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February 26, 2026Journal of Autism and Developmental DisordersOpen Access

The Under-Identification of Autism in Females: A Review and Analysis of Sex-Based Scoring Differences Observed in Autism Diagnostic Observation Schedule (ADOS) Module 3

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Authors

YYYuen Yvonne YuAWAustin WymanCFCalliana J. Faulk

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Overview

This review examines sex-based scoring differences in autism diagnosis among children, suggesting implications for identification bias.

Key Points

  • The aim is to investigate clinician perceptions and biases in using the Autism Diagnostic Observation Schedule for diagnosing autism in females.
  • Reviewed literature on sex differences in autism presentations.
  • Analyzed data from 813 children using multidimensional item response theory.
  • Examined differential item functioning of ADOS Module 3 items for sex bias.
  • Identified six ADOS items with significant sex bias.
  • Females were frequently underscored on four social communication items.
  • Females were overscored on two items related to restricted behaviors.
  • Impact on scores was minor, affecting overall scores by approximately 0.41 points.

Cite This Study

Yu et al. (2026) studied this question.

synapsesocial.com/papers/699fe2eb95ddcd3a253e673dhttps://doi.org/10.1007/s10803-026-07253-z
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