Sex differences in the course of autistic and co-occurring psychopathological symptoms in adolescents with and without autism spectrum disorder
Authors: Horwitz Ernst , Vos Melissa , De Bildt Annelies , Greaves-Lord Kirstin , Rommelse Nanda , Schoevers Robert , Hartman Catharina 
Published: January 2023

There is an ongoing debate as to whether autism spectrum disorder (ASD) is expressed differently in women than men. It is unclear whether differences found are specific to autism or merely reflecting normative development. In this study, we compared sex differences in developmental trajectories of autistic and co-occurring psychopathological symptoms in adolescents with milder forms of autism to those in a normative group matched for intelligence quotient (IQ) and socioeconomic status. Data of five assessment waves from ages 11 to 22 years were analyzed using linear mixed modeling. We found that in adolescence, sex differences in developmental trajectories of psychopathological symptoms specific for autism are confined to the repetitive stereotyped domain (males had higher scores on the sensory/stereotypic and resistance to change domains, the latter difference disappeared during adolescence due to an increase of these problems in females with ASD). Other sex differences, among which an increase over time in affective and anxiety problems in females was the most outstanding, were also observed in typically developing females. These sex-specific differences have relevance in the clinical care of men and women with autism, although they are subtle compared to differences between individuals with and without autism, which are broadly present in internalizing and externalizing problem domains. Lay abstract There is an ongoing debate as to whether autism spectrum disorder (ASD) is expressed differently in women than men. Studies on sex differences in autistic symptoms and symptoms of other psychiatric problems present in individuals with autism generally do not include a general population comparison group, making it unclear whether differences are specific to autism or merely reflecting development in the general population. In this study, we compared sex differences in the course of autistic and at the same time present symptoms of other psychiatric problems in adolescents with milder forms of ASD to those in a group of the general population with an equal intelligence quotient (IQ) and socioeconomic status. Data of five assessment moments from ages 11 to 22 years were analyzed using a statistic procedure that allowed us to determine which factors affect the course of symptoms over time. We found that in adolescence, sex differences in the course of psychopathological symptoms specific for autism are confined to the repetitive stereotyped domains. Males had higher scores on the sensory/stereotypic and resistance to change domains, the latter difference disappeared during the course of adolescence due to an increase of these problems in autistic females. Other sex differences, among which an increase over time in mood and anxiety problems in females was the most outstanding, were also observed in females without autism. These sex-specific differences have relevance in the clinical care of autistic men and women, although they are subtle compared to differences between individuals with and without autism.