Gender differences in developmental profiles of Chinese children with autism spectrum disorder: An age-stratified analysis using the C-PEP-3

BACKGROUND: Gender differences in autism spectrum disorder (ASD) remain understudied in Chinese populations. Previous studies using simple domain comparisons have yielded inconsistent findings. OBJECTIVE: This study examined gender differences in developmental delay profiles across the seven domains of the Chinese version of the Psychoeducational Profile-3rd Edition (C-PEP-3), and evaluated the gender-sensitivity of this widely used assessment tool in Chinese children with ASD across different age groups. METHODS: We analyzed C-PEP-3 profiles from 1050 children with ASD (834 boys, 216 girls; aged 2-10 years) assessed at the Beijing Autism Association from 2021 to 2024. Nine children had missing scores for all seven C-PEP-3 developmental domains; therefore, the primary complete-case analytic sample comprised 1041 children (826 boys and 215 girls). A Multivariate Analysis of Covariance (MANCOVA) first tested the overall multivariate gender effect across seven developmental lag scores, followed by age-stratified ANCOVAs for each domain within three age groups (2-3, 4-6, 7-10 years), controlling for chronological age and applying Benjamini-Hochberg false discovery rate (FDR) correction. RESULTS: = 0.029, Cohen's d = -0.36). No significant gender differences were found in any domain for the 4-6 or 7-10 year age groups. CONCLUSIONS: Few significant gender differences in C-PEP-3 developmental lag scores were detected across domains and age groups, with girls aged 2-3 years showing smaller cognitive performance delays than boys as the sole exception. This pattern of largely null findings may reflect genuinely similar developmental profiles between boys and girls with ASD in Chinese clinical samples, and/or the possibility that the C-PEP-3's domain-general structure limits its capacity to detect gender-specific patterns; distinguishing between these interpretations will require further validation research.