Sex differences in the evaluation and diagnosis of autism spectrum disorders among children.
Sex differences in the evaluation and diagnosis of autism spectrum disorders among children.
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DOI：
10.1016/j.dhjo.2009.07.001
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发表时间：
2010-04
影响因子：
4.5
通讯作者：
Mandell D
中科院分区：
文献类型：
--
作者：
Giarelli E;Wiggins LD;Rice CE;Levy SE;Kirby RS;Pinto-Martin J;Mandell D
自闭症谱系障碍（ASD）最一致的特征之一是男性占主导地位，大约四名男性对一名女性。我们试图在一个大型的、基于人群的队列中，在首次发育评估的年龄、诊断年龄、认知障碍对这些结果的影响以及性别特异性行为特征方面，检查符合ASD病例定义的儿童的性别差异。我们对一项基于人群的ASD患病率研究所收集的数据进行了二次分析。样本包括2，568名出生于1994年的儿童，他们符合自闭症和发育障碍监测（ADDM）网络为ASD监测建立的ASD病例定义。有发育障碍史和行为特征符合DSM-IV-TR标准的自闭症、自闭症和广泛性发育障碍（未在现有评估记录中另行说明）的儿童通过两种途径被归类为ASD病例：简化和非简化。如果记录中记录了ASD诊断，则进行简化审查。数据是通过由疾病控制和预防中心资助的ADDM网络在美国13个地点收集的。男性占81%。在首次评估时的平均年龄或诊断时的平均年龄方面，有ASD的现有记录图表诊断的患者没有性别差异。女孩比男孩更不可能有记录的诊断（比值比[OR] = 0.76，p = 0.004）。该分析针对认知障碍状态进行了调整。在logistic模型中，性别和认知障碍的相互作用项，智商70或更低的女孩比智商70或更低的男孩更不可能有记录的诊断（OR = 0.70，95%置信区间[CI] = 0.50-0.97，p = 0.035）。智商大于70的男孩比智商70或更低的男孩更不可能有记录的诊断（OR = 0.60，95% CI = 0.49-0.74，p < .001）。这一发现（不太可能有书面诊断）也适用于智商大于70的女孩（OR = 0.45，95%CI = 0.32-0.66，p <0.001）。女孩更有可能有类似于强奸的行为（p <0.001）。男孩更可能有多动症或注意力持续时间短和攻击性行为（p <0.01）。女孩，特别是那些没有认知障碍的女孩，可能比男孩晚被正式认定。这可能会延迟转诊进行早期干预。社区教育工作应该提醒临床医生和家长注意男孩和女孩的ASD潜力。
One of the most consistent features of the autism spectrum disorders (ASDs) is the predominance among males, with approximately four males to every female. We sought to examine sex differences among children who met case definition for ASD in a large, population-based cohort with respect to age at first developmental evaluation, age of diagnosis, influence of cognitive impairment on these outcomes, and sex-specific behavioral characteristics. We conducted a secondary analysis of data collected for a population-based study of the prevalence of ASD. The sample comprised 2,568 children born in 1994 who met the case definition of ASD as established by the Autism and Developmental Disabilities Monitoring (ADDM) Network for ASD surveillance. Children who had a history of developmental disability and behavioral features consistent with the DSM-IV-TR criteria for autistic disorder, Asperger's disorder, and Pervasive Developmental Disorder–Not Otherwise Specified in existing evaluation records were classified as ASD cases via two paths: streamlined and nonstreamlined. Streamlined reviews were conducted if there was an ASD diagnosis documented in the records. Data were collected in 13 sites across the United States through the ADDM Network, funded by the Centers for Disease Control and Prevention. Males constituted 81% of the sample. There were no differences by sex in average age at first evaluation or average age of diagnosis among those with an existing documented chart diagnosis of an ASD. Girls were less likely than boys to have a documented diagnosis (odds ratio [OR] = 0.76, p = .004). This analysis was adjusted for cognitive impairment status. In the logistic model, with the interaction term for sex and cognitive impairment, girls with IQ of 70 or less were less likely than boys with IQ of 70 or less to have a documented diagnosis (OR = 0.70, 95% confidence interval [CI] = 0.50–0.97, p = .035). Boys with IQ greater than 70 were less likely than boys with IQ of 70 or less to have a documented diagnosis (OR = 0.60, 95% CI = 0.49–0.74, p < .001). This finding (less likely to have a documented diagnosis) was also true for girls with IQ greater than 70 (OR = 0.45, 95% CI = 0.32–0.66, p < .001). Girls were more likely to have notations of seizure-like behavior (p < .001). Boys were more likely to have notations of hyperactivity or a short attention span and aggressive behavior (p < .01). Girls, especially those without cognitive impairment, may be formally identified at a later age than boys. This may delay referral for early intervention. Community education efforts should alert clinicians and parents to the potential of ASDs in boys and girls.