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Sex differences in the evaluation and diagnosis of autism spectrum disorders among children

机译：儿童自闭症谱系障碍评估和诊断中的性别差异

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Background: One of the most consistent features of the autism spectrum disorders (ASDs) is the predominance among males, with approximately four males to every female. We sought to examine sex differences among children who met case definition for ASD in a large, population-based cohort with respect to age at first developmental evaluation, age of diagnosis, influence of cognitive impairment on these outcomes, and sex-specific behavioral characteristics. Methods: We conducted a secondary analysis of data collected for a population-based study of the prevalence of ASD. The sample comprised 2,568 children born in 1994 who met the case definition of ASD as established by the Autism and Developmental Disabilities Monitoring (ADDM) Network for ASD surveillance. Children who had a history of developmental disability and behavioral features consistent with the DSM-IV-TR criteria for autistic disorder, Asperger's disorder, and Pervasive Developmental Disorder-Not Otherwise Specified in existing evaluation records were classified as ASD cases via two paths: streamlined and nonstreamlined. Streamlined reviews were conducted if there was an ASD diagnosis documented in the records. Data were collected in 13 sites across the United States through the ADDM Network, funded by the Centers for Disease Control and Prevention. Results: Males constituted 81% of the sample. There were no differences by sex in average age at first evaluation or average age of diagnosis among those with an existing documented chart diagnosis of an ASD. Girls were less likely than boys to have a documented diagnosis (odds ratio [OR] = 0.76, p = .004). This analysis was adjusted for cognitive impairment status. In the logistic model, with the interaction term for sex and cognitive impairment, girls with IQ of 70 or less were less likely than boys with IQ of 70 or less to have a documented diagnosis (OR = 0.70, 95% confidence interval [CI] = 0.50-0.97, p = .035). Boys with IQ greater than 70 were less likely than boys with IQ of 70 or less to have a documented diagnosis (OR = 0.60, 95% CI = 0.49-0.74, p < .001). This finding (less likely to have a documented diagnosis) was also true for girls with IQ greater than 70 (OR = 0.45, 95% CI = 0.32-0.66, p < .001). Girls were more likely to have notations of seizure-like behavior (p < .001). Boys were more likely to have notations of hyperactivity or a short attention span and aggressive behavior (p < .01). Conclusions: Girls, especially those without cognitive impairment, may be formally identified at a later age than boys. This may delay referral for early intervention. Community education efforts should alert clinicians and parents to the potential of ASDs in boys and girls.
机译：背景：自闭症谱系障碍（ASD）最一致的特征之一是男性占主导地位，每名女性中大约有4男性。我们试图研究在大型人群研究中符合ASD病例定义的儿童之间的性别差异，包括首次发育评估时的年龄，诊断年龄，认知障碍对这些结局的影响以及特定性别的行为特征。方法：我们对收集的数据进行了二次分析，以进行基于人群的ASD患病率研究。样本包括1994年出生的2568名儿童，他们符合自闭症和发育障碍监测（ADDM）网络进行ASD监测的ASD病例定义。具有发育障碍和行为特征的历史符合自闭症，阿斯伯格氏病和广泛性发育障碍的DSM-IV-TR标准的儿童-现有评估记录中未指定的儿童通过两种途径被归类为ASD病例：简化和精简。如果记录中记录了ASD诊断，则进行简化的审查。通过由疾病控制和预防中心资助的ADDM网络在美国的13个站点中收集了数据。结果：男性占样本的81％。在现有的ASD图表诊断中，首次评估的平均年龄或平均诊断年龄没有性别差异。与男孩相比，女孩诊断的可能性较小（优势比[OR] = 0.76，p = .004）。该分析针对认知障碍状态进行了调整。在逻辑模型中，以性别和认知障碍的交互作用项，智商为70或更低的女孩比智商为70或更低的男孩更有可能得到书面诊断（OR = 0.70，95％置信区间[CI] = 0.50-0.97，p = .035）。智商大于70的男孩比智商70或小于70的男孩更不可能有书面诊断（OR = 0.60，95％CI = 0.49-0.74，p <.001）。这一发现（不太可能有确凿的诊断结果）对于智商大于70（OR = 0.45，95％CI = 0.32-0.66，p <.001）的女孩也是如此。女孩更有可能表现出癫痫样行为（p <.001）。男孩更有可能表现为过度活跃或注意力不集中和攻击行为（p <.01）。结论：女孩，特别是那些没有认知障碍的女孩，在年龄上可能比男孩晚。这可能会延迟转介以进行早期干预。社区教育的努力应提醒临床医生和父母注意男孩和女孩患自闭症的潜力。

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