Although considerable work has documented higher prevalence rates of autism spectrum disorder (ASD) in boys, fewer studies have focused on sex differences within samples of young children at‐risk for ASD. This study examined sex differences in ASD symptom domains and ASD screening outcomes among toddlers (18–35 months) and preschoolers (36–72 months) with ASD‐related concerns. Participants included 480 children between 18 and 72 months evaluated by university‐based ASD specialty clinics. Results revealed significant sex differences in severity of social communication (SC) deficits across age groups. Within the toddler group, girls diagnosed with ASD displayed greater SC deficits according to standardized observation and clinician severity ratings. Within the preschool group, girls diagnosed with ASD were rated by parents as having more severe SC deficits, but these differences were not corroborated by standardized observations or clinician ratings. No sex differences emerged for severity of restricted repetitive behaviors (RRBs) for either age group. Across the entire referred sample, boys and girls did not differ in terms of scores on commonly used screening instruments. Importantly, results suggest that two of the most commonly used ASD screeners (i.e., Modified‐Checklist for Autism in Toddlers‐Revised with Follow‐up and Social Communication Questionnaire ) may underidentify RRBs in toddler and preschool‐aged girls as screening scores were only influenced by severity of SC deficits. Greater SC deficits in young girls with ASD along with its impact on screening status suggests greater attention be placed on the under‐identification of ASD in girls as well as current screening measures' ability to tap into the topography of ASD symptoms across genders. Autism Res 2020, 13: 157–166. © 2019 International Society for Autism Research, Wiley Periodicals, Inc.

中文翻译：

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幼儿和学龄前儿童的ASD症状：性别差异检查。

尽管大量工作证明男孩自闭症谱系障碍（ASD）的患病率较高，但针对内在性别差异的研究较少有自闭症危险的年幼儿童样本。这项研究检查了患有ASD相关问题的幼儿（18-35个月）和学龄前儿童（36-72个月）在ASD症状方面的性别差异和ASD筛查结果。参加者包括480名18到72个月不等的儿童，这些儿童是由大学ASD专业诊所评估的。结果显示，不同年龄组的社交沟通（SC）缺陷严重程度存在明显的性别差异。在幼儿组中，根据标准化观察和临床医生的严重程度分级，被诊断患有ASD的女孩表现出更大的SC赤字。在学龄前儿童组中，父母将被诊断患有ASD的女孩评估为严重的SC缺陷，但是标准化的观察结果或临床医生的评估并不能证实这些差异。对于任何年龄组，重复性行为受限的严重程度均未出现性别差异。在整个参考样本中，男孩和女孩在常用筛查仪器上的得分没有差异。重要的是，研究结果表明，两个最常用的ASD筛查者（即，针对“自闭症的改良清单”（经随访和社会沟通问卷修订））可能无法识别蹒跚学步和学龄前女孩的RRB，因为筛查分数仅会受到影响根据SC缺陷的严重程度。患有ASD的年轻女孩中更大的SC缺陷及其对筛查状况的影响表明，应更多地关注女孩对ASD的识别不足以及当前筛查措施对性别的ASD症状进行地形学分析的能力。男孩和女孩在常用筛查工具上的分数没有差异。重要的是，研究结果表明，两个最常用的ASD筛查者（即，针对儿童自闭症的修订清单，并通过随访和社会沟通问卷进行了修订）可能无法识别蹒跚学步和学龄前女孩的RRB，因为筛查分数只会受到影响根据SC缺陷的严重程度。患有ASD的年轻女孩中更大的SC缺陷及其对筛查状况的影响表明，应更多地关注女孩对ASD的识别不足以及当前筛查措施对性别的ASD症状进行地形学分析的能力。男孩和女孩在常用筛查工具上的分数没有差异。重要的是，研究结果表明，两个最常用的ASD筛查者（即，针对“自闭症的改良清单”（经随访和社会沟通问卷修订））可能无法识别蹒跚学步和学龄前女孩的RRB，因为筛查分数仅会受到影响根据SC缺陷的严重程度。患有ASD的年轻女孩中更大的SC缺陷及其对筛查状况的影响表明，应更多地关注女孩对ASD的识别不足以及当前筛查措施对性别的ASD症状进行地形学分析的能力。修改后的《幼儿自闭症检查表》（经随访和社会沟通问卷修订版）可能不足以识别幼儿和学龄前女孩的RRB，因为筛查分数仅受SC缺陷严重程度的影响。患有ASD的年轻女孩中更大的SC缺陷及其对筛查状况的影响表明，应更多地关注女孩对ASD的识别不足以及当前筛查措施对性别的ASD症状进行地形学分析的能力。修改后的《幼儿自闭症检查表》（经随访和社会沟通问卷修订版）可能不足以识别幼儿和学龄前女孩的RRB，因为筛查分数仅受SC缺陷严重程度的影响。患有ASD的年轻女孩中更大的SC缺陷及其对筛查状况的影响表明，应更多地关注女孩对ASD的识别不足以及当前筛查措施对性别的ASD症状进行地形学分析的能力。Autism Res 2020，13：157-166。©2019国际自闭症研究会，Wiley Periodicals，Inc.