**1. Introduction**

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268 Autism Spectrum Disorder - Recent Advances

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tion). doi:10.1176/appi.books.9780890425596.744053

Autism spectrum disorder (ASD) is a prevalent, life-long, neurodevelopmental disorder diagnosed in more than 1% of children in the United States (the most recent estimate exceeds one in 68 children) with strong gender basis towards males (one in 42 boys) relative to females (one in 189 girls) [1]. In addition to the diagnostic impairments specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for ASD in socialization, restricted, repetitive patterns of behavior, interests, or activities, and communi‐ cation, which must be present in the early developmental period, many individuals diagnosed with an ASD frequently have co-morbid aggression and severe irritability, hyperactivity, and repetitive behaviors, which can become a major source of additional distress and can interfere with functioning [2]. Similarly, others have observed the occurrence of co-morbid conditions among individuals diagnosed with an ASD as follows: hyperactivity (67%), sensory processing problems (85%), anxiety/fear (74%), behavioral problems (89%), and obsessive-compulsive behaviors (92%) [3]. These investigators described that behavioral problems and obsessivecompulsive behaviors were reported to be the most serious and problematic. In addition, investigators described that some individuals diagnosed with an ASD show significant deterioration in symptoms about the time of puberty [4]. Among the symptoms that worsened according to these investigators were disruptive behavior, destructiveness, restlessness, and partial loss of acquired social and academic skills.

In considering the aforementioned facts, it was previously hypothesized that male hormones (androgens) may play a critically important role in the clinical presentation of individuals diagnosed with an ASD and that reduction of androgens in individuals diagnosed with an

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ASD would result in a significant amelioration of their clinical symptoms [5]. The purpose of this critical review is to examine evidence supporting the role of androgens in mediating ASD traits/symptoms, elevated androgens among individuals diagnosed with an ASD, and the observed important role for anti-androgen medications in treatment of ASD traits/symptoms.
