A scoping review of sex/gender differences in pragmatic language and friendship characteristics in autistic children and adolescents

Difficulties with social communication is core to an autism diagnosis, resulting in poorer pragmatic language ability and difficulty making and sustaining friendships, compared to neurotypical (NT) individuals. This review investigated sex/gender differences in pragmatic language skills and friendship characteristics in autistic children and adolescents and discusses potential links between these two concepts. PubMed, PsycInfo and Google Scholar were searched for articles investigating gender differences in autistic individuals in pragmatic language skills and friendship characteristics. The nineteen studies included in this review provide evidence to suggest that autistic females demonstrate greater pragmatic language ability compared to autistic males. Similar to NT female populations, autistic girls express pressure to maintain a large social circle and, despite improved pragmatic ability, still express friendships as effortful. Pressure to have a large social circle may result in autistic girls camouflaging their symptoms in order to fit into their peer group. These sex/gender differences have implications for considering a potential female phenotype during ASD diagnosis and treatment.