Recognizing the overlooked: rethinking autism spectrum disorder symptom presentation in girls.

This study looked at how autism shows up differently in boys and girls aged 2-5 years. Researchers found that while girls were referred for assessment earlier than boys, they had more obvious symptoms by the time they were evaluated. Girls showed stronger signs in areas like communication, social skills, copying others, and responding to visual cues. This suggests that girls might need to have more noticeable symptoms before parents and professionals recognize they might have autism, which could mean some girls are being missed or diagnosed later.

This cross-sectional study examined gender differences in autism spectrum disorder symptom presentation among 125 preschool children (103 boys, 22 girls) aged 2-5 years referred for suspected ASD. Using the Childhood Autism Rating Scale (CARS), researchers found that girls were assessed at a younger median age (28 vs. 33 months) but demonstrated significantly higher symptom severity scores across multiple domains, particularly in nonverbal communication, social relationships, imitation, and visual response. Girls in both minimal and severe symptom groups showed more pronounced presentations, with a strong negative correlation between age and symptom scores. These findings suggest girls may require more obvious symptoms before referral, potentially leading to missed or delayed recognition of milder autism presentations in girls.

Results suggest current identification practices may miss girls with subtler autism presentations. Clinicians should consider gender-specific symptom patterns and maintain high index of suspicion for autism in girls, even with milder presentations. Earlier identification strategies for girls may be needed to prevent delayed diagnosis and intervention access.

Small sample size with only 22 girls limits generalizability. Cross-sectional design prevents causal inferences. Study relies on single assessment tool (CARS) and lacks longitudinal follow-up. Selection bias possible as study only included children already referred for suspected ASD.

Autism spectrum disorder (ASD) is more frequently diagnosed in boys than in girls, possibly due to gender-based differences in symptom presentation or referral patterns. This study investigates gender-related variations in symptom severity and clinical presentation among preschool children referred for suspected ASD. This study included 125 children (boys: n=103; girls: n=22) aged 2-5 years suspected of having ASD. The Childhood Autism Rating Scale (CARS) was used to evaluate autism-related symptoms, focusing on presenting complaints and gender-specific differences in nonverbal communication and social interaction.

Girls had a significantly younger median age at assessment (28 months) compared to boys (33 months, p=0.03). In the minimal to no symptoms group, girls had significantly higher total CARS scores (median 26 vs. 22.5, p < 0.001) and elevated ratings in domains such as nonverbal communication (p=0.03), relationship to people (p=0.01), imitation (p < 0.001), and visual response (p < 0.001). In the severe group, girls also showed significantly higher scores in adaptation to change, taste, smel, and touch response and use, and fear or nervousness. Effect sizes ranged from small to strong.

A negative correlation was found between assessment age and total CARS score (r= -0.45, p < 0.01), particularly among girls. This study highlights that girls may exhibit more prominent symptoms by the time they are referred for clinical evaluation, raising concerns about missed or delayed recognition of milder symptom profiles.