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Although both sex and gender influence people with developmental disabilities, there is relatively little research on these factors and their influences among individuals with fetal alcohol spectrum disorder (FASD), a complex neurodevelopmental disability impacting an estimated 4%\u20135% of the population. Understanding sex\u2010 and gender\u2010related differences in FASD is needed to facilitate evidence\u2010informed assessment, treatment planning, and advocacy. To begin unpacking these factors, we investigated sex\u2010based differences in clinical presentation and experiences among individuals assessed for FASD across the lifespan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed 2574 clinical records from 29 FASD diagnostic centers in Canada. Participants ranged in age from 1 to 61\u2009years (mean 15.2\u2009years), and more than half (58.3%) were male at birth. Study variables included participant demographics, physical indicators of prenatal alcohol exposure (PAE), neurodevelopmental impairment, FASD diagnosis, co\u2010occurring physical and mental health diagnoses, and environmental adversity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no significant differences between males and females with respect to FASD diagnostic outcome or physical indicators of PAE. However, males experienced significantly more neurodevelopmental impairment. Females experienced higher rates of endocrine problems, anxiety, and depressive\/mood disorders, whereas males had higher rates of attention deficit\u2010hyperactivity disorder, conduct disorder, and oppositional defiant disorder. Adversity also differed by sex, with females experiencing higher rates of trauma and legal problems with victimization\/custody, and males having more difficulties with school and offending\/incarceration. Sex\u2010based differences were most apparent in adolescents (13\u201317\u2009years) and adults (\u226525\u2009years).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Individuals with PAE\/FASD experience notable sex\u2010related differences in clinical presentation and experiences across the lifespan. Findings from this study should help to guide researchers, service providers, and policy makers to improve FASD screening, diagnosis, and intervention and better address the needs of individuals with PAE\/FASD of all genders.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.15017","type":"journal-article","created":{"date-parts":[[2023,3,18]],"date-time":"2023-03-18T15:00:15Z","timestamp":1679151615000},"page":"613-623","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Sex\u2010related differences among individuals assessed for fetal alcohol spectrum disorder in Canada"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7230-2532","authenticated-orcid":false,"given":"Katherine","family":"Flannigan","sequence":"first","affiliation":[{"name":"Canada Fetal Alcohol Spectrum Disorder Research Network Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Poole","sequence":"additional","affiliation":[{"name":"Canada Fetal Alcohol Spectrum Disorder Research Network Vancouver British Columbia Canada"},{"name":"Centre of Excellence for Women's Health Victoria British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1936-0669","authenticated-orcid":false,"given":"Jocelynn","family":"Cook","sequence":"additional","affiliation":[{"name":"Canada Fetal Alcohol Spectrum Disorder Research Network Vancouver British Columbia Canada"},{"name":"Society of Obstetricians and Gynaecologists of Canada Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Unsworth","sequence":"additional","affiliation":[{"name":"Canada Fetal Alcohol Spectrum Disorder Research Network Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(79)90164-8"},{"issue":"5","key":"e_1_2_8_3_1","first-page":"385","article-title":"Gender differences in mental health","volume":"48","author":"Afifi M.","year":"2007","journal-title":"Singapore Medical Journal"},{"key":"e_1_2_8_4_1","first-page":"132","article-title":"Profile of the first 1,400 patients receiving diagnostic evaluations for fetal alcohol spectrum disorder at the Washington State Fetal Alcohol Syndrome Diagnostic & Prevention Network","volume":"17","author":"Astley S.J.","year":"2010","journal-title":"Journal of Population Therapeutics and Clinical Pharmacology"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2021.08.207"},{"issue":"1","key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini Y.","year":"1995","journal-title":"Journal of the Royal Statistical Society: Series B: Methodological"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.2307\/1165312"},{"key":"e_1_2_8_8_1","unstructured":"Canadian Institutes of Health Research. 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