Journal article
Sex-Related Measurement Bias in Autism Spectrum Disorder Symptoms in the Baby Siblings Research Consortium
JAMA network open, v 8(8), e2525887
01 Aug 2025
PMID: 40779266
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Disparities exist in age of diagnosis and prevalence of autism spectrum disorder (ASD) for female compared with male children. Correcting for sources of bias is critical for improving equitable ASD identification.
To determine whether sex differences exist in measurement of ASD symptoms using the Autism Diagnostic Observation Schedule (ADOS) among young children at high familial likelihood (HFL) and low familial likelihood (LFL) of ASD.
This cohort study collected longitudinal, prospective data from the Baby Siblings Research Consortium between January 1, 2003, and December 31, 2021. Participants included 3106 children who had an older sibling with ASD (HFL group) and 1444 without (LFL group). Data from as many as 3 visits when participants were aged 20 to 40 months were included. Analysis occurred between March 1, 2023, and May 29, 2025.
Child sex and age and ASD diagnosis.
Measurement invariance by sex and age was examined across item-level ADOS data. Diagnostic group and sex differences were then examined using mixed-effect models on corrected scores.
Repeated visits (n = 7557) from 4550 participants (2548 [56.0%] male) were included, of whom 1444 (31.7%) were in the LFL and 3016 (68.3%) in the HFL groups. Confirmatory factor analysis indicated social communication and restricted and repetitive behaviors models fit the data well in the HFL group but poorly in the LFL group. In the HFL group, females were rated as less impaired in eye contact (differential item functioning estimate [SE] = 0.088 [0.033]; P = .01), and their response to joint attention (differential item functioning estimate [SE] = 0.290 [0.105]; P = .01) and quality of social overtures (differential item functioning estimate [SE] = 0.053 [0.019]; P = .005) was associated with less underlying social communication difficulties compared with males. Adjusting for differential item functioning by age and sex resulted in moderate levels of measurement differences. Females showed milder autistic traits than males, although this gap was smaller in the participants diagnosed with ASD.
Sex differences exist in the general population in many social communication traits, yet ASD diagnostic thresholds do not account for these sex differences. Future instrument development, as well as clinician training, should acknowledge milder presentation (fewer difficulties with eye contact or quality of social impairments) in many females. This may help identify developmental differences earlier and improve outcomes for autistic females (estimate [SE] = -0.160 [0.061]; P = .009).
Metrics
4 Record Views
Details
- Title
- Sex-Related Measurement Bias in Autism Spectrum Disorder Symptoms in the Baby Siblings Research Consortium
- Creators
- Catherine A Burrows - University of MinnesotaSooyeon Sung - Kyung Hee UniversityShuting Zheng - The University of Texas at AustinGreg S Young - University of California, DavisTony Charman - King's College LondonCheryl Klaiman - Children's Healthcare of AtlantaAmi Klin - Children's Healthcare of AtlantaNatasha Marrus - Washington University in St. LouisSally Ozonoff - University of California, DavisJoseph Piven - University of North Carolina at Chapel HillDiana L Robins - Drexel UniversityRebecca J Schmidt - University of California, DavisA J Schwichtenberg - Purdue University West LafayetteSara Jane Webb - University of WashingtonLonnie Zwaigenbaum - University of AlbertaLeslie J Carver - University of California San DiegoKatarzyna Chawarska - University of California San DiegoSuzanne Curtin - Brock UniversityShafali S Jeste - Children's Hospital of Los AngelesJana M Iverson - Boston UniversityRebecca J Landa - Johns Hopkins UniversityDaniel S Messinger - University of MiamiJane E Roberts - University of South CarolinaWendy L Stone - University of WashingtonHelen Tager-Flusberg - Boston UniversityAmy N Esler - University of MinnesotaMeghan Miller - University of California, DavisSomer L Bishop - University of California, San FranciscoJed T Elison - University of Minnesota
- Publication Details
- JAMA network open, v 8(8), e2525887
- Publisher
- JAMA Network
- Number of pages
- 15
- Grant note
- National Institutes of Health: K23 HD112507, K99 MH131841, R01 MH068398, R01MH083727, R01 MH059630, 5U54MH066417U54 MH066417, R01MH059630, RO1 NS12098, R01 DC10290, R01 MH090194, R01 MH107573, P50 HD055784, R01 HD054979, R01 HD073255, P50 HD055782, R01HD043292, P50 MH115716, R01 MH087554, R01HD072018 Autism Science Foundation: BSRC 17-001, BSRC 21-001, BSRC 23-001 Simons Foundation for Autism Research: 386098, 140209 UK Medical Research Council: MR/R011427/1, G0701484, MR/K021389/1, MR/T003057/1 Marcus FoundationJoseph B. Whitehead FoundationGeorgia Research Alliance
the ADOS-2 from Western Psychological Services outside the submitted work. No other disclosures were reported. Funding/Support: This work was supported by the grants K23 HD112507 (principal investigator [PI], Dr Burrows), K99 MH131841 (PI, Dr Zheng), R01 MH068398 and R01 MH099046 (PI, Dr Ozonoff), P50 HD103526 (PI, Leonard J. Abbeduto, PhD), P50 MH100029 and R01MH083727 (PI, Dr Klin), R01 MH059630 and 5U54MH066417U54 MH066417 (PI, Dr Landa), R01MH059630, R01 MH059630, RO1 NS12098, and R01 DC10290 (PI, Dr Tager-Flusberg), R01 MH090194 and R01 MH107573 (PI, Dr Roberts), P50 HD055784 (PIs, Dr Jeste and Susan Bookheimer, PhD), R01 HD054979 and R01 HD073255 (PI, Dr Iverson), P50 HD055782 (PI, Dr Webb), R01HD043292 (PI, Dr Stone), P50 MH115716, R01 MH087554, R01 MH100182, and R01 MH124892 (PI, Dr Chawarska), U24 ES028533 (PI, Dr Schmidt), R01ES028089 and R01HD057284 (PIs, Drs Stone and Messinger), R01 HD047417 (PI, Dr Messinger), R01 HD055741 (PI, Dr Piven), R01 HD052804 (PI, Dr Carver), R01 HD064820 (PI, Dr Webb), R00MH092431 (PI, Dr Schwichtenberg), R01HD072018 (PIs, Athena Vouloumanons, PhD, and Dr Curtin), and R01MH121416 (PI, Dr Miller) from the National Institutes of Health. Additional support was provided by grants BSRC 17-001, BSRC 21-001, and BSRC 23-001 (PI, Dr Young) and BSRC 22-001 (PI, Lasso Informatics) from the Autism Science Foundation; grants AS8370 (PI, Dr Ozonoff), AS6020 (PI, Dr Piven), and AS8431, AS7470, and AS9494 (PI, Dr Young) from Autism Speaks; grants SFARI 386098 (PI, Dr Schmidt) and SFARI 140209 (PI, Dr Piven) from the Simons Foundation for Autism Research; grants 62924 and 102665 (PIs, Jessica Brian, PhD, CPsych, and Dr Zwaigenbaum) from the Canadian Institutes of Health Research; grants MR/R011427/1, G0701484, MR/K021389/1, and MR/T003057/1(PIs, Dr Charman, Mark Johnson, PhD, and Emily Jones, PhD) from the UK Medical Research Council; the Marcus Foundation and the Joseph B. Whitehead Foundation (PI, Dr Klin); and the Georgia Research Alliance (PI, Dr Klin).
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Psychological and Brain Sciences (Psychology); A.J. Drexel Autism Institute
- Web of Science ID
- WOS:001546956000007
- Scopus ID
- 2-s2.0-105013326776
- Other Identifier
- 991022076198404721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Psychology, Developmental