(PS3-A11) Autism Spectrum Disorder Variation by Gender: Examining Symptom Profiles in the ADOS-II

Approximately 3-4 boys for every girl meet the clinical criteria for autism spectrum disorder (ASD) in studies of community diagnostic patterns and in studies of autism using samples of convenience (Lai et al., 2015). However, girls with autism have been hypothesized to be underdiagnosed, possibly because they may present with differing symptom profiles as compared to boys. Specifically, females have been found to present with significantly less restrictive and repetitive behaviors (RRBs) and externalizing symptoms (Mandy et al., 2012), both of which are associated with the target treatment outcomes of therapeutic and behavioral interventions. As a result, treatment using therapeutic methods, such as Cognitive Behavioral Therapy, requires an understanding of the sex-differential presentation of autism that likely leads to manifestation of different mental health outcomes. In fact, girls have been shown to have significantly later diagnoses (Supekar & Menon, 2015), which has been linked with worse lifelong mental health outcomes. Therefore, this secondary data analysis will use the National Database of Autism Research (NDAR) sourced data from behavioral interventions to examine in what ways gender, symptom profiles, and age are associated with one another in a gold standard assessment of autism symptoms, the Autism Diagnostic Observation Schedule II (ADOS-II; Lord, 2012). ADOS-II scores from 4100 children ages 6-14 years from 68 different studies in NDAR indicated that age and gender were significant predictors of total algorithm, RRB, and social communicative difficulties (SCD) composite severity scores. Female’s scores on the RRB total indicates that interventions may not be capturing, and thereby understanding, the true nature of the clinical needs of autistic females. Confirmatory factor analysis also determined that the ADOS-II’s algorithmic variables’ structure differed between the male and female subsamples, such that a partial metric invariance model showed females responding worse to the current algorithmic structure than males on the RRB total. Overall, this study recommends to source clinical needs for female clients from their reported problems, which may appear as more socially shy from camouflaging or masking, rather than the typically externalizing symptoms associated with an autism diagnosis.