Introduction:
When it comes to neurodevelopmental diseases, autism spectrum disorder (ASD) is one of the most well-known. It is defined by extensive impairments in reciprocal social communication as well as confined, repetitive interests and behaviours. ASD is diagnosed commonly, four times more in males as compared to females (1,2). Autism spectrum disorder (ASD) is a lifelong neurodevelopment issue that can have a severe impact on adult functioning too (3) despite the fact that much of the early research into ASD was conducted on children is encouraging. Autism Spectrum Disorder in adults can exhibit itself in a variety of ways, depending on the kind of the condition that is present. In order to help adults with ASD their rehabilitation is required on a regular basis and to rehabilitate them first their day to day concerns need to be understood regarding their new surroundings as successfully as possible. For adults with ASD, there is a lack of health services research (4-8) including identification of comorbid health difficulties, rigorous treatment trials (pharmacological and psychological), development of new pharmacotherapies, transition and aging across the lifespan, gender differences, life skills, consideration of the views of people with ASD, cost and efficiency of services (6, 9,10) theory discussion on Social Responsiveness and how different categories may affect adults with ASD is also lacking. Except all this the influence of gender and social responsiveness on Autism Spectrum Disorder (ASD) is also not understood properly (11-13).
Thus, the present study aimed to fill the current literature gap by focusing on autism spectrum disorder (ASD), gender influence and social responsiveness by exploring the impact of ASD categories on male and female adults with ASD and investigate social responsiveness among male and female adults with ASD. In recent research, it has been discovered that young people with autism spectrum disorder (ASD) have fewer opportunities than their peers who do not have ASD. Unemployment and underemployment in the United States are at an all-time high, according to official statistics. Postsecondary education is only attended by a small percentage of the population. In most cases, individuals remain in their homes, with their families or with other close relatives or friends who are supportive. Nearly 40% of the population spends little or no time with their friends, indicating a scarcity of opportunities for community or social involvement on their part (6). In addition, according to the National Institute of Mental Health, individuals with autism spectrum disorder (ASD) may have changes in their ASD symptoms, behaviors, and co-occurring health conditions between adolescence and young adulthood. As a result of these changes, they may find themselves unable to function and participate fully in society.
The current paper focus on the objectives
- To investigate social responsiveness among male and female adults with ASD.
- To find out the impact of Autism spectrum disorder (ASD) categories on social responsiveness in adults.
Methodology
The current study included a sample from a larger study of males and females with ASD (N = 60). Males and females who fulfilled the criteria of being a typical ASD participant according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, (American Psychiatric Association) were included (14). The diagnosis of ASD and the categorization was confirmed by medical reports from their consultant psychologists/psychiatrists who evaluated all these individuals. Individuals of both gender (male and female) with ASD of different severity of diagnostic categories: mild [21], moderate [21] and high functioning [18] were analyzed with Social responsiveness (SR) as a variable over 7 months from October 2021 to February 2022. Social Responsiveness Scale-2, Relative/Other report online form (SRS-2 Adult), developed by John Constantino and his colleagues (15) was used for the current study. The SRS-2 scale is a well-recognized autism evaluation scale which offers the simplicity of a screener as well as the potency of a diagnostic instrument. Completed in just fifteen minutes to twenty minutes, the SRS-2 assesses social impairment related with ASDs as well as quantifies its severity (16). Separate consent forms and personal information forms were also filled. Statistical analysis was done using SPSS 25 (17). Input data was verified for errors and recorded on a spread sheet. The mean and standard deviation were used to compute quantitative descriptive statistics. Independent samples t-test was used to compare mean values to determine significance between male and females. One Way ANOVA is used to compare three or more than three groups.
After ANOVA post hoc analysis done to find differences between groups in various combinations.
Results
The mean Social Responsiveness Scale (SRS-2 Adult) score was 84.3889 with standard deviation of 20.59166 while for gender GN group was 87.5714 with standard deviation of 19.92932 (Table1). T-test in Table 1, suggested that there were no significant differences (p>0.001, df=59) between male and female for both Social responsiveness (SR) and gender (GN) groups. Levine’s homogeneity of variance test was also conducted which showed values of no significant difference, hence the assumption of homogeneity is met.
| Table 1: t-test between Male and Female for Social responsiveness (SR) and gender (GN) groups. |
|
GN |
N |
Mean |
Std. Deviation |
t value |
P |
SR |
Female |
18 |
84.3889 |
20.59166 |
.561 |
.680 |
|
Male |
42 |
87.5714 |
19.92932 |
|
|
Table 2 shows the descriptive analysis of samples used in this based on three ASD categories. The mean values for mild, moderate and high functioning categories were found to be 90.90 ± 14.08, 101.19 ± 13.05 and 64.61 ± 12.54 respectively.
| Table 2: Descriptive analysis of samples based on ASD categories. |
| ASD categories |
N |
Mean |
Std. Deviation |
High functioning |
18 |
64.6111 |
12.54704 |
Mild |
21 |
90.9048 |
14.08866 |
Moderate |
21 |
101.1905 |
13.05994 |
Total |
60 |
86.6167 |
20.00855 |
One-way ANOVA test was conducted to find the differences between these categories (Table 3), which suggest that there was significant difference (p<0.001, df=2) between ASD categories. Tukey's Post Hoc analysis (Table 4) was also conducted to statistically explain the significant difference between ASD categories from each other which suggested that there are significant (p<0.001) between all three subsets given in Table 4.
| Table 3: One Way ANOVA between Social responsiveness (SR) and ASD categories (high functioning, mild and moderate). |
| ASD Categories |
Sum of squares |
Df |
Mean square |
F |
P |
Between ASD categories |
13562.858 |
2 |
6781.429 |
38.434 |
0.001** |
Within ASD categories s |
10057.325 |
57 |
176.444 |
|
|
Total |
23620.183 |
59 |
|
|
|
| ** < .001 |
| Table 4: Tukey's Post Hoc Analysis between ASD categories (high functioning, mild and moderate) for one-one comparison. |
| ASD Categories (I) |
ASD Categories (J) |
Mean difference (I-J) |
Std. Error |
P |
High functioning |
Mild |
-26.29365 |
4.25553 |
0.001** |
Moderate |
-36.57937 |
4.25559 |
0.001** |
Mild |
High functioning |
26.29365 |
4.26668 |
0.001** |
Moderate |
-10.28571 |
4.09930 |
0.039* |
Moderate |
High functioning |
35.57937 |
4.26668 |
0.001 |
Moderate |
10.28571 |
4.09930 |
0.001 |
| ** <.001, *<.05 |
Discussion
Table 1 determines that males and females have no significant differences with the severity of autistic symptoms, similar to few other studies emphasizing the similar results (18). It is noteworthy that the results of our study are contrary to the results of many previous studies that state significant differences have been found between males and females (1,2) earlier studies suggest that males are more likely than females to have more severe autistic symptoms. This may be certainly relevant for autism spectrum disorder (ASD), which has around four affected males for every one affected female. The inclusion and study of autistic females has received increased attention in recent years, and geneticists have made significant progress in identifying novel genetic risk variants for ASD. This has enabled us to examine the relationships between genetic risk factors, hormones, and observed patterns of gender-differential vulnerability to ASDs.
It has been determined that, in order to further our understanding of the relationships between gender-differential biology and ASD risk factors, additional study is required (19, 20, 21). Levine’s homogeneity values shows that the assumption of homogeneity is met. Results obtained by earlier studies show an increased likelihood of males being diagnosed with autism spectrum disorder compared to females may also be due to females having little representation in the autism spectrum disorder literature, leading to a lack of knowledge of the variations in social function that exist between men and women with autism (22). Specifically, the current study investigated gender differences in ASD categories. The findings revealed that no observed gender differences were seen but influential differences were reflected in social responsiveness and various categories of ASDs.
Different categories of ASD exhibit with different clinical presentations and neuro-phenotypes,
which should be taken into consideration while developing treatment regimens in the future. Furthermore a statistically significant
difference in social responsiveness between mild, moderate, or high functioning ASD group which suggests that based on the severity
or category of ASD, an autistic individual has hard time with social interaction and communication. It is interesting to note
that not many studies were found on the categories of ASD and social responsiveness, thus this study can be considered as novel
study in this realm. One study by Kurita (23) describes a subset of ASD children who showed signs of abnormalities prior to
regression. In this study among the 97 autistic children with speech loss that participated 78.3% showed some developmental
difficulties before the onset of the speech loss, including lack of stranger anxiety and limited social responsiveness. However this study was on children and not adults.
Specifically, in the present study no significant difference was found between female and male suggesting that gender has no significant impact over the ASD (3) but different ASD categories have different severity impact on Social Responsiveness (SR). The impact in individuals suffering from mild and moderate ASD was mild and moderate respectively. The impact was very high among individual suffering from high functioning ASD and they face hard time with social interaction and communication like difficult to make friends, get stressed when faced with a challenging social situation, not make much eye contact or engage in small talk. This may be as a result of high functioning category having a slightly better perception of their social environment as compared to mild and moderate categories of ASD.
Limitations and future directions
It is worth noting that the current sample consists of a small number of participants belonging only to three categories of high functioning, mild and moderate excluding severe category which restricts the generalizability of the results. It is important to keep in mind that all tests have been evaluated through the parent-report forms and questionnaires and completed by only one parent. Future studies can analyze reports from both parents to be more conclusive. Another limitation is that the parental stress index's impact on the child's parental report may be considered in further researches. For example, a parent who is particularly burdened by his child's behavior can overestimate the symptoms or, vice versa, can underestimate them because of his/her difficulty in accepting his/her ward’s condition. Higher stress levels may mediate the scores obtained. Finally, since there wasn’t any control group taken therefore the observed sex differences in behavioral symptoms characterize ASD or reflect those found in the general population cant be conclusively established (24). Thus future work may include an active control group to strengthen findings. Thus this study is a significant try for filling the current literature gap associated with the influence of gender and social responsiveness on ASD. Future studies can include studying the differentiation of ASD individuals based on social backgrounds.
Conclusion
Findings from the study contribute to understanding why adults with autism spectrum disorder (ASD) are less likely to demonstrate social responsiveness in a stressful situation. In order to help these individuals navigate through their daily social challenges developing interventions based on improving social responsiveness, social awareness and emotion regulation may prove to be beneficial to these individuals (25). Thus the conclusive findings of this study point towards gender having no considerable impact on ASD and the severity of ASD varies between different categories. Thus, this study fills a large knowledge gap on the influence of gender and social responsiveness on ASD. Further research will be beneficial to understand how social factors affect ASD.
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