Gender-Based Differences in Autism Spectrum Disorder: Evidence From an Indian Clinical Cohort

Area of Science:

• Neurodevelopmental Disorders
• Pediatric Neurology
• Genetics and Genomics

Background:

• Autism Spectrum Disorder (ASD) is a neurodevelopmental condition affecting social communication and behavior.
• Global ASD prevalence shows a higher male-to-female ratio (3:1–4:1), potentially due to the female protective effect, extreme male brain theory, female autism phenotype, and camouflaging.
• Understanding these gender differences is crucial for assessing the full impact of ASD in India.

Purpose of the Study:

• To investigate gender-based differences in Autism Spectrum Disorder (ASD) presentation and diagnosis within the Indian context.
• To explore potential reasons for the underdiagnosis of ASD in females.
• To inform the development of gender-sensitive diagnostic approaches.

Main Methods:

• A cross-sectional retrospective study of 515 children diagnosed with ASD (aged 12 months–21 years) was conducted in Bengaluru, India.
• Standardized assessments included WISC-IV, WPPSI-IV, VABS-II for cognitive functioning; ISAA, SRS for ASD severity and comorbidities; and COM DEALL, BSID-III for development.
• Sociodemographic and clinical variables were analyzed for gender differences, with age adjustment.

Main Results:

• The observed male-to-female ratio for ASD was 4:1.
• Females had a higher median annual family income (₹14,00,000) compared to males (₹9,50,000).
• Girls presented with greater ASD severity (SRS-II), including social communication deficits, autistic mannerisms, and social awareness issues. A positive family history of developmental disorders (11.8% vs. 4.9%) and asthma (5.8% vs. 1.8%) were more common in females.

Conclusions:

• The 4:1 male-to-female ratio aligns with global trends, but findings suggest potential under-identification of females with ASD in India.
• Increased symptom severity, familial risk, and socioeconomic factors in females support the female protective effect and camouflaging hypotheses.
• There is a critical need for gender-sensitive diagnostic tools to improve ASD detection and understanding in females.