Diagnosing ASD in Children Aged 6-18: Gender Differences and the Diagnostic Process.

Area of Science:

• Neurodevelopmental disorders
• Child psychology
• Diagnostic methodologies

Background:

• Autism spectrum disorder (ASD) diagnosis becomes more complex with age, particularly in girls.
• Existing diagnostic tools may not fully capture the heterogeneous presentation of ASD across genders.
• The neurodiversity paradigm offers a framework for understanding diverse ASD presentations.

Purpose of the Study:

• To explore developmental factors and diagnostic tools impacting ASD diagnoses after age six.
• To evaluate how tools like the ADOS-2 and Social Attribution Test (SAT) capture gender-specific ASD presentations.
• To integrate the neurodiversity paradigm into ASD diagnostic considerations.

Main Methods:

• Retrospective analysis of 91 children (73 boys, 18 girls) aged 6-18 assessed for ASD.
• Multivariate Generalized Linear Models (GLMs) used to identify predictors of diagnosis.
• Controlled for age, gender, and language difficulties in the analysis.

Main Results:

• Boys exhibited more atypical development and restricted interests; girls showed higher sensory sensitivity.
• Social Affect (SA) scores, age of initial concern, and absence of language difficulties significantly predicted ASD diagnosis.
• Gender differences in ASD symptom presentation were observed.

Conclusions:

• Current diagnostic tools may have limitations in identifying "masking" phenotypes, particularly in girls.
• There is a need for gender-sensitive diagnostic criteria and implicit measures like the SAT.
• Longitudinal studies with comprehensive assessments are crucial for capturing ASD diversity, especially in social and language skills.