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

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Volume Title

A2 Katsausartikkeli tieteellisessä aikakauslehdessä

Date

2023-01

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Mcode

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Language

en

Pages

34
1-34

Series

Journal of Intellectual Disability Research, Volume 67, issue 1

Abstract

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

Description

Funding Information: E. S. received grants from the Finnish Cultural Foundation (Suomen Kulttuurirahasto) and the Päivikki and Sakari Sohlberg Foundation (Päivikki ja Sakari Sohlbergin Säätiö). M. C. received grants from the Academy of Finland, the Arvo and Lea Ylppö Foundation and FRAXA Research Foundation, USA. J. S. is funded by the Academy of Finland (grant nos. 325981 and 328954). Publisher Copyright: © 2022 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Keywords

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

Other note

Citation

Saure , E , Castrén , M , Mikkola , K & Salmi , J 2023 , ' Intellectual disabilities moderate sex/gender differences in autism spectrum disorder: a systematic review and meta-analysis ' , Journal of Intellectual Disability Research , vol. 67 , no. 1 , pp. 1-34 . https://doi.org/10.1111/jir.12989