ArticleJournal of autism and developmental disorders2026
The Under-Identification of Autism in Females: A Review and Analysis of Sex-Based Scoring Differences Observed in Autism Diagnostic Observation Schedule (ADOS) Module 3.
Article in Journal of autism and developmental disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Rethinking Clinical Visibility in Autistic Females: Autistic Camouflaging and Menstrual Cycle Variability.International journal of environmental research and public health · 2026Review
- Consensus Among Differential Item Functioning Effect Size Measures: A Simplified Approach to Reporting Effect Size.Educational and psychological measurement · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors.
Funding
Abstract
purposeEmerging research highlights sex differences in autism presentation, raising questions about the validity of clinician-administered diagnostic tools like the gold-standard Autism Diagnostic Observation Schedule (ADOS). This study examines whether clinicians’ perceptions, potentially biased toward male-typical presentations, contribute to sex bias in ADOS items and the under-identification of autism in females.
methodsIn a sample of 813 children, multidimensional item response theory graded response models were employed to analyze differential item functioning (DIF) of items in ADOS Module 3 (the version commonly administered to school-aged children with fluent spoken language).
resultsSix items showed significant sex bias. On four social communication items, females tended to be underscored, meaning rated as showing fewer autistic features (e.g., more emotion talk) than males with equivalent levels of autism latent traits. In contrast, females tended to be overscored on two items related to restricted or repetitive behaviors and interests (i.e., more finger mannerisms, specific interests, or repetitive behaviors). The impact of sex bias on overall scores was small, ranging from 0.10 to 0.28 points per item, and approximately 0.41 points on the overall test score.
conclusionThis analysis joins three previous reports of specific ADOS items that function differently in females than males, with converging evidence identifying two problematic items (D2 and D4). Overall, DIF was small and unlikely to affect ADOS classification. We speculate that the direction and consistency of DIF in social communication items might reflect underlying phenomena (viz., masking, clinician bias) that may relate to female underdiagnosis more generally.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.