Meta-Analysis of Sex Differences in Social and Communication Function in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

Sex-based differences in placental DNA methylation profiles related to gestational age: an NIH ECHO meta-analysis

The placenta undergoes many changes throughout gestation to support the evolving needs of the foetus. There is also a growing appreciation that male and female foetuses develop differently in utero, with unique epigenetic changes in placental tissue. Here, we report meta-analysed sex-specific associations between gestational age and placental DNA methylation from four cohorts in the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Programme (355 females/419 males, gestational ages 23-42 weeks). We identified 407 cytosine-guanine dinucleotides (CpGs) in females and 794 in males where placental methylation levels were associated with gestational age. After cell-type adjustment, 55 CpGs in females and 826 in males were significant. These were enriched for biological processes critical to the immune system in females and transmembrane transport in males. Our findings are distinct between the sexes: in females, associations with gestational age are largely explained by differences in placental cellular composition, whereas in males, gestational age is directly associated with numerous alterations in methylation levels.

Longitudinal studies of challenging behaviours in autistic children and adults: A systematic review and meta-analysis

Autistic children and adults are at increased risk of showing behaviours that may be described as challenging, however, little is known about whether or how these behaviours may change over time. Given the profound impact that challenging behaviour can have on both the autistic individual and their support network, it is critical that the trajectory of challenging behaviours be better understood. This systematic review and meta-analysis identified and synthesised observational longitudinal studies of challenging behaviour in autistic individuals. Fifty-six studies were included in the systematic review, and the effect sizes of 37 independent samples arising from 34 of these reports were examined through meta-analysis. Crucially, across the 37 samples, scores on the measures of challenging behaviour reduced by a small, yet significant, extent over time. Although age of the sample at baseline assessment did not moderate the effect, the time between the baseline assessment and final follow-up and age at final follow-up both moderated the magnitude of the effect, with challenging behaviour scores reducing to a larger extent in (a) studies with longer intervals between baseline and final follow-up and (b) studies with older samples at follow-up. The results from the current systematic review and meta-analysis have both theoretical and practical implications for understanding challenging behaviour over time in autistic individuals. Avenues for future research are also highlighted that may allow better understanding, and therefore support of, challenging behaviour in autistic individuals.

Measurement invariance of the Autism Impact Measure (AIM) across sex in children with autism spectrum disorder

Measurement invariance, or the degree to which an instrument measures constructs consistently across subgroups, is critical for appropriate interpretations of measures. Given sex differences in the phenotypic and clinical presentation of autism spectrum disorder (ASD), it is particularly important to examine measurement invariance in autism instruments to ensure that ASD measures are not biased toward the more common male ASD phenotype. This study represents an important preliminary investigation evaluating the measurement equivalence of the Autism Impact Measure (AIM) across children and adolescents with ASD. The results indicated that the AIM demonstrated measurement invariance at the configural, metric, and scalar levels across sex in all five domains, including Repetitive Behavior, Communication, Atypical Behavior, Social Reciprocity, and Peer Interaction. These results suggest that ASD core symptoms assessed by the AIM were similar among male and female groups. In addition, the latent means for all five factors were not statistically significantly different across sex groups, revealing no systematic differences on any of the AIM subscales for males and females. Overall, this study showed that the AIM detects core ASD symptoms across all five areas equivalently in males and females and is not biased toward males with ASD.

Examine sex differences in autism spectrum disorder in school-aged children and adolescents with fluent language

There are noteworthy sex disparities in the prevalence of autism spectrum disorders (ASD), while findings regarding the sex differences in core symptoms are inconsistent. There are few relevant studies on sex differences in mainland China. This study was dedicated to a deeper understanding of the impact of sex differences on the clinical presentation of ASD with fluent language. We retrospectively studied 301 children with ASD (58 females) and utilized raw scores from the ADI-R and ADOS and the intelligence quotient (IQ) to measure symptomatology. Based on the Full-Scale IQ (FS-IQ), a binary split of average, above-average IQ (high-IQ), and below-average IQ (low IQ) occurs at 85. Across the entire sample, males and females are comparable in the FS-IQ, while males scored higher in the Perceptual Reasoning Index (PRI) (F = 7.812, p = 0.006). ADI-R did not find any statistically significant sex differences in the diagnostic cutoff score satisfaction or the raw domain scores. While a significant effect of sex on ADOS social affect domain scores was found in the total sample [λ = 0.970, partial η²  = 0.030, F (3,295) = 3.019, p = 0.030]. Tests of between-subjects effects revealed that males scored higher than females mainly in the ADOS reciprocal social interaction subcategory (partial η²  = 0.022, F = 6.563, p = 0.011). Stratified analysis revealed that the effect of sex on ADOS reciprocal social interaction subcategory scores only significant in the low-IQ children with ASD (partial η²  = 0.092, F = 10.088, p = 0.002). In general, overall cognitive functioning is similar across males and females with ASD, while males have a higher perceptual reasoning ability. Females with ASD are more likely to have comorbid intellectual impairment than males, and they could require additional intervention support. Autistic children with low IQs are more likely to exhibit sex differences in their core symptoms than children with high IQs. Intelligence plays a key role in sex-based differences in the core symptoms of ASD.

Development and validation of the conversation questionnaire: A psychometric measure of communication challenges generated from the self-reports of autistic people

Existing measures of communication challenges in autism are based on diagnostic criteria and research/clinical observations of autistic people, rather than what autistic people themselves identify as difficulties. In this study, the Conversation Questionnaire (CQ) was developed based on community engagement with autistic people to identify what they find challenging about conversation. This new tool was then administered online to autistic, dyslexic and neurotypical people (N = 312) in a validation phase of the study. Item-response theory modelling indicated that a two-dimensional structure accounted for response patterns. These dimensions reflected difficulties knowing what to say (15 items) and engaging in behaviours possibly disruptive to neurotypical conversation (21 items). The dimensions showed good internal consistency and convergent and discriminant validity, and could distinguish between autistic and neurotypical people (d = 1.59 and d = 2.07 respectively). The CQ might help contribute to diagnostic assessment for autism in adults as part of a holistic assessment. The questionnaire might also be useful with other neurodiverse groups, and provide a tool for clinicians and researchers to identify individuals' strengths and difficulties in conversation (e.g., as part of interventions in speech and language therapy).

Motor Skills are Associated with Participation of Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) generally have a delay in the development of motor skills when compared to typical children, however, to date, no study has investigated whether motor limitations can interfere in the participation of these children. The objectives of this study were: verify if the motor skills can explain the frequency, the percentage of number of activities, the involvement and the desire to change in participation at home, school and community of children with autism spectrum disorder (ASD) and; identify if contextual factors would modify the association between motor skills and participation outcomes. The participation and the motor skills were evaluated in 30 children with ASD between 5 and 10 years old. Participation outcomes were measured by the Participation and Environment Measure-Children and Youth (PEM-CY) and the motor skills were assessed by the Timed Up and Go, Timed Up and Down Stairs, Test of Gross Motor Development-2nd edition and Pediatric Balance Scale. The results of the study demonstrated that the motor skills of the locomotion, objects control, change position and balance explained participation outcomes of children with ASD classified from mild to moderate, between 5 and 10 years old. Moreover, the sex variable modified the association between the motor skills and the school participation, with girls performing less activities at this setting.

A Developmental Profile of Children With Autism Spectrum Disorder in China Using the Griffiths Mental Development Scales

The purpose of this study was to profile the mental development of children aged 18 to 96 months with autism spectrum disorder (ASD) using the Chinese version of the Griffiths Mental Development Scales (GMDS), and to explore the relationships between developmental levels and ASD severity, the sex of the child and the age of ASD diagnosis. Children with ASD (n = 398; 337 boys, 61 girls) were recruited and ASD severity evaluated using the Autism Behavior Checklist and the Childhood Autism Rating Scale, while the GMDS was used to evaluate the children's mental development. Study participants were divided into groups according to GMDS general and subscale quotients, ASD severity, sex, and age. The majority of groups divided according to the GMDS quotients exhibited an unbalanced distribution in respect of the six domains of the GMDS and there were significant differences within the six subscale quotients. Autism severity, sex and age had significant effects on the overall level of development of autistic children. The quotients recorded for the children with more severe ASD were significantly lower than those for the children with less severe ASD. A markedly higher proportion of developmental delay was recorded for girls than boys in relation to the performance subscale. The locomotor quotient decreased in line with age at diagnosis, while autism severity and age had significant effects on the general and subscale quotients and sex had a significant effect on performance quotient. Children with ASD exhibit an uneven cognitive development profile, and their overall developmental levels are affected by autism severity, sex and age. Specific cognitive domains differ according to sex in children with ASD. Locomotor skills tend to decrease according to the age at diagnosis for autistic children aged 18 to 84 months. Autism severity and age are also associated with the level of functioning in different cognitive areas. These findings contribute to define the cognitive developmental profiles of children with ASD.