Sex differences in neuropsychological profiles of youth with autism spectrum disorder

Autism spectrum disorder (ASD) is more prevalent in males, and females are underrepresented in the extant autism research literature, resulting in limited knowledge and historical misconceptions about female presentations. One such misconception is that females with ASD are more likely to be cognitively impaired than males. Empirical studies of sex differences in cognition have focused mainly on IQ and proposed superior performance in males diagnosed with autism. Little research has examined sex differences in broader neuropsychological functioning in autism. In this study, we used multivariate analyses of covariance (MANCOVAs) to compare performance on eight domains of neuropsychological (i.e. Intellectual Abilities, Language, Executive Functioning, Attention, Sensorimotor Skills, Social and Adaptive Functioning, and Emotional and Behavioral Functioning) in 101 autistic children and adolescents aged 8–17 years who were assigned male (MSAB; n = 61) and female (FSAB; n = 40) sex at birth. Follow‑up univariate analyses of covariance (ANCOVAs) were performed on individual measures within domains of functioning where group differences were identified. Significant sex differences were observed in the domains of Language, Executive Functioning, and Emotional and Behavioral Functioning. Follow-up univariate analyses indicated that females scored higher on measures of expressive language and vocabulary, made fewer nonperseverative errors, and had higher levels of parent-reported internalizing problems. Together, these findings do not support previous misconceptions of greater cognitive impairment in females with ASD. In contrast, these results suggest that females with autism may show relative strengths in verbal expression and problem-solving; however, they also may experience higher levels of internalizing symptoms.