A systematic review and meta‐analysis of sex/gender differences in social interaction and communication in autistic and nonautistic children and adolescents

Authors: Henry Wood-Downie, Bonnie Wong, Hanna Kovshoff, Samuele Cortese and Julie Hadwin
Published: 2020
Publication: Child Psychology and Psychiatry

Background: Evidence increasingly suggests that ASD manifests differently in females than males. Previous reviews investigating sex/gender differences in social interaction and social communication have focused at the level of broad constructs (e.g. comparing algorithm scores from pre‐existing diagnostic instruments) and have typically reported no significant differences between males and females. However, a number of individual studies have found sex/gender differences in narrow construct domains.
Method: We conducted a systematic review and random effects model meta‐analyses (in January 2019 and updated January 2020) that investigated sex/gender differences in narrow construct measures of social communication and interaction in autistic and nonautistic children and adolescents, and adults. Study quality was appraised using the Appraisal Tool for Cross‐Sectional Studies (AXIS, BMJ Open, 6, 2016, 1).
Results: Across 16 studies (including 2,730 participants), the analysis found that female (vs. male) individuals with ASD had significantly better social interaction and social communication skills (SMD = 0.39, p < .001), which was reflective of a similar sex/gender profile in nonautistic individuals (SMD = 0.35, p < .001). Nonautistic males had significantly better social interaction and communication than males with ASD (SMD = 0.77, p < .001). Nonautistic females also had significantly better social interaction and communication than females with ASD (SMD = 0.72, p <.001). Nonautistic males had better social interaction and communication than females with ASD, though this difference was not significant (SMD = 0.30, p = .07).
Conclusions: This systematic review and meta‐analysis highlighted important sex/gender differences in social interaction and communication for individuals with ASD, likely not captured by pre‐existing diagnostic instruments, which potentially contribute to the under recognition of autism in females, and may need to be reflected in the diagnostic process.

Wood-Downie, H., Wong, B., Kovshoff, H., Cortese, S. & Hadwin, J. A. (2020) Research Review: A systematic review and meta‐analysis of sex/gender differences in social interaction and communication in autistic and nonautistic children and adolescents. Journal of Child Psychology and Psychiatry. DOI: 10.1111/jcpp.13337

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Understanding the school outcomes for, and experiences of, siblings of children with autism

Assignment type: Thesis
Author: Alexandra Gregory
Submitted: June 2018

Abstract

A systematic literature review was conducted to explore the educational outcomes for, and experiences of, siblings of children on the autism spectrum (autism siblings). Whilst there is a growing body of research on the psychological outcomes for autism siblings, few studies have considered how this might influence the school context. Findings were linked to the Siblings Embedded Systems Framework; school factors, psychological internal challenges and resources, peers and other formal and informal social systems, and personal interpretation of events. Overall, school outcomes and experiences showed large variation, suggesting that some autism siblings are at increased risk of difficulties in the school context, but that autism siblings do not automatically experience challenges in school. Nevertheless, the review highlighted a number of methodological limitations of the evidence-base in this area, including the small body of literature, particularly in the UK, studies of low methodological rigour, such as those employing small sample sizes, and reliance on solely parent-reported outcomes. This limits the conclusions that can be drawn.

The empirical study extended the current literature to explore two school-related outcomes; sense of school belonging and academic self-concept. Using online questionnaires, autism siblings and siblings of typically developing children without autism (typical siblings) aged 11 to 16 years in secondary schools across the UK took part.

Data on sibling wellbeing were also triangulated via self-, parent/carer- and teacher reports. Relative to typical siblings, autism siblings self-reported significantly lower school belonging and academic self-concept, in addition to significantly lower self, parent- and teacher-reported wellbeing outcomes. Regression models established that sibling-reported internalising and externalising behaviours significantly predicted both school-related outcomes. Sibling group was also a significant predictor in all models, demonstrating that even once demographic variables and sibling wellbeing were controlled, robust sibling group differences were still present. Despite these findings, there was a greater variation in autism siblings’ school outcomes compared to typical siblings. Therefore, this study highlights the importance of taking an individualised and person-centred approach to understanding the varying needs of, and providing support to, siblings of children on the autism spectrum.

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An exploration of how the secondary school experience contributes to elevated anxiety levels for adolescents on the autism spectrum

Assignment type: Thesis
Author: Eleanor Hayes
Submitted: June 2018

Abstract

Children and young people on the autism spectrum show elevated anxiety levels in comparison to typically developing peers and those with other special educational needs. However, despite the significant time spent in school, few researchers have focused on how the school environment contributes to elevated anxiety levels in autism. A systematic review of the literature was conducted, exploring causes of anxious affect for autistic adolescents attending mainstream school. Experiences in the school environment that were highlighted as sources of anxiety included adverse noises, the behaviour of others and the social identity of autistic pupils. Additionally, academic pressure, transitions, disliked subjects, homework and handwriting were highlighted as sources of anxiety. Key frameworks of anxiety and autism (Boulter et al., 2014; Wood & Gadow, 2010) were used to understand these findings.An empirical study was also conducted to explore how the secondary school experience contributed to elevated anxiety following the Intolerance of Uncertainty framework of anxiety and autism proposed by Boulter et al. (2014). A school-based sample of 30 autistic adolescents aged 11-14, took part in the study. Parents completed measures of anxiety, sensory processing, autism symptom severity, and teachers completed a measure of social skills. Participants on the autism spectrum completed a measure of the number and types of experiences causing feelings of anxiety in the school social and learning environment. Indirect pathways from sensory sensitivities and social and environmental experiences in school to anxiety symptoms through intolerance of uncertainty were then tested. Findings supported and extended the key framework of anxiety in autism proposed by Boulter et al. (2014), demonstrating significant indirect pathways from experiences in school, sensory sensitivities and autism traits to anxiety through intolerance of uncertainty.

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The participation of autistic pupils in decision-making about their school experiences: A case study of one school

Assignment type: Thesis
Author: Chantelle Zilli
Submitted: June 2018

Abstract

Beginning reading skills are often taught through phonics-based methods. Learning to read is a cognitively demanding task, and for those children who struggle, research has shown that individualised interventions can facilitate the development of reading skills. Although research has demonstrated the effectiveness of phonics as a teaching method with typically developing children, less research has evaluated this method with children who are educated in special school settings. A systematic review was conducted to evaluate research over the past 43 years into the effectiveness of phonics as a method for teaching reading to children who are educated in special school settings. The findings suggested that phonics teaching leads to improvements in phonics skills. However, improvements in phonics skills often did not generalise to whole word reading skills.

The empirical paper evaluated the computerised phonics-based intervention Headsprout Early Reading with eight pupils aged 7 to 19 years, educated in a special school for children and young people who experience severe learning difficulties. The intervention took place over 21 weeks. Three learning conditions were employed, such that four participants completed Headsprout as it was designed with typically developing students, two participants did not complete negation activities, and two non-verbal participants completed Headsprout minus speaking activities. Results indicated that all of the participants improved in initial sound fluency, non-word reading, and word recognition. Participants in the no-negation condition showed improvements despite not completing these activities. The findings suggest that individualised phonics-based reading interventions can be used to support development of early reading skills for students are educated in special school settings.

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Understanding the experience of social anxiety in adolescent girls with autism spectrum disorders

Assignment type: Thesis
Author: Leanne Pickering
Submitted: June 2017

Abstract

Literature Review: Pathways to social anxiety often reflect a set of complex and interacting factors including intrinsic and environmental factors. Theoretical models of social anxiety have highlighted that children and adolescents’ peer experiences can increase risk for social anxiety. This systematic review explored the role of peers in the development of social anxiety in adolescent girls. It aimed to identify peer-related risk factors (i.e., peer acceptance, peer attachment, friendship quality, peer support, and victimisation) that place adolescents at risk for social anxiety, including those specific to girls. The results showed that while some peer experiences were relevant to understanding risk across genders, others placed girls at increased risk. For example, low peer acceptance was significantly associated with increased social anxiety in boys and girls, both concurrently and over time. Those factors that placed girls at increased risk of social anxiety and avoidance, relative to boys, included limited close friendships, negative friendship experiences and relational victimisation. The review suggested that researchers might usefully start to develop frameworks that capture generic as well as gender-specific risk for social anxiety. These will facilitate the development of prevention and intervention methods to support girls at increased risk, that focus on improving the quality of their peer relationships.

Empirical Paper: The onset of adolescence represents an age where young people are at risk for the development of social anxiety. Increasingly, research has highlighted an increased risk of social anxiety in girls with Autism Spectrum Disorders (ASD). However, there remains a lack of understanding of their experiences and the extent to which they are consistent with current models of anxiety in ASD. This qualitative study aimed to develop an understanding of the experience of social anxiety in adolescent girls with ASD from the perspective of young people themselves, their parents and teachers. Semi-structured interviews were conducted with four triads, with girls interviewed using an ‘ideal classroom’ activity to explore their perception of school-based social situations. Four interrelated themes emerged from the data across all four triads including (1) barriers to social situations, (2) quality of relationships, (3) coping with social situations, and (4) desire to ‘fit in’. The results found that girls’ experiences were underpinned by factors present in typical pathways to social anxiety (e.g. negative peer experiences and poor social skills) and that girls’ sensory sensitivity to noise acted as an autism-specific pathway. Implications for professionals who work with adolescent girls diagnosed with ASD were discussed, including the delivery of targeted training and workshops to increase staff understanding and raise peer acceptance.

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Academic self-concept and sense of school belonging of adolescent siblings of autistic children

Authors: Alexandra Gregory, Richard P. Hastings and Hanna Kovshoff
Published: 2020
Publication: Research in Developmental Disabilities

Background: Whilst there is a growing body of research on the psychological outcomes for siblings of autistic children (autism siblings), few studies have considered the school context.
Aims: To explore group differences on two school-related self-reported outcomes for autism siblings and siblings of non-autistic children: sense of school belonging, and academic self-concept. Data on self- and parent/carer-reported behavioural and emotional problems were also collected.
Methods and procedures: 65 autism siblings and a comparison group of 57 siblings of non-autistic children aged 11–16 years completed questionnaires measuring sense of school belonging, academic self concept, and behaviour problems. 73 parents in the autism sibling and 67 parents in the comparison sibling group completed the behaviour problems measure.
Outcomes and results: Autism siblings reported significantly lower school belonging and academic self-concept, and had significantly poorer self- and parent- reported behaviour problems. When controlling for demographic variables and internalising and externalizing behaviour, robust sibling group differences on academic variables remained.
Conclusions and implications: Autism siblings reported poorer school-related outcomes and increased behavioural difficulties relative to siblings of non-autistic children. There was wide variation in autism siblings’ outcomes, highlighting the importance of taking an individualised and contextualised approach to understanding the varying needs of autism siblings.

Gregory, A., Hastings, R. & Kovshoff, H. (2020) Academic self-concept and sense of school belonging of adolescent siblings of autistic children. Research in Developmental Disabilities, 96, [103519]. DOI: 10.1016/j.ridd.2019.103519

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Keys to engagement: A case study exploring the participation of autistic pupils in educational decision‐making at school

Authors: Chantelle Zilli, Sarah Parsons and Hanna Kovshoff
Published: 2019
Publication: British Journal of Educational Psychology

Background: the UNCRC (1989) established the importance of listening to children’s views globally. In England, seeking the views of pupils with special educational needs and disability about their education, and involving them in decision-making, has been mandatory since 2015. Autistic children’s views and experiences are particularly underrepresented in this context.
Aims: to provide a detailed, exploratory analysis of practices that enable autistic pupils to participate in educational decision-making; and to generate new knowledge about pupil participation in a school context, using the Framework for Participation (Black-Hawkins, 2010) as an analytical frame.
Sample: Four male pupils aged 11-15, with autism spectrum diagnoses, and 11 staff members from a specialist, independent school took part in this case study.
Methods: Observations were made of pupils in lessons, and pupils completed a photo-voice activity focusing on where they felt ‘most listened to’ in the school. Staff members participated in semi-structured interviews.
Results: A range of practices supported pupils’ participation in everyday decision-making, underpinned by a respectful and positive culture led by the senior management team. The focus was on what learners can do, and how they make decisions to facilitate achievement. Pupils and staff developed mutually respectful relationships, within which boundaries were negotiated and compromises offered. Flexibility through decision making was provided within the timetabling and content of the curriculum. Pupils’ special interests and expertise were valued as ‘keys’ to supporting their engagement.
Conclusions: These insights provide a tool for reflection by educators and Educational Psychologists for considering how they might promote the participation of autistic pupils in different educational contexts.

Zilli, C., Parsons, S. & Kovshoff, H. (2019) Keys to engagement: A case study exploring the participation of autistic pupils in educational decision‐making at school. British Journal of Educational Psychology doi:10.1111/bjep.12331

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Fact sheet for schools: Autism (undergraduate assignment)

This year, for the mid-term assignment of the undergraduate module in Educational Psychology at the University of Southampton, we asked our third year students to create information fact sheets for schools on the topic of either working memory or Autism.

We are delighted to present three of our favourites from the top scoring pieces of work on Autism here:

Sarah Bristow
Joshua Hyde
Gemma Tikkoo

Copyright note: we believe that images used in these leaflets – sourced by students on the web – constitute ‘fair use,’ since they are of reduced resolution, comprise only a small percentage of the overall work and are a used here non-commercially for educational purposes. If you wish to discuss this further, please email c.woodcock@soton.ac.uk. 

Print Concept Knowledge in Young Children with Autism: Why Should it be Impaired and What are the Implications for Intervention?

Assignment type: Essay
Author: Sophie Smith
Submitted: November 2018

Emergent literacy skills are developmental precursors to formal literacy. They are predictive of later reading and writing ability. Identifying children with poor emergent literacy can increase the likelihood of timely intervention. Children with autism spectrum disorder (ASD) are a group at risk of poor reading comprehension. However, there is relatively little research into their emergent literacy. It is often cited that they show a pattern of strong code-related and poor meaning-focused skills. There is a problem with using these composites, as children with ASD show strengths and weaknesses within the code-related domain, where letter naming is good, but print concept knowledge (PCK) is impaired. PCK relates to knowledge of print function and conventions and the organisation of books. In this essay, reasons for this discrepancy are explored. It is argued that weak central coherence in children with ASD can account for their ability to process local features such as letters but not global book features such as the front cover. This is exacerbated by adults who may find it challenging to engage these children in literacy activities, and therefore show an instructional bias towards the skills they already show aptitude and interest in. Based on this explanation, possible interventions are considered. These include systematic, explicit instructional techniques such as print referencing and task analysis, as well as interest development strategies to encourage motivation for looking at books. It is concluded that educational psychologists (EPs) should play a role in evaluating and promoting these strategies to improve PCK in children with ASD.

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Exploring the experiences of typically developing siblings who have a brother or sister with Autism Spectrum Condition

Assignment type: Thesis
Author: Kirsty Underwood
Submitted: June 2016

Abstract

This thesis explores the experiences of typically developing siblings (TD-Sibs) who have grown up with a brother or sister with Autism Spectrum Condition (ASC). The first chapter presents a systematic review of the literature, using an Interactive Factors Framework (IFF) approach (a framework that is used to guide Educational Psychology practice), to consider TD-Sibs’ experiences from a holistic perspective. A total of 22 studies were identified from the systematic search process. The review highlights many inconsistencies in findings, and methodological limitations. Within the sampled research, the quantitative studies tended to focus on potential behavioural, social and emotional difficulties for TD-Sibs, however, there is currently insufficient, consistent evidence to conclude that TD-Sibs, as a group, will experience difficulties in these areas. Through eliciting sibling voice directly, qualitative studies revealed positive aspects for TDSibs, as well as, previously unconsidered challenges. The review identifies gaps in the research base and concludes with an IFF diagram to visually represent and synthesise the positive and challenging experiences from the 22 studies as a whole.

The empirical paper explores the views of young adult siblings, who have grown up with a brother or sister with ASC, to gain a greater understanding of their lived experience and how this may interact with their education. Semi-structured interviews were conducted with six participants (aged 19 to 21), and analysed using Interpretative Phenomenological Analysis (IPA). Five super-ordinate themes were identified: Striving to do well; Sense of responsibility; Self-Management; Voice and Acceptance. These exploratory findings identified some positive aspects of being a TD-Sib, however participants predominantly recounted a number of struggles and hidden challenges, which influenced some aspects of their educational experiences. Practical implications and avenues for future research are discussed.

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The hypothesised female ASC phenotype: Implications for research and practice

Authors: Henry Wood & Bonnie Wong
Published: 2017
Publication: Educational Psychology Research and Practice

There is a growing body of evidence suggesting that the behavioural manifestation of autism spectrum condition (ASC) differs between males and females, and there may be a female-specific phenotype of the condition (Lai, Lombardo, Auyeung, Chakrabarti, & Baron-Cohen, 2015). However, current conceptualisations of ASC have been developed predominately from samples of males, meaning our understanding of the condition may be male-biased (Kirkovski, Enticott, & Fitzgerald, 2013). Consequently, ASC in females may be under-diagnosed because current assessments are based on a male-specific manifestation of the condition (Mandy et al., 2012). This paper begins with a review of qualitative literature exploring the experiences of females with ASC. Building upon identified themes, quantitative research is reviewed to ascertain whether there are sex/gender differences in four areas of the hypothesised ASC female phenotype. Preliminary evidence suggests there may be sex/gender differences in ASC, but more research is needed to fully substantiate this conclusion.

Wood, H., & Wong, B. (2017). The hypothesised female ASC phenotype: Implications for research and practice. Educational Psychology Research and Practice, 3(2), 50–58. Available at: https://www.uel.ac.uk/schools/psychology/research/educational-psychology-research-and-practice/volume-3-no-2-2017

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The Co-morbidity of Autism Spectrum Condition and Oppositional Defiant Disorder. So What?

Assignment type: Essay
Author: Joanna Spragg
Submitted: May 2015

There is considerable research attention given to psychiatric comorbidity in children and adolescents with a diagnosis of autism spectrum conditions (ASC). This essay aims to consider one such comorbid diagnosis, that of oppositional defiant disorder (ODD) and question its value as an explanation of the behaviour of children and young people on the autism spectrum. Much of the existing research exploring the comorbidity of ASC and ODD comes from a neuropsychological perspective and is focused on validity and accurate measures. The research supports the diagnostic validity of ODD, however this essay will take a different perspective and consider the usefulness of a comorbid diagnosis of ODD for a child or young person with ASC and those supporting them. This argument will be placed in the context of some of the recognised core cognitive differences that are associated with a diagnosis of ASC, as well as potential wider contributing factors. Potential implications for educational psychologists will be considered throughout.

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