most psychotherapists are female ([<reflink idref="bib89" id="ref170">89</reflink>]). The inclination to female peers and the increased exposure to female adults may contribute to the relatively non-conforming play behavior in autistic boys and the relatively conforming play behavior in autistic girls.</p> <hd id="AN0185859362-24">Broader theoretical and developmental implications</hd> <p>The EMB framework has been used in two prior studies on this topic ([<reflink idref="bib28" id="ref171">28</reflink>]; [<reflink idref="bib42" id="ref172">42</reflink>]), even though the framework was not originally developed to explain sex-typical play in autistic children. The present study was not specifically designed to evaluate the theoretical framework. Yet, the current findings of non-conforming play in autistic boys and unaltered play in autistic girls do not support a "hyper-masculinized" developmental profile in autistic individuals that would have been predicted based on the extended EMB framework ([<reflink idref="bib42" id="ref173">42</reflink>]; [<reflink idref="bib75" id="ref174">75</reflink>]).</p> <p>A recent systematic review has reported that gender identity diversity is elevated in the autistic community, especially in autistic individuals assigned female at birth ([<reflink idref="bib62" id="ref175">62</reflink>]). Nonetheless, almost all the studies examining gender identity diversity in autistic individuals have focused on adolescents and/or adults ([<reflink idref="bib62" id="ref176">62</reflink>]). A recent longitudinal study assessed gender identity diversity repeatedly in autistic and non-autistic children and adolescents annually for 4 years across an age range of 10–16 years, showing that autistic boys had a rather stable trajectory of increased gender identity diversity across the 4 years, whereas autistic girls had a fluid trajectory across the 4 years ([<reflink idref="bib16" id="ref177">16</reflink>]). Taken together, the current findings and the findings by [<reflink idref="bib16" id="ref178">16</reflink>] suggest that aspects of gender development in autistic girls and boys may unfold differently, and autistic girls may exhibit more dynamical developmental patterns.</p> <p>It is noteworthy that sex-typical play may have long-term implications. Prior studies have reported that childhood sex-typical play behavior predicts sex-typical occupational interests in adolescence and adulthood ([<reflink idref="bib45" id="ref179">45</reflink>], [<reflink idref="bib47" id="ref180">47</reflink>]). Prior reviews have also highlighted the link between self-socialization (understanding and following sex-typical norms in society) and sex-typical play behavior ([<reflink idref="bib46" id="ref181">46</reflink>]; [<reflink idref="bib84" id="ref182">84</reflink>]). These prior studies have focused on non-autistic individuals. Further research may examine whether sex-typical play can predict long-term outcomes in autistic individuals and whether similar socio-cognitive factors contribute to the development of sex-typical play in autistic individuals.</p> <p>According to certain observations in the broader autism research literature, in theory, both autistic boys and girls would be expected to play in a non-conforming manner. These observations or accounts cannot fully explain the current findings suggesting non-conforming play in autistic boys only. Yet, to offer a more comprehensive discussion, these perspectives are reviewed briefly in the Supplemental Material. Furthermore, issues pertaining to cultural, familial, and schooling influences are discussed in the Supplemental Material.</p> <hd id="AN0185859362-25">Limitations</hd> <p>The sample size in the present study was limited. This was especially the case for autistic girls. Recruiting young autistic girls for the present study was challenging because (<reflink idref="bib1" id="ref183">1</reflink>) autism diagnosis is less prevalent in girls than in boys ([<reflink idref="bib57" id="ref184">57</reflink>]); (<reflink idref="bib2" id="ref185">2</reflink>) diagnosis of autism in girls tends to be delayed compared with that in boys ([<reflink idref="bib22" id="ref186">22</reflink>]); and (<reflink idref="bib3" id="ref187">3</reflink>) autistic girls are more likely to be classified as having intellectual disability than are autistic boys ([<reflink idref="bib73" id="ref188">73</reflink>]). The relatively small sample of autistic girls may have limited the present study's ability to detect significant effects. However, given there were no consistent or clear patterns observed in autistic girls, even if these effects became significant in a larger sample, it is unlikely that these mixed findings would lead to a different conclusion.</p> <p>Another limitation is that the present study focused on children without intellectual disability. Further research may look at sex-typical play behavior in autistic and non-autistic children with more diverse cognitive profiles and assess how sex-typical play behavior may be related to their cognitive profiles. Moreover, although the observational method used to measure toy play in the present study enables a standardized assessment procedure, it has limited ecological validity. Further research may include an even wider range of play measures by conducting field observation. In addition, to increase the ability to detect any subgroup differences or subgroup-specific effects in the current small sample, the present study conducted key comparisons within each sex without having examined interactions between sex and diagnosis status first. Further research with larger samples employing more conventional statistical approaches is needed to corroborate the current findings. Notably, there was no community involvement in the present study. Researchers may incorporate insights from the autistic community when designing new studies on this topic.</p> <p>The present study may also be limited by the fact that the sex-typical play measures employed were not specifically developed for Chinese children or autistic children. Nonetheless, these play measures consistently showed large differences between non-autistic boys and non-autistic girls as well as high internal consistency, suggesting that these were valid and reliable measures of sex-typical play for the current sample. The consistency in the direction of effects across all play measures (parent-reported, self-reported, observational) in the comparisons among boys further suggests that the effects are reliable and are not susceptible to limitations of individual measures. Further research may psychometrically validate sex-typical play measures in autistic and non-autistic children in Chinese populations.</p> <p>Finally, the present study assessed only vocabulary and abstract reasoning but not other language abilities such as pragmatics and narrative skills or socio-cognitive skills involving self-insight. Despite the consistency in findings across different types of measures (parent reports, observation, self-reports) in boys, certain language and socio-cognitive abilities may have an impact on children's self-reports. Further research may examine the links among different aspects of cognition, sex-typical play, and autism.</p> <hd id="AN0185859362-26">Conclusions</hd> <p>In the present study, autistic boys consistently exhibited less male-typical/more female-typical play than did non-autistic boys across different play outcomes assessed by parent-reported, self-reported, and observational measures, although there were no differences in vocabulary, abstract reasoning, or age between autistic and non-autistic boys. No clear or consistent differences were observed in comparisons of autistic and non-autistic girls. Future studies may investigate and pinpoint the mechanisms underlying the similarities and differences in sex-typical play between autistic and non-autistic boys and girls with diverse cognitive profiles using a wide range of play measures.</p> <hd id="AN0185859362-27">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-aut-10.1177_13623613251321207 for Sex-typical toy, activity, and playmate preferences in autistic and non-autistic children by Jacqueline C S To and Karson T F Kung in Autism</p> <p>The authors would like to thank all the participants and all the recruitment helpers who made this research possible.</p> <ref id="AN0185859362-28"> <title> References </title> <blist> <bibl id="bib1" idref="ref112" type="bt">1</bibl> <bibtext> Aguinis H., Beaty J. C., Boik R. J., Pierce C. A. (2005). Effect size and power in assessing moderating effects of categorical variables using multiple regression: A 30-year review. 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Sex Roles, 54, 469–483. https://doi.org/10.1007/s11199-006-9019-x</bibtext> </blist> </ref> <ref id="AN0185859362-29"> <title> Footnotes </title> <blist> <bibtext> Jacqueline C S To: Data curation; Formal analysis; Project administration; Writing—original draft.Karson T F Kung: Conceptualization; Formal analysis; Investigation; Methodology; Writing—review & editing.</bibtext> </blist> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: KTFK was funded by the Hong Kong Research Grants Council (Early Career Scheme: 27608921; General Research Fund: 17614823).</bibtext> </blist> <blist> <bibtext> This research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. This study was approved by the Departmental Research Ethics Committee of the Department of Psychology at the University of Hong Kong (Ref: 3036092059) on 11 April 2023. Informed parental consent was obtained for all participants prior to the study.</bibtext> </blist> <blist> <bibtext> Jacqueline C S To</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0009-0007-3505-6249 Karson T F Kung</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0002-1598-1513</bibtext> </blist> <blist> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> <blist> <bibtext> In this report, for brevity, sex is used to refer to one's sex assigned at birth, and boys and girls are used to refer to children assigned male at birth and children assigned female at birth, respectively. This report focuses on sex, instead of gender or gender identity, and uses sex to refer to the binary groups of boys and girls. This approach was chosen because many theoretical perspectives and empirical studies on play in boys and girls have been developed based on the traditional binary categories of male and female instead of gender identity/diversity or the spectrum of sex and gender ([46]; [84]), even though some prior studies have examined play in individuals with a differences of sex development (DSD) condition ([48]) and in gender-diverse populations ([39]; [90]).</bibtext> </blist> </ref> <aug> <p>By Jacqueline C S To and Karson T F Kung</p> <p>Reported by Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib67" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib80" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib85" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib69" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib81" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib30" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib38" firstref="ref7"></nolink> <nolink 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  Data: Sex-Typical Toy, Activity, and Playmate Preferences in Autistic and Non-Autistic Children
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  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Jacqueline+C%2E+S%2E+To%22">Jacqueline C. S. To</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0007-3505-6249">0009-0007-3505-6249</externalLink>)<br /><searchLink fieldCode="AR" term="%22Karson+T%2E+F%2E+Kung%22">Karson T. F. Kung</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-1598-1513">0000-0002-1598-1513</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. 2025 29(7):1727-1739.
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  Label: Availability
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  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
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  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Play%22">Play</searchLink><br /><searchLink fieldCode="DE" term="%22Toys%22">Toys</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Preadolescents%22">Preadolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Vocabulary%22">Vocabulary</searchLink><br /><searchLink fieldCode="DE" term="%22Abstract+Reasoning%22">Abstract Reasoning</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Hong+Kong%22">Hong Kong</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/13623613251321207
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1362-3613<br />1461-7005
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Play, in particular sex-typical play, is important for affective, cognitive, and social development. There is limited research on sex-typical play in autistic children. The few prior studies on this topic relied heavily on reports or involvement of caregivers/parents, did not assess cognitive abilities, and examined a limited number of sex-typical play outcomes. The present study examined sex-typical play in 120 children without intellectual disability (30 autistic boys, 35 non-autistic boys, 20 autistic girls, 35 non-autistic girls) aged 4-11 years. Vocabulary and abstract reasoning were also assessed. Consistently across all five play measures (parent-reported composite play, self-reported activity preferences, self-reported toy preferences, self-reported playmate preferences, and observed toy play), there were medium or large, and mostly significant, differences between autistic and non-autistic boys, suggesting less male-typical/more female-typical play in autistic boys. Autistic and non-autistic boys did not differ in vocabulary, abstract reasoning, or age. No consistent, clear, or significant patterns emerged in comparisons of autistic and non-autistic girls. The more non-conforming play in autistic boys concurs with certain prior findings suggesting that the autistic community is not confined to social norms and shows increased gender diversity. The potential link between the unaltered play in autistic girls and camouflaging is considered.
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  Data: 2025
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  Data: EJ1474624
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      – Text: English
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        PageCount: 13
        StartPage: 1727
    Subjects:
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Play
        Type: general
      – SubjectFull: Toys
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      – SubjectFull: Gender Differences
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      – SubjectFull: Children
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      – SubjectFull: Preadolescents
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      – SubjectFull: Vocabulary
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      – SubjectFull: Abstract Reasoning
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      – SubjectFull: Age Differences
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Hong Kong
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      – TitleFull: Sex-Typical Toy, Activity, and Playmate Preferences in Autistic and Non-Autistic Children
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