{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:54:01Z","timestamp":1760187241156,"version":"3.41.2"},"reference-count":47,"publisher":"The Ewha Medical Journal, Ewha Womans University College of Medicine","issue":"1","license":[{"start":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T00:00:00Z","timestamp":1738281600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2021M3E5D9021878"],"award-info":[{"award-number":["2021M3E5D9021878"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.e-emj.org"],"crossmark-restriction":true},"short-container-title":["Ewha Med J"],"abstract":"<jats:p>\n                Autism spectrum disorder involves challenges in social communication and\n                    restricted, repetitive behaviors. Historically, males have received autism\n                    diagnoses at comparatively high rates, prompting an underrepresentation of\n                    females in research and an incomplete understanding of sex-specific symptom\n                    presentations and comorbidities. This review examines sex differences in the\n                    prevalence of common comorbidities of autism to inform tailored clinical\n                    practices. These conditions include attention deficit hyperactivity disorder,\n                    anxiety disorders, conduct disorder, depression, epilepsy, intellectual\n                    disability, and tic disorders. Attention deficit hyperactivity disorder is\n                    prevalent in both sexes; however, females may more frequently exhibit the\n                    inattentive subtype. Anxiety disorders display inconsistent sex differences,\n                    while conduct disorder more frequently impacts males. Depression becomes more\n                    common with age; some studies indicate more pronounced symptoms in adolescent\n                    girls, while others suggest greater severity in males. Epilepsy is more\n                    prevalent in females, especially those with intellectual disabilities. Despite\n                    displaying a male predominance, intellectual disability may exacerbate the\n                    severity of autism to a greater degree in females. No clear sex differences have\n                    been found regarding tic disorders. Overall, contributors to sex-based\n                    differences include biases stemming from male-centric diagnostic tools,\n                    compensatory behaviors like camouflaging in females, genetic and neurobiological\n                    differences, and the developmental trajectories of comorbidities. Recognizing\n                    these factors is crucial for developing sensitive diagnostics and sex-specific\n                    interventions. Inconsistencies in the literature highlight the need for\n                    longitudinal studies with large, diverse samples to investigate autism\n                    comorbidities across the lifespan. Understanding sex differences could\n                    facilitate earlier identification, improved care, and personalized\n                    interventions, thus enhancing quality of life for individuals with autism.\n            <\/jats:p>","DOI":"10.12771\/emj.2024.e79","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T00:24:46Z","timestamp":1735259086000},"update-policy":"https:\/\/doi.org\/10.12771\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sex differences in the prevalence of common comorbidities in autism:\n                    a narrative review"],"prefix":"10.12771","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9718-6046","authenticated-orcid":false,"given":"Yoo Hwa","family":"Hong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7144-4739","authenticated-orcid":false,"given":"Da-Yea","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0521-2718","authenticated-orcid":false,"given":"Heejeong","family":"Yoo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4998","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"issue":"6","key":"key2.0250224102028e+13_B1","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1203\/PDR.0b013e31819e7203","article-title":"Epidemiology of pervasive developmental disorders","volume":"65","author":"Fombonne","year":"2009","journal-title":"Pediatr 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adolescents","volume":"42","author":"Mandy","year":"2012","journal-title":"J Autism Dev Disord"},{"issue":"6","key":"key2.0250224102028e+13_B5","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1177\/1362361316668653","article-title":"Parent-reported differences between school-aged girls and boys on\n                        the autism spectrum","volume":"21","author":"Sutherland","year":"2017","journal-title":"Autism"},{"issue":"7","key":"key2.0250224102028e+13_B6","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1177\/1362361315611381","article-title":"Does sex influence the diagnostic evaluation of autism spectrum\n                        disorder in adults?","volume":"20","author":"Wilson","year":"2016","journal-title":"Autism"},{"issue":"5","key":"key2.0250224102028e+13_B7","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s10803-006-0215-x","article-title":"High rates of psychiatric co-morbidity in PDD-NOS","volume":"37","author":"de 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childhood autism diagnosis and the\n                        impact of co-occurring conditions","volume":"16","author":"Gu","year":"2023","journal-title":"Autism Res"},{"issue":"10","key":"key2.0250224102028e+13_B11","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.36872","article-title":"Prevalence and trends in diagnosed ADHD among US children and\n                        adolescents, 2017-2022","volume":"6","author":"Li","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"11","key":"key2.0250224102028e+13_B12","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/j.jaac.2012.08.024","article-title":"Are autism spectrum disorder and attention-deficit\/hyperactivity\n                        disorder different manifestations of one overarching disorder? Cognitive and\n                        symptom evidence from a clinical and population-based sample","volume":"51","author":"van der Meer","year":"2012","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"17","key":"key2.0250224102028e+13_B13","doi-asserted-by":"crossref","first-page":"2420","DOI":"10.12998\/wjcc.v7.i17.2420","article-title":"Attention deficit hyperactivity disorder and comorbidity: a\n                        review of literature","volume":"6","author":"Gnanavel","year":"2019","journal-title":"World J Clin Cases"},{"issue":"5","key":"key2.0250224102028e+13_B14","doi-asserted-by":"crossref","first-page":"21m03189","DOI":"10.4088\/PCC.21m03189","article-title":"Sex differences in psychiatric comorbidities in adolescents with\n                        autism spectrum disorder: a national inpatient sample\n                        analysis","volume":"24","author":"Vadukapuram","year":"2022","journal-title":"Prim Care Companion CNS 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systematic\n                        review and meta-analysis","volume":"26","author":"Liu","year":"2022","journal-title":"Autism"},{"issue":"7","key":"key2.0250224102028e+13_B32","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.biopsych.2008.04.030","article-title":"Epilepsy in autism is associated with intellectual disability and\n                        gender: evidence from a meta-analysis","volume":"64","author":"Amiet","year":"2008","journal-title":"Biol Psychiatry"},{"issue":"2","key":"key2.0250224102028e+13_B33","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s40474-016-0085-7","article-title":"Systematic review of the prevalence and incidence of intellectual\n                        disabilities: current trends and issues","volume":"3","author":"McKenzie","year":"2016","journal-title":"Curr Dev Disord Rep"},{"issue":"4","key":"key2.0250224102028e+13_B34","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1023\/A:1025054610557","article-title":"Epidemiological surveys of autism and other pervasive\n                        developmental disorders: an update","volume":"33","author":"Fombonne","year":"2003","journal-title":"J Autism Dev Disord"},{"issue":"1","key":"key2.0250224102028e+13_B35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/jir.12989","article-title":"Intellectual disabilities moderate sex\/gender differences in\n                        autism spectrum disorder: a systematic review and\n                        meta-analysis","volume":"67","author":"Saure","year":"2023","journal-title":"J Intellect Disabil Res"},{"issue":"4","key":"key2.0250224102028e+13_B36","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.jocrd.2014.06.002","article-title":"The prevalence of tic disorders and clinical characteristics in\n                        children","volume":"3","author":"Scahill","year":"2014","journal-title":"J Obsessive Compuls Relat Disord"},{"issue":"1","key":"key2.0250224102028e+13_B37","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/1362361307070992","article-title":"Tics and Tourette syndrome in autism spectrum\n                        disorders","volume":"11","author":"Canitano","year":"2007","journal-title":"Autism"},{"issue":"1","key":"key2.0250224102028e+13_B38","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s13034-023-00625-8","article-title":"Clinical characteristics of comorbid tic disorders in autism\n                        spectrum disorder: exploratory analysis","volume":"17","author":"Kim","year":"2023","journal-title":"Child Adolesc Psychiatry Ment Health"},{"issue":"2","key":"key2.0250224102028e+13_B39","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1017\/S1092852922000074","article-title":"Sex differences in patients with Tourette\n                        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autism perceptions","volume":"18","author":"Brickhill","year":"2023","journal-title":"PLoS One"},{"issue":"6","key":"key2.0250224102028e+13_B43","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1177\/1362361316671012","article-title":"Quantifying and exploring camouflaging in men and women with\n                        autism","volume":"21","author":"Lai","year":"2017","journal-title":"Autism"},{"issue":"5","key":"key2.0250224102028e+13_B44","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1007\/s10803-018-03878-x","article-title":"Understanding the reasons, contexts and costs of camouflaging for\n                        autistic adults","volume":"49","author":"Cage","year":"2019","journal-title":"J Autism Dev Disord"},{"issue":"5","key":"key2.0250224102028e+13_B45","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1007\/s10964-013-0011-9","article-title":"Developmental trajectories and predictors of externalizing\n                        behavior: a 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