Sex differences in internalising problem trajectories of autistic and non-autistic youth across childhood and adolescence

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Suominen, E., Zahir, R., Hampton, S., Cooper, K., Midouhas, E., Flouri, E., Saunders, R., & Mandy, W. (2025). Sex differences in internalising problem trajectories of autistic and non-autistic youth across childhood and adolescence. Journal of Affective Disorders, 394(Pt B), 120678. https://doi.org/10.1016/j.jad.2025.120678

Publication date: 16 Nov 2025 Added to AutiHub: 15 Sep 2026 Type: Article Article language: English
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Authors

Publication authors
8
Publication authors identified as autistic
1 / 8 (12.5%)
  1. Elna Suominen
  2. Reesha Zahir
  3. Sarah Hampton *
  4. Kate Cooper
  1. Emily Midouhas
  2. Eirini Flouri
  3. Rob Saunders
  4. Will Mandy

Abstract

BACKGROUND: Autistic children and adolescents experience high rates of internalising problems such as anxiety and depression. In the general population, female children and adolescents typically show higher trajectories of internalising symptoms - but little is known about sex differences among autistic youth. This study examined sex differences in the developmental course of internalising symptoms among autistic and non-autistic youth across childhood and adolescence. METHODS: Participants included autistic (n = 573) and non-autistic (n = 15,945) individuals from the Millennium Cohort Study. Internalising symptoms were assessed via parent-report Strengths and Difficulties Questionnaire at six timepoints (ages 3-17). Latent Growth Curve Modelling (LGCM) was used to model trajectories, and growth factors were regressed onto autism diagnosis, sex, and their interaction. Additionally, separate LGCMs were fitted to autistic and non-autistic male and female groups to describe internalising trajectories. RESULTS: Autism diagnosis was associated with higher baseline internalising symptoms and steeper increases over time. Female sex was linked to steeper increases in internalising symptoms, despite slightly lower initial levels. The interaction between sex and autism diagnosis was not statistically significant, indicating no additional combined effect on trajectories. Overall, autistic youth had higher internalising trajectories than non-autistic youth, with group differences emerging earlier in males (age 7) than females (age 11). CONCLUSION: This study showed that that sex differences in developmental trajectories of internalising problems among autistic youth parallel those seen in the general population, but with increased severity.

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Cited bibliography overview

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Cited references
88
With a DOI
78
Without a DOI, from raw bibliography text
10
3 / 88 (3.4%) cited references include at least one author identified as autistic.
References with data to complete
1 / 88 (1.1%)
References with detected author names
88 / 88 (100.0%)
Without detected author names
0
Without a structured title
1
Without a stable identifier
10
References with raw author names still to review
0
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
396
From DOI or external metadata
396
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
0
114 / 396 (28.8%) names are linked to an author already present in AutiHub. 282 / 396 (71.2%) names are not yet linked.
Names linked to a person identified as autistic
3 / 396 (0.8%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 3 / 114 (2.6%). Distinct people identified as autistic: 3 / 342 (0.9%).
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