Sex differences in the temporal dynamics of autistic children's natural conversations.

Researchers studied how autistic boys and girls talk differently in conversations. They found that autistic girls talk more and sound more like non-autistic children, while autistic boys speak slower and take longer pauses. This might explain why autism is harder to spot in girls. Understanding these differences could help doctors better identify autism in girls who are often missed during diagnosis.

This study examined sex differences in conversational patterns among school-aged autistic children compared to non-autistic peers. Researchers analyzed 5-minute conversations between 45 autistic children (29 boys, 16 girls) and 47 non-autistic children (23 boys, 24 girls) with adult confederates. Key findings revealed distinct communication profiles: autistic girls used significantly more words and produced longer speech segments than autistic boys, while autistic boys spoke more slowly, interrupted less, and had longer response delays compared to other groups. Autistic girls' speaking patterns more closely resembled non-autistic children in word count and rate.

These findings suggest different conversational presentations between autistic boys and girls, which may contribute to underdiagnosis in girls and highlight the need for sex-sensitive diagnostic approaches.

Findings suggest need for sex-sensitive diagnostic tools and screening approaches. Autistic girls' more typical-appearing conversational patterns may contribute to missed diagnoses. Results could inform development of personalized interventions targeting specific communication profiles and improve identification of autism in girls.

Study limited to verbally fluent children aged 6-15 years. Results may not apply to younger children, adults, or non-verbal individuals. Small sample size requires replication in larger studies. Authors note results should be interpreted with caution.

Autistic girls are underdiagnosed compared to autistic boys, even when they experience similar clinical impact. Research suggests that girls present with distinct symptom profiles across a variety of domains, such as language, which may contribute to their underdiagnosis. In this study, we examine sex differences in the temporal dynamics of natural conversations between naïve adult confederates and school-aged children with or without autism, with the goal of improving our understanding of conversational behavior in autistic girls and ultimately improving identification. Forty-five school-aged children with autism (29 boys and 16 girls) and 47 non-autistic/neurotypical (NT) children (23 boys and 24 girls) engaged in a 5-min "get-to-know-you" conversation with a young adult confederate that was unaware of children's diagnostic status.

Groups were matched on IQ estimates. Recordings were time-aligned and orthographically transcribed by trained annotators. Several speech and pause measures were calculated. Groups were compared using analysis of covariance models, controlling for age.

Autistic girls used significantly more words than autistic boys, and produced longer speech segments than all other groups. Autistic boys spoke more slowly than NT children, whereas autistic girls did not differ from NT children in total word counts or speaking rate. Autistic boys interrupted confederates' speech less often and produced longer between-turn pauses (i.e., responded more slowly when it was their turn) compared to other children. Within-turn pause duration did not differ by group.

Our sample included verbally fluent children and adolescents aged 6-15 years, so our study results may not replicate in samples of younger children, adults, and individuals who are not verbally fluent. The results of this relatively small study, while compelling, should be interpreted with caution and replicated in a larger sample. This study investigated the temporal dynamics of everyday conversations and demonstrated that autistic girls and boys have distinct natural language profiles. Specifying differences in verbal communication lays the groundwork for the development of sensitive screening and diagnostic tools to more accurately identify autistic girls, and could inform future personalized interventions that improve short- and long-term social communication outcomes for all autistic children.