Sex Differences in Psychopathology and Neurocognition in Community Youth With Autism Spectrum Disorder

Autism spectrum disorder (ASD) diagnosis is more common in males than females. To understand sex differences in psychopathology and neurocognitive performance, research systematically comparing males and females with autism spectrum disorder to non-autistic peers is critically needed. We examined sex differences in psychopathology and neurocognitive performance profiles in ASD and typically developing youths from the Philadelphia Neurodevelopment Cohort (PNC), a U.S. community sample ascertained through pediatric (non-mental-health) network. We studied 218 youths with ASD diagnosis (IQ> 70, 171 males, 47 females, mean age 12.3 years), age and sex matched to 872 Non-ASD controls. We compared psychopathology in multiple domains including mood-anxiety, fear (phobias), externalizing and psychosis spectrum symptoms as well as neurocognitive function comparing Social and Non-Social cognitive domains. Repeated-measures mixed models were applied with ASD, sex, and their interaction as fixed factors, and psychopathology and neurocognitive domains as within-group factors. All models controlled for age, socioeconomic status, IQ, and ADHD. Findings indicated sex differences in the associations between ASD and co-occurring psychopathology. Among adolescents with ASD, males exhibited more pronounced fear and mood symptoms than females. Analyses also revealed ASD-related sex differences across neurocognitive domains: performance in Social Cognition was lower in adolescents with ASD compared to non-ASD peers for both sexes, while males with ASD showed greater difficulties in Non-Social Cognition relative to females with ASD. In conclusion, ASD diagnosis is associated with sex differences in psychopathology and neurocognition in early adolescence in a large community sample. Results add to the understanding of sex-specific manifestations of ASD in youth.