Clinical characteristics and problems diagnosing autism spectrum disorder in girls.

BACKGROUND: Autism is a neurodevelopmental disorder with various clinical presentations. It has been historically considered a male disorder. An increasing number of authors stress the existence of sex/gender bias in prevalence and the need to define sex/gender differences in the clinical presentation. REVIEW: Recently, an increasing number of authors have studied the impact of sex/gender on autism's clinical presentation. The sex ratio of four boys to one girl commonly reported in literature is questioned. Sociocultural and familial influences can impact female clinical presentation as well as the way the difficulties of girls with autism are perceived. Issues of autism diagnostic instruments such as sex/gender bias are also studied since they have an impact on the access to diagnosis for girls. Clinical variability is a part of autism spectrum disorder, but some traits appear to be more specific of the female phenotype: existence of a "camouflage" phenomenon and less unusual play or restricted interests. DISCUSSION: Better understanding and diagnosis of females with autism is required to ensure the access to the support and treatment they need. Professionals must apprehend the sex/gender clinical differences to prevent the frequent misdiagnosis or missed diagnosis of females with autism. CONCLUSION: Pursuing research on sex/gender differences seems necessary to ensure appropriate support and diagnosis of undiagnosed females.

Emotions and voluntary action: what link in children with autism?

This research focuses on the impact of emotions--defined as "motivational states"--on the organization of goal directed locomotion in children with autism. Walking toward a goal involves both cognitive processes responsible for movement planning and automatic processes linked to movement programming. To these processes, motivation leading to achieving the goal is added. For some authors, a deficit of planning and/or programming processes is highlighted in autism. Others stand for some impairment of the emotional system. The aim of this research is to link these two viewpoints and to determine if, in children with autism, the organization of locomotion is affected by a positive/aversive emotion conferred to an object to fetch. Twenty-nine children participated in the study (11 children with autism--mean age 122 months; 9 mental age-matched controls--mean age 36 months; and 9 chronological age-matched controls--mean age 122 months). They were instructed to go and get a positive or aversive emotional valence object located straight ahead, at 30° to the right or straight ahead then moved at mid-distance to the right. Gait analysis was performed using the Vicon system. The main results suggest that a positive emotional context promotes the cognitive processes involved in movement planning while an aversive emotional context blocks it or disturbs it in children with autism. No emotions effect is observed on movement programming. It is suggested that emotions triggered off and modulated movement planning and that the deficit observed was related to a developmental impairment rather than to a developmental delay.