B-49: Exploring Sex Differences in Verbal Fluency in Autism Spectrum Disorder: An Analysis of Phonemic and Semantic Fluency

Abstract

Objective: This study examined whether individuals with Autism Spectrum Disorder (ASD) exhibit differential performance on phonemic and semantic fluency tasks, and whether sex and age contribute to variability in performance. Method/Data Selection: Sample = 135 individuals (ages 7–53) with a documented diagnosis of ASD evaluated at a neuropsychological clinic in the Midwestern United States, including male and female participants. Verbal fluency was assessed using raw scores from standard phonemic (FAS) and semantic (Animals) fluency tasks. A cross-sectional design examined differences in fluency performance by sex and age. Group differences by sex were analyzed using ANOVA, with post hoc comparisons adjusted using Tukey procedures. Multiple linear regression analyses assessed verbal fluency performance by sex and age. Results/Data Synthesis: Both sex and age were significantly associated with phonemic and semantic fluency (Animals: F(1, 56) = 14.37, p < .001; FAS: F(1, 57) = 14.29, p < .001). Females demonstrated significantly higher performance than males on both tasks (Animals: mean difference = 6.97, 95% CI [3.29, 10.65], p < .001; FAS: mean difference = 12.97, 95% CI [6.10, 19.84], p < .001). No sex by age interaction was observed. Regression analyses indicated that sex and age significantly predicted phonemic fluency (adjusted R2 = .36) and semantic fluency (adjusted R2 = .27). Conclusions: Verbal fluency in ASD may reflect domain-specific performance patterns influenced by both sex and age. The observed female advantage across fluency tasks may reflect compensatory mechanisms or differential developmental trajectories, underscoring the importance of considering sex as a meaningful variable in neuropsychological assessment and research in ASD.