Gender Differences in Social Communication in Autism Spectrum Disorder (ASD): Narratives

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication (SC), and the presence of restricted and repetitive interests/behaviours. ASD is diagnosed in 1 in 59 people in a 4:1 male:female ratio. Reasons for this uneven diagnostic ratio are unclear but possibly females may present with a more subtle or unique symptom profile and therefore may be under- or misdiagnosed. Examination of SC abilities of girls’ with ASD may provide insight into the female profile, as deficits in SC are universally impaired in ASD. Competence in SC requires synchronous application of social, cognitive and linguistic skill, and is vulnerable to subtle differences in functioning; therefore, sensitive assessment tools are imperative. Narrative analysis is one way to measure SC skills, as it engages a speaker in a complex cognitive-linguistic task embedded in a social context. Objective: The primary objective was to examine gender differences in SC ability in children with ASD using narrative analysis. The secondary objective was to determine if the gender differences found in participants’ with ASD would also be found in matched typically developing (TD) participants. Methods: Data for the participants with ASD were collected as part of a larger Canadian longitudinal study. Matched TD participants were recruited from Edmonton area. All participants were administered a battery of assessments including a standardized narrative task (Expression Reception and Recall of Narrative Instrument – ERRNI) and follow up Detailed Transcript Analysis (DTA) was conducted on the narratives. DTA focused on how well the basic story was constructed, known as story macrostructure, as well as on story microstructure which includes devices to enhance the story such as adding descriptive words or phrases, and sources of confusion for a listener, such as examples of incoherence. To examine if gender differences were present when the participants with ASD were 8-years-old, a series of independent samples t-tests was run with gender as the independent variable (IV) and the subtest/index scores (ERRNI, DTA) as the dependent variables (DVs). The second study’s aim was to determine the stability and pattern of the gender differences over time. The same participants were re-examined two years later at age 10, using the same measures, and their performance compared to their performance at age 8. For this analysis, a series of repeated measures ANOVAs was run with gender and time as IVs and the subtest/index scores (ERRNI, DTA) as DVs. Finally, in the third study, to determine if the gender differences found in the participants’ with ASD were also present in the TD participants, a series of MANOVAs with subtest/index scores (ERRNI, DTA) as DVs and gender and diagnostic group as IVs was run for each age group. Follow up univariate ANOVAs were conducted if MANOVA results were significant, and t-tests for the TD group were conducted if univariate ANOVAs were significant for gender. Results: For the 8-year-olds with ASD, significant gender differences were found on the ERRNI and DTA. The 8-year-old girls with ASD told a story that had significantly more salient plot points compared to the boys with ASD. Detailed analysis revealed that girls semantically enhanced their narratives (by adding details around character intentions), and avoided referencing errors significantly more than boys. On the longitudinal analysis, gender differences were consistently seen in the same areas and followed the same pattern as previously described with one additional difference on the Pragmatic Index of DTA, where 10-year-old girls with ASD had significantly fewer pragmatic errors than 10-year-old boys with ASD. When examining the TD group, significant gender differences were seen on measures of DTA only. For the 8-year-olds, significant differences were seen in pragmatic errors (where girls had fewer). For the 10-year-olds, significant differences were seen in pragmatic errors (where girls had fewer), sematic enhancement (girls enhanced more) and referencing errors (girls had fewer). Conclusion: Results demonstrate narrative skill strength in girls regardless of diagnostic status. This suggests that the girls and boys from this study have differing SC profiles, and in particular the boys and girls with ASD had consistently large significant differences. The girls with ASD demonstrated areas of narrative strength compared to the boys with ASD. This finding and future work may help to expand the understanding of the female presentation of ASD.

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