Sex differences in Social Cognition in Autism Spectrum Disorders (ASD)

Impairments in social cognition are one of the key symptoms of Autism Spectrum
Disorder (ASD). The mechanisms underlying the impairments in social cognition
remain largely unknown. Adolescence is an important developmental stage in
which social cognition is being shaped due to significant psychological
challenges in terms of identity, self-consciousness, and relationships with
others. Previous efforts that addressed the etiology of social impairments in
ASD have been hampered by the highly heterogeneous nature of ASD. One of the
most striking sources of heterogeneity in ASD is biological sex, as
demonstrated by the 4:1 male:female ratio. Even though sex differences in the
general population in the social domain have been well established, sex
differences in the ASD population remain understudied. Previous research has
suggested a female presentation of ASD that is associated with attenuated ASD
core symptoms and a distinctive psychopathology including better social
cognition resulting in more enhanced socio-communicative behavior compared to
males with the condition. Due to this distinct female phenotype in ASD, females
with ASD are often diagnosed after a significant delay, are misdiagnosed, or
may not be diagnosed altogether, resulting in a lack of support and treatment.
It is of great importance to better understand the phenotype of females with
ASD and its underlying mechanisms, particularly with respect to their
similarities and differences compared to affected males. Seeing the lack of
studies addressing this issue, it is important to investigate sex differences
in ASD in a comprehensive range of aspects of social cognition, ranging from
basic processes like facial emotion recognition to more complex processes like
empathy and theory of mind.

The main objective of this study is to identify similarities and/or differences
in social cognition between males and females with ASD at the behavioral,
neuropsychological, and neurophysiological level during adolescence.

This study has a cross-sectional, 2x2 full factorial design with sex and
presence or absence of ASD as factors.

The risks, possible discomforts and burden of this study are estimated as low.
Questionnaires will be filled out at home, while the other assessments will be
performed during a single clinic visit. The total duration of the study is
approximately 6 hours for participants with ASD and approximately 5 hours for
typically developing control participants, including filling out questionnaires
at home (40 min), an diagnostic assessment of ASD traits (60 min; ASD
participants only), an EEG assessment (120 min including breaks), a
neuropsychological assessment including an IQ screener (65 min including
breaks) and breaks. Possible discomforts include wearing an EEG cap, washing
hair subsequent to the EEG assessment, and the concentration required during
the neuropsychological assessments. A better understanding of the female
phenotype in ASD and the underlying mechanisms of impairments in social
cognition in the disorder is essential for future improvement of treatments as
well as better recognition of females with ASD. It is crucial that sex
differences in social cognition in ASD are assessed in adolescents, since
adolescence is the most important stage of life for both the development of
social cognition and the development of sex specific behaviors.