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Gender Differences in Medical and Behavioral Co-morbidities in Children Ages 2-5 Years with ASD

TitleGender Differences in Medical and Behavioral Co-morbidities in Children Ages 2-5 Years with ASD
Publication TypeConference Abstract
Year of Publication2016
AuthorsZamora, I, Yin, L, Shui, AM
Conference NamePAS.

Background: ASD occurs 5 times more among boys (1 in 54) than girls (1 in 252; Baio, 2012). The evidence for sex differences in regards to the behavioral presentation and comorbid diagnoses between boys and girls with ASD is mixed. However, some previous research findings have yielded some gender differences, which has implications in the diagnosis and management of girls with ASD (Kirkovski, Enticott, & Fitzgerald, 2013; Frazier & Georgiades, 2014, May, Cornish & Rinehart, 2013; Van Wijngaarden-Cremers et al, 2014).

Objective: This project is an observational study that explores differences in medical and behavioral co-morbidities by gender in children ages 2-5 years with ASD in the Autism Speaks Autism Treatment Network (AS-ATN) Registry.

Design/Methods: AS-ATN Registry data was collected at the time of enrollment, after a clinical assessment was conducted by an Autism specialist or assessment team. The sample included 662 (16.63%) females and 3319 (83.37%) males with a diagnosis of ASD (Pervasive Developmental Disorder, Autistic Disorder and Asperger’s Disorder). 78.05 % of the sample was Caucasian/White, 5.99 % Asian, 7.74% African-American and 8.22% other/multiracial. Average age of the sample at the time of enrollment was 3.89 years (SD=1.08). The outcome variables included severity of symptoms, adaptive functioning, behavioral presentation, and medical co-morbid diagnoses. Descriptive statistics or tabulations of outcome variables and covariates potentially associated with gender were run overall and by gender. Any potential outcomes and covariates with significant gender associations at the 0.05 level were analyzed using adjusted linear or logistic regression models. Race, ASD diagnosis, and age were included as covariates in subsequent adjusted models.

Results: Girls had a higher prevalence of medical co-morbidities that included constipation, stomach pain, and PICA. Girls were also reported to have a higher rate of behavioral challenges related to anxiety, sleep problems, emotional reactivity, overall internalizing problems, affective problems, and taste/smell sensitivities (see Table 2). There were no differences between girls and boys regarding the types of medication prescribed, severity of ASD symptoms, age of first concern and age of diagnosis.

Conclusions: Young girls with ASD may present more often with gastrointestinal issues or behavioral challenges compared to boys. These differences in findings highlight the unique needs of girls with ASD and have important implications in their medical and behavioral care.

Table 1. Demographic Information

Age Group Variable Overall % (n) or mean (SD) Male % (n) or mean (SD) Female % (n) or mean (SD) p-value 2-5 years n=3981 n=3319 n=662
Caucasian race 78.1 (2933) 78.8 (2461) 74.3 (472) 0.015

DSM-IV Diagnosis                0.007
      Autism    78.5 (2920) 79.1 (2449) 76.0 (471)  
      PDD/NOS   18.7 (696)  18.6 (576)  19.4 (120)  
      Asperger  2.7 (102)   2.4 (73)    4.7 (29)    

Age (years) 3.9 (1.1)   3.9 (1.1)   3.8 (1.1)   0.041

Table 2. Adjusted Regression Model Results

Age Group Outcome Category Outcome Variable Female vs. Male Estimate Odds Ratio (95% CI) or β (SE) p-value 2-5 years1 Medical CSHQ wakes 1x/night problem (Y/N) 1.22 (1.00-1.49) 0.0562 CSHQ Sleep Onset Delay score 3 vs. 1 1.30 (1.00-1.70) 0.0534 2 vs. 1 1.00 (0.78-1.29) 0.9737 Constipation (Y/N) 1.58 (1.28-1.95) <.0001*** Stomach pain (Y/N) 1.43 (1.09-1.88) 0.0107* Anxiety (Y/N) 2.03 (1.33-3.10) 0.0010** PICA (Y/N) 1.55 (1.07-2.24) 0.0197*

Behavioral (CBCL)   Emotionally Reactive raw score  0.44 (0.18) 0.0146*
    Anxious/Depressed raw score 0.22 (0.14) 0.1303
    Sleep Problems raw score    0.39 (0.17) 0.0225*
    Internalizing Problems raw score    1.22 (0.48) 0.0105*
    Affective Problems raw score    0.53 (0.16) 0.0007***
    Anxiety Problems raw score  0.29 (0.18) 0.1111

Sensory (SSP)   Taste/Smell Sensitivity 1.41 (0.38) 0.0002***

1Adjusted for Caucasian race (Y/N), DSM-IV diagnosis (Autism/PDD-NOS/Asperger’s), and age (years) * p<0.05