Sex-specific metrics for success: Gaps in social word use are bigger for autistic girls than boys

Abstract

Autistic girls are often diagnosed late, missed, or misdiagnosed, which can negatively impact quality of life and mental health. Although research shows the social profiles of autistic girls differ from boys in systematic ways that might explain gaps in diagnosis, little is known about how autistic girls’ social language compares to their same-sex non-autistic peers. This study investigated social words—words that make reference to other people—produced by 138 age- and IQ-matched autistic and non-autistic youth (ages 6–15) during one Autism Diagnostic Observation Schedule, Second Edition task. Girls used significantly more social words than boys across both diagnostic groups. There was a larger gap in social word production between autistic girls and non-autistic girls than autistic boys and non-autistic boys, with non-autistic girls using the most social words. Non-autistic girls’ social language behavior—including their social word production—sets an especially high bar for autistic girls, who often report trying to blend in with other girls. Growing evidence of the distinct social language profiles of autistic and non-autistic girls versus boys should guide researchers and clinicians to assess autism in ways that are sensitive to sex-associated differences and develop interventions that consider the norms of youth’s target social circles.

Lay Abstract

Autism is often diagnosed later in girls and women as compared to boys and men. More research is needed to understand how autism presents differently in girls. This study investigates how autistic and non-autistic youth aged 6 to 15 years use social words (e.g. “friend,” “mom,” “help,” “talk”) during an interview about friends, relationships, and marriage as part of an autism diagnostic assessment. Overall, girls used more social words compared to boys and talked more about friends. Specifically, non-autistic girls used the most social words in comparison with other groups. Highly social language produced by non-autistic girls may make it especially hard for autistic girls to blend in with other girls and could lead them to engage in more camouflaging behaviors to hide their autistic characteristics. With such different average social language behavior from girls and boys, researchers should consider adapting autism assessments and interventions to support the unique needs of autistic girls.