Sex Disparities in Autism Spectrum Disorder Among Adolescents in the Western Pacific Region: Insights From...

Autism spectrum disorder (ASD) is associated with substantial health-related burden and support needs for adolescents and families, yet cross-cultural patterns in sex differences remain underexplored. We examined sex-stratified patterns in ASD epidemiology and clinical presentation among adolescents in the Western Pacific region, with a focus on China.

We used a dual approach: (1) secondary analysis of Global Burden of Disease (GBD) 2021 data from 31 Western Pacific countries/territories, assessing ASD prevalence and years lived with disability (YLDs) from 1990 to 2021 using Joinpoint regression and age-period-cohort (APC) analysis; and (2) network analysis of ASSS symptom-domain scores among 845 adolescents (571 males, 274 females) with ASD from a tertiary hospital in China.

Male-to-female prevalence ratios ranged from 2:1 to 3:1 across countries. Significant increases in male prevalence and YLDs were observed in East Asia, especially China, whereas female patterns remained relatively stable. APC analysis showed the highest ASD risk among younger adolescents (10-15 years) in China, contrasting with other countries where male risk increased and female risk decreased with age. In the Chinese clinical sample, the communication-related domain was the most central in both sex-stratified networks; the third most central domain differed by sex (restricted/repetitive behaviours in males vs. sensorimotor-related symptoms in females). Female networks showed stronger links between the ASSS "empathy deficits" domain and peer interaction difficulties.

Sex-stratified differences in adolescent ASD prevalence and domain-level clinical patterns are evident across the Western Pacific region and may reflect a combination of diagnostic practices and sociocultural context. These findings support the value of sex-aware assessment and context-sensitive supports, while highlighting the need for future studies that better characterise gender and other contextual determinants of presentation.