Children’s Finds Sex and Autism Risk Differences in Infant Vocalizations

ATLANTA, June 19, 2020 – Early detection of autism spectrum disorder in infants is often indicated through various biomarkers. Now, research from Marcus Autism Center, an affiliate of Children’s Healthcare of Atlanta, and the University of Memphis indicates boys produce significantly more vocalizations known as protophones than girlsa difference that is more pronounced in boys at high risk for autism in the first six months after birth.

“Parents of children at high risk of autism should be aware their children could exhibit differences in behavior from the earliest months of life,” said Gordon Ramsay, PhD, Director of the Spoken Communication Laboratory at Marcus Autism Center. “This has been consistently demonstrated in results from biomarkers like eye-tracking and neuroimaging. Now our research shows this difference also shows up in vocal measurements in boys.”

Dr. Ramsay and his team recorded the daylong home vocalizations of 100 infants during the first 12 months of life. The recordings were then analyzed by D. Kimbrough Oller, PhD, Chair of Excellence in the School of Communication Sciences and Disorders at the University of Memphis, to determine whether there were differences between boys and girls, and those at high and low risk for autism (with high risk defined as having a sibling with autism).

After a five-year collaboration funded by the National Institutes of Health (NIH), Drs. Oller and Ramsay found boys produce significantly more protophones, the precursors to speech, including vowel-like sounds, squeals and growls, than girls. This difference was even more pronounced in infants at high risk for autism at the beginning of the first year. The team published their findings in Current Biology.

“Both high and low risk groups show the advantage of boys in the rate of vocalizations being produced,” Dr. Oller said. “This is a big surprise. The presumed difference between boys and girls in language later in life in general is small, and it favors girls, but the male protophone advantage we observed in the first year is more than four times larger than the commonly reported female language advantage.”

Drs. Ramsay and Oller noted these differences primarily occur between 0 and 6 months of age, while the female advantage begins after the first year with slightly larger vocabulary sizes and other female language advantages continuing throughout life. They discovered while quantity of protophones is higher in boys, quality is not, suggesting this finding may not be related to language development alone. From an evolutionary perspective, they hypothesize this difference may be due to boys’ higher risk of medical complications in the first year, as boys are 60% more likely to be born prematurely, their infant mortality rate is 30% higher, and they are known to be at greater risk of autism from birth.

“Boys are known to be generally more vulnerable in the first year of life than girls, so these results may reflect the evolution of vocal signaling strategies eliciting parental care to buffer the elevated risk,” said Dr. Oller, who is also a Professor with the Konrad Lorenz Institute for Evolution and Cognition Research in Austria.

While the team is still exploring the implications of this unexpected finding, the exaggerated difference in boys at high risk for autism provides evidence for an early biomarker in pre-speech vocal behavior.

“If early protophone production is indeed a fitness signaling strategy with evolutionary origins, it is natural that differences between boys and girls would be more pronounced in infants at risk of autism, and more likely to elicit early concern from parents in ways that promote the health and survival of the child,” said Dr. Ramsay, who is also an Assistant Professor in the Emory University School of Medicine Department of Pediatrics.

Dr. Ramsay hopes these findings will encourage parents to seek treatment sooner, before their child’s first words, when the window of opportunity is greatest for shaping their child’s long-term health.

For more information:

Julie Kuchta

Children's Healthcare of Atlanta


About Children’s Healthcare of Atlanta

As the only freestanding pediatric healthcare system in Georgia, Children’s Healthcare of Atlanta is the trusted leader in caring for kids. The not-for-profit organization’s mission is to make kids better today and healthier tomorrow through more than 60 pediatric specialties and programs, top healthcare professionals, and leading research and technology. Children’s is one of the largest pediatric clinical care providers in the country, managing more than one million patient visits annually at three hospitals, Marcus Autism Center, the Center for Advanced Pediatrics, urgent care centers and neighborhood locations. Consistently ranked among the top children’s hospitals by U.S. News & World Report, Children’s Healthcare of Atlanta has impacted the lives of kids in Georgia, across the United States and around the world for more than 100 years thanks to generous support from the community.

About Emory University School of Medicine

About Emory University School of Medicine
Emory University School of Medicine is a leading institution with the highest standards in education, biomedical research and patient care, with a commitment to recruiting and developing a diverse group of students and innovative leaders. Emory School of Medicine has more than 3,400 full- and part-time faculty, 592 medical students, 497 allied health students in five programs, 1,388 residents and fellows in 115 accredited programs, and 92 MD/PhD students. Medical school faculty received $588.4 million in external research funding in fiscal year 2022. The school is best known for its research and treatment in infectious disease, brain health, heart disease, cancer, transplantation, orthopaedics, pediatrics, renal disease, ophthalmology and geriatrics.

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