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Research Review: A systematic review and meta‐analysis of sex/gender differences in social interaction and communication in autistic and nonautistic children and adolescents
Author(s) -
WoodDownie Henry,
Wong Bonnie,
Kovshoff Hanna,
Cortese Samuele,
Hadwin Julie A.
Publication year - 2021
Publication title -
journal of child psychology and psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.652
H-Index - 211
eISSN - 1469-7610
pISSN - 0021-9630
DOI - 10.1111/jcpp.13337
Subject(s) - psychology , meta analysis , developmental psychology , construct (python library) , autism , gender role , social relation , social psychology , medicine , computer science , programming language
Background Evidence increasingly suggests that ASD manifests differently in females than males. Previous reviews investigating sex/gender differences in social interaction and social communication have focused at the level of broad constructs (e.g. comparing algorithm scores from pre‐existing diagnostic instruments) and have typically reported no significant differences between males and females. However, a number of individual studies have found sex/gender differences in narrow construct domains. Methods We conducted a systematic review and random effects model meta‐analyses (in January 2019 and updated January 2020) that investigated sex/gender differences in narrow construct measures of social communication and interaction in autistic and nonautistic children and adolescents, and adults. Study quality was appraised using the Appraisal Tool for Cross‐Sectional Studies (AXIS, BMJ Open , 6 , 2016, 1). Results Across 16 studies (including 2,730 participants), the analysis found that female (vs. male) individuals with ASD had significantly better social interaction and social communication skills (SMD = 0.39, p < .001), which was reflective of a similar sex/gender profile in nonautistic individuals (SMD = 0.35, p < .001). Nonautistic males had significantly better social interaction and communication than males with ASD (SMD = 0.77, p < .001). Nonautistic females also had significantly better social interaction and communication than females with ASD (SMD = 0.72, p <.001). Nonautistic males had better social interaction and communication than females with ASD, though this difference was not significant (SMD = 0.30, p = .07). Conclusions This systematic review and meta‐analysis highlighted important sex/gender differences in social interaction and communication for individuals with ASD, likely not captured by pre‐existing diagnostic instruments, which potentially contribute to the under recognition of autism in females, and may need to be reflected in the diagnostic process.