Females with autism may face greater challenges when it comes to organization, independence skills, and real world planning, according to new research published in the journal Autism Research.
The study is the largest to date to analyze executive function (the ability to make a plan, get organized, and follow through) and adaptive skills (the ability to perform basic daily tasks like getting up and dressed or making small talk) in women and girls with autism spectrum disorder (ASD).
“Our goal was to look at real world skills, not just the diagnostic behaviors we use clinically to diagnose ASD, to understand how people are actually doing in their day to day lives,” says Allison Ratto Ph.D., a psychologist in the Center for Autism Spectrum Disorders at Children’s National and one of the study’s authors.
“When parents were asked to rate a child’s day-to-day functioning, it turns out that girls were struggling more with these independence skills. This was surprising because in general, girls with ASD have better social and communication skills during direct assessments. “
“The natural assumption would be that those communication and social skills would assist them to function more effectively in the world, but we found that this isn’t always the case.”
For the study, researchers at the Center for Autism Spectrum Disorders at Children’s National Health System, the National Institute of Mental Health and The George Washington University collected data from several questionnaires in which parents had rated their child’s executive function and adaptive behavior.
The research involved 79 females and 158 males aged seven to 18 who met clinical criteria for autism spectrum disorders. The groups were matched for intelligence, age and level of autism and ADHD symptoms.
The findings add to a growing body of research focused on how ASD may affect females differently than males. The ratio of girls to boys with autism is approximately three to one.
Since there are more males with ASD, existing data is mainly focused on traits and challenges in that population. This is especially true in clinical trials, where enrollment is overwhelmingly male.
“Our understanding of autism is overwhelmingly based on males, similar to the situation faced by the medical community once confronted with heart disease research being predominantly male,” said senior author Lauren Kenworthy, Ph.D., director of the Center for Autism Spectrum Disorders.
“We know how to identify signs, symptoms, and treatments for autism in males, but we know very little about unique aspects of it in females.”
The lack of research on how autism presents in females may contribute to misdiagnosis and delay or prevent intervention. Such delays can have a significant effect on outcomes, as research has shown the critical importance of early diagnosis and intervention in ASD.
“Our focus in caring for children with autism is equipping ALL of them with strategies and skills to allow them to function and succeed in day-to-day living,” said Kenworthy.
“This study highlights that some common assumptions about the severity of challenges faced by girls with ASD may be wrong, and we may need to spend more time building the adaptive and executive function skills of these females if we want to help them thrive.”
“Enhancing our understanding of how biological differences change the presentation of autism in the long term is crucial to giving every person with ASD the tools they need to succeed in life,” she said.