Sex Differences in Autism Spectrum Disorders: A Multidisciplinary Review

Autism spectrum disorder (ASD) is a polygenic neurodevelopmental disorder; yet, there is significant disparity in ASD prevalence among males versus females. Research aims to disentangle the phenotypic/genotypic differences between males and females with ASD. This article provides a comprehensive review of the literature exploring sex differences in ASD across disciplines. Findings support that females with ASD present with fewer RRBs, variable social-communicative skills, weaker adaptive skills, higher levels of anxiety and externalizing behaviors, variable executive functions (better set-shifting, poorer verbal working memory, comparable mental rotation/planning), variable language and better story-telling skills, less detailed visual perceptual styles/typical social attention, and better memory, compared to males with ASD. In contrast, few sex differences in cognitive development and early childhood ASD symptoms emerged. Biological sex/ASD-related differences also exist, with some interesting relationships to the broad autism phenotype. Finally, a greater percentage of individuals with ASD are gender diverse relative to the general population. Clarifying and understanding ASD-related sex differences in symptomatology is essential to tailoring treatment interventions, with relevance for identifying more homogenous biological phenotypes that can be utilized in future genetic studies.