Abstract
Possible gender differences in manifestations of autism spectrum disorder (ASD) were examined using data on production of narratives. The Expression, Reception and Recall of Narrative Instrument (ERRNI; Bishop, Expression, Reception and Recall of Narrative Instrument, Harcourt assessment, London, 2004) was administered to a sample of matched 8-year-old intellectually able boys and girls with ASD (13M, 13F), who had been selected from a large, longitudinal study. In addition, transcripts of the narratives were analyzed in detail. Significant gender differences were found in narrative production. Girls included more salient story elements than boys. On detailed language analysis, girls were also shown to tell richer stories, including more descriptors of planning or intention. Overall, our findings suggest that subtle differences in social communication may exist between intellectually able boys and girls with ASD. If reliably identifiable in young children, such gender differences may contribute to differential diagnosis of ASD. In addition, such differences may pave the way for differential approaches to intervention when the target is effective communication in sophisticated discourse contexts.
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References
Adams, C. (2002). Practitioner review: The assessment of language pragmatics. Journal of Child Psychology and Psychiatry, 43(8), 973–987. https://doi.org/10.1111/1469-7610.00226.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). American Psychiatric Association: Washington, DC.
American Speech-Language-Hearing Association (2015). Language in brief. Retrieved from https://www.asha.org/Practice-Portal/Clinical-Topics/Spoken-Language-Disorders/Language-In--Brief/.
Andersson, G. W., Gillberg, C., & Miniscalco, C. (2013). Pre-school children with suspected autism spectrum disorders: Do girls and boys have the same profiles? Research in Developmental Disabilities: A Multidisciplinary Journal, 34(1), 413–422. https://doi.org/10.1016/j.ridd.2012.08.025.
Attwood, T., & Grandin, T. (2006). Asperger’s and girls. Arlington: Future Horizons, Inc.
Baio, J., Wiggens, L., Christensen, D., Maenner, M., Daniels, J., Warren, Z., … Dowling, N. (2018). Prevalence of Autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveillance Summaries, 67(No. SS-6), 1–23. https://doi.org/10.15585/mmwr.ss6706a1.
Baird, G., & Norbury, C. F. (2016). Social (pragmatic) communication disorders and autism spectrum disorder. Archives of Disease in Childhood, 101(8), 745–751. https://doi.org/10.1136/archdischild-2014-306944.
Banney, R. M., Harper-Hill, K., & Arnott, W. L. (2015). The Autism Diagnostic Observation Schedule and narrative assessment: Evidence for specific narrative impairments in autism spectrum disorders. International Journal of Speech-Language Pathology, 17(2), 159–171. https://doi.org/10.3109/17549507.2014.977348.
Bishop, D. V. (2004). Expression, reception and recall of narrative instrument. London: Harcourt assessment.
Botting, N. (2002). Narrative as a tool for the assessment of linguistic and pragmatic impairments. Child Language Teaching & Therapy, 18(1), 1–21. https://doi.org/10.1191/0265659002ct224oa.
Buckner, J. P., & Fivush, R. (1998). Gender and self in children’s autobiographical narratives. Applied Cognitive Psychology, 12(4), 407–429.
Capps, L., Losh, M., & Thurber, C. (2000). ‘The frog ate the bug and made his mouth sad’: Narrative competence in children with autism. Journal of Abnormal Child Psychology, 28(2), 193. https://doi.org/10.1023/A:1005126915631.
Carter, A. S., Black, D. O., Tewani, S., Connolly, C. E., Kadlec, M. B., & Tager-Flusberg, H. (2007). Sex differences in toddlers with autism spectrum disorders. Journal of Autism & Developmental Disorders, 37(1), 86–97. https://doi.org/10.1007/s10803-006-0331-7.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Oxford: Routledge.
Cowley, J., & Glasgow, C. (1994). The renfrew bus story (American Ed.). Centreville: The Centreville School.
Dean, M., Kasari, C., Shih, W., Frankel, F., Whitney, R., Landa, R., Lord, C., … Harwood, R. (2014). The peer relationships of girls with ASD at school: Comparison to boys and girls with and without ASD. J Child Psychol Psychiatr, 55, 1218–1225. https://doi.org/10.1111/jcpp.12242.
Diehl, J., Bennetto, L., & Young, E. (2006). Story recall and narrative coherence of high-functioning children with autism spectrum disorders. Journal of Abnormal Child Psychology, 34(1), 87–102. https://doi.org/10.1007/s10802-005-9003-x.
Ehlers, S., & Gillberg, C. (1993). The epidemiology of Asperger syndrome. A total population study. Journal of Child Psychology & Psychiatry & Allied Disciplines, 34(8), 1327–1350. https://doi.org/10.1111/1469-7610.ep11358370.
Gillam, R. B., & Pearson, N. A. (2004). Test of narrative language. Austin: PRO-ED.
Gillberg, C., & Steffenburg, S. (1987). Outcome and prognostic factors in infantile autism and similar conditions: A population-based study of 46 cases followed through puberty. Journal of Autism & Developmental Disorders, 17(2), 273–287. https://doi.org/10.1007/BF01495061.
Harrop, C., Shire, S., Gulsrud, A., Chang, Y., Ishijima, E., Lawton, K., & Kasari, C. (2015). Does gender influence core deficits in ASD? an investigation into social-communication and play of girls and boys with ASD. Journal of Autism & Developmental Disorders, 45(3), 766–777. https://doi.org/10.1007/s10803-014-2234-3.
Hartley, S. L., & Sikora, D. M. (2009). Sex differences in autism spectrum disorder: An examination of developmental functioning, autistic symptoms, and coexisting behavior problems in toddlers. Journal of Autism & Developmental Disorders, 39(12), 1715–1722. https://doi.org/10.1007/s10803-009-0810-8.
Hebert-Myers, H., Guttentag, C. L., Swank, P. R., Smith, K. E., & Landry, S. H. (2006). The importance of language, social, and behavioral skills across early and later childhood as predictors of social competence with peers. Applied Developmental Science, 10(4), 174–187. https://doi.org/10.1207/s1532480xads1004_2.
Hiller, R. M., Young, R. L., & Weber, N. (2014). Sex differences in autism spectrum disorder based on DSM-5 criteria: Evidence from clinician and teacher reporting. Journal of Abnormal Child Psychology, 42(8), 1381–1393. https://doi.org/10.1007/s10802-014-9881-x.
Kauschke, C., van der Beek, B., & Kamp-Becker, I. (2016). Narratives of girls and boys with autism spectrum disorders: Gender differences in narrative competence and internal state language. Journal of Autism and Developmental Disorders, 46, 840–852. https://doi.org/10.1007/s10803-015-2620-5.
Kelley, E., Naigles, L., & Fein, D. (2010). An in-depth examination of optimal outcome children with a history of autism spectrum disorders. Research in Autism Spectrum Disorders, 4(3), 526–538. https://doi.org/10.1016/j.rasd.2009.12.001.
Kim, S. H., Paul, R., Tager-Flusber, H., & Lord, C. (2014). Language and communication in autism. In F. Volkmar, S. Roger, R. Paul & K. A. Pelphry (Eds.), Handbook of autism and pervasive developmental disorders, volume I: Diagnosis, development and brain mechanisms (pp. 230–262). Hoboken: Wiley.
King, D., Dockrell, J., & Stuart, M. (2014). Constructing fictional stories: A study of story narratives by children with autistic spectrum disorder. Research in Developmental Disabilities, 35(10), 2438–2449. https://doi.org/10.1016/j.ridd.2014.06.015.
King, D., Dockrell, J. E., & Stuart, M. (2013). Event narratives in 11–14 year olds with autistic spectrum disorder. International Journal of Language & Communication Disorders, 48(5), 522–533. https://doi.org/10.1111/1460-6984.12025.
Kopp, S., & Gillberg, C. (2011). The autism spectrum screening questionnaire (ASSQ)-revised extended version (ASSQ-REV): An instrument for better capturing the autism phenotype in girls? A preliminary study involving 191 clinical cases and community controls. Research in Developmental Disabilities, 32, 2875–2888. https://doi.org/10.1016/j.ridd.2011.05.017.
Kreiser, N., & White, S. (2014). ASD in females: Are we overstating the gender difference in diagnosis? Clinical Child & Family Psychology Review, 17(1), 67–84. https://doi.org/10.1007/s10567-013-0148-9.
Kuo, M. H., Orsmond, G. I., Cohn, E. S., & Coster, W. J. (2013). Friendship characteristics and activity patterns of adolescents with an autism spectrum disorder. Autism: The International Journal of Research & Practice, 17(4), 481–500. https://doi.org/10.1177/1362361311416380.
Lai, M., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. Lancet, 383(9920), 896–910. https://doi.org/10.1016/S0140-6736(13)61539-1.
Lai, M., Lombardo, M. V., Pasco, G., Ruigrok, A. N. V., Wheelwright, S. J., Sadek, S. A., … Baron-Cohen, S. (2011). A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS ONE, 6(6), 1–10. https://doi.org/10.1371/journal.pone.0020835.
Landa, R., & Goldberg, M. (2005). Language, social and executive functions in high functioning autism: A continuum of performance. Journal of Autism and developmental Disorders, 35(5), 557–573. https://doi.org/10.1007/s10803-005-0001-1.
Lawson, L., Joshi, R., Varbaro, J., & Dissanayake, C. (2018). Gender differences during toddlerhood in autism spectrum disorder: A prospective community-based longitudinal follow-up study. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-018-3516-y.
Lord, C., Risi, S., Lambrecht, L., Cook, E. H. Jr., Leventhal, B. L., DiLavore, P. C., Pickles, A., & Rutter, M. (2000). The Autism Diagnostic Observation Schedule Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism & Developmental Disorders, 30(3), 205–223. https://doi.org/10.1023/A:1005592401947.
Losh, M., & Capps, L. (2003). Narrative ability in high-functioning children with autism or Asperger’s syndrome. Journal of Autism & Developmental Disorders, 33(3), 239–251. https://doi.org/10.1023/A:1024446215446.
Losh, M., & Capps, L. (2006). Understanding of emotional experience in autism: Insights from the personal accounts of high-functioning children with autism. Developmental Psychology, 42(5), 809–818. https://doi.org/10.1037/0012-1649.42.5.809.
Loveland, K., & Tunali, B. (1993). Narrative language in autism and the theory of mind hypothesis: A wider perspective. In S. Baron-Cohen, H. Tager-Flusberg & D. J. Cohen (Eds.), Understanding other minds: Perspectives from autism (pp. 247–266). Oxford: Oxford University Press.
Loveland, K. A., McEvoy, R. E., Tunali, B., & Kelley, M. L. (1990). Narrative story telling in autism and Down’s syndrome. British Journal of Developmental Psychology, 8(1), 9–23. https://doi.org/10.1111/j.2044-835X.1990.tb00818.x.
Maccoby, E. E. (2002). Gender and group process: A developmental perspective. Current Directions in Psychological Science, 11(2), 54–58. https://doi.org/10.1111/1467-8721.00167.
Makinen, L., Loukusa, S., Leinonen, E., Moilanen, I., Ebeling, H., & Kunnari, S. (2014). Characteristics of narrative language in autism spectrum disorder: Evidence from the Finnish. Research in Autism Spectrum Disorders, 8(8), 987–996. https://doi.org/10.1016/j.rasd.2014.05.001.
May, T., Cornish, K., & Rinehart, N. (2014). Does gender matter? A one year follow-up of autistic, attention and anxiety symptoms in high-functioning children with autism spectrum disorder. Journal of Autism & Developmental Disorders, 44(5), 1077–1086. https://doi.org/10.1007/s10803-013-1964-y.
McLennan, J. D., Lord, C., & Schopler, E. (1993). Sex differences in higher functioning people with autism. Journal of Autism and Developmental Disorders, 23(2), 217–227. https://doi.org/10.1007/BF01046216.
Meier, C. R., DiPerna, J. C., & Oster, M. M. (2006). Importance of social skills in the elementary grades. Morgantown: West Virginia University Press.
Norbury, C. (2005). The relationship between theory of mind and metaphor: Evidence from children with language impairment and autistic spectrum disorder. British Journal of Developmental Psychology, 23(3), 383–399. https://doi.org/10.1348/026151005X26732.
Norbury, C. F., & Bishop, D. V. M. (2003). Narrative skills of children with communication impairments. International Journal of Language & Communication Disorders, 38(3), 287–313. https://doi.org/10.1080/136820310000108133.
Norbury, C. F., Gemmell, T., & Paul, R. (2014). Pragmatics abilities in narrative production: A cross-disorder comparison. Journal of Child Language, 41(3), 485–510. https://doi.org/10.1017/S030500091300007X.
Novogrodsky, R. (2013). Subject pronoun use by children with autism spectrum disorders (ASD). Clinical Linguistics & Phonetics, 27(2), 85–93. https://doi.org/10.3109/02699206.2012.742567.
Parish-Morris, J., Liberman, M., Cieri, C., Herrington, J., Yerys, B., Bateman, L., … Schultz, R. (2017). Linguistic camouflage in girls with autism spectrum disorder. Molecular Autism, 8, 48. https://doi.org/10.1186/s13229-017-0164-6.
Roux, A., Shattuck, P., Cooper, B., Anderson, K., Wagner, M., & Narendorf, S. (2013). Postsecondary employment experiences among young adults with an autism spectrum disorder. Journal of the American Academy of Child and Adolescent psychiatry, 52(9), 931–939. https://doi.org/10.1016/j.jaac.2013.05.019.
Rumpf, A., Kamp-Becker, I., Becker, K., & Kauschke, C. (2012). Narrative competence and internal state language of children with Asperger syndrome and ADHD. Research in Developmental Disabilities, 33, 1395–1407. https://doi.org/10.1016/j.ridd.2012.03.007.
Rutter, M., LeCouteur, A., & Lord, C. (2003). ADI-R: The Autism Diagnostic Interview-Revised. Los Angeles: Western Psychological Services.
Semel, E., Wiig, E., & Secord, W. (2003). Clinical evaluation of language fundamentals (4th ed.). San Antonio: Pearson.
Siller, M., Swanson, M. R., Serlin, G., & George, A. (2014). Internal state language in the storybook narratives of children with and without autism spectrum disorder: Investigating relations to theory of mind abilities. Research in Autism Spectrum Disorders, 8(5), 589–596. https://doi.org/10.1016/j.rasd.2014.02.002.
Solomon, M., Miller, M., Taylor, S., Hinshaw, S., & Carter, C. (2012). Autism symptoms and internalizing psychopathology in girls and boys with autism spectrum disorders. Journal of Autism & Developmental Disorders, 42(1), 48–59. https://doi.org/10.1007/s10803-011-1215-z.
Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland Adaptive Behavior Scales: Second Edition (Vineland II). Survey Interview Form/Caregiver Rating Form: Pearson Assessments.
St Clair, M., Pickles, A., Durkin, K., & Conti - Ramsden, G. (2010). A longitudinal study of behavioral, emotional and social difficulties in individuals with a history of specific language impairment (SLI). Journal of Communication Disorders, 44(2), 186–199. https://doi.org/10.1016/j.jcomdis.2010.09.004.
Suh, J., Eigsti, I., Naigles, L., Barton, M., Kelley, E., & Fein, D. (2014). Narrative performance of optimal outcome children and adolescents with a history of an autism spectrum disorder (ASD). Journal of Autism & Developmental Disorders, 44(7), 1681–1694. https://doi.org/10.1007/s10803-014-2042-9.
Szatmari, P., Georgiades, S., Duku, E., Bennett, T., Bryson, S., Fombonne, E., … The Pathways in ASD Study Team. (2015). Developmental trajectories of symptom severity and adaptive functioning in an inception cohort of preschool children with autism spectrum disorder. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2014.2463.
Tager-Flusberg, H. (1995). ‘Once upon a ribbit’: Stories narrated by autistic children. British Journal of Developmental Psychology, 13(1), 45–59. https://doi.org/10.1111/j.2044-835X.1995.tb00663.x.
Tager-Flusberg, H., & Sullivan, K. (1994). Predicting and explaining behavior: A comparison of autistic, mentally retarded and normal children. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 35(6), 1059–1075. https://doi.org/10.1111/j.1469-7610.1994.tb01809.x.
Tager-Flusberg, H., & Sullivan, K. (1995). Attributing mental states to story characters: A comparison of narratives produced by autistic and mentally retarded individuals. Applied Psycholinguistics, 16(3), 241–256. https://doi.org/10.1017/S0142716400007281.
Taylor, J., Henninger, N., & Mailick, M. (2015). Longitudinal patterns of employment and postsecondary education for adults with autism and average-range IQ. Autism, 19(7), 785–793. https://doi.org/10.1177/1362361315585643.
Tillmann, J., Ashwood, K., Absoud, M., Bolte, S., Bonnet-Brilhault, F., Buitelaar, J., … Charman, T. (2018). Evaluating sex and age differences in ADI-R and ADOS scores in a large European multi-site sample of individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48, 2490–2505. https://doi.org/10.1007/s10803-018-3510-4.
Volden, J., Dodd, E., Engel, K., Smith, I. M., Szatmari, P., Fombonne, E., … The Pathways in ASD Study Team. (2017). Beyond sentences: Using the Expression, Reception, and Recall of Narratives Instrument to assess communication in school-aged children with autism spectrum disorder. Journal of Speech, Language & Hearing Research. 60(8), 2228–2240. https://doi.org/10.1044/2017_JSLHR-L-16-0168.
Wechsler, D. (2003). Wechsler Intelligence Scale for Children (4th edn.). Toronto: Pearson Education.
Wijngaarden-Cremers, P., van Eeten, E., Groen, W. B., Van Deurzen, P. A., Oosterling, I. J., & Van der Gaag, R. J. (2014). Gender and age differences in the core triad of impairments in autism spectrum disorders: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 44(3), 627–635. https://doi.org/10.1007/s10803-013-1913-9.
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We are grateful to the parents and children who participate in the Pathways in ASD study, and to the current and past members of the study team. We are also grateful to our funders, the Canadian Institutes for Health Research, Kids Brain Health, Autism Speaks, the Sinneave Family Foundation, Alberta Innovates Health Solutions, The Mayberry Family Foundation, and The Government of British Columbia.
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OC and JV conceived of the study and its design, collected the data, performed the statistical analysis, participated in the design and interpretation of the data, and drafted the manuscript; IM-S contributed to the design of the study, participated in the design and interpretation of the data, and drafted the manuscript; and ED, LZ, CW, PS, PM, TV, TB, SG, ME, and WU participated in interpretation of the data, and critically reviewed and revised the manuscript. All authors read and approved the final manuscript.
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Conlon, O., Volden, J., Smith, I.M. et al. Gender Differences in Pragmatic Communication in School-Aged Children with Autism Spectrum Disorder (ASD). J Autism Dev Disord 49, 1937–1948 (2019). https://doi.org/10.1007/s10803-018-03873-2
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DOI: https://doi.org/10.1007/s10803-018-03873-2