Sex, Gender, and Camouflage in Autism Spectrum Disorder: A Multimodal, Accelerated Longitudinal Design

项目总结 自闭症谱系障碍(ASD)的确诊比例为四名男性对一名女性。自闭症女性 比男性更晚被诊断出来，并呈现出不同于男性的细微差别的优势和弱点 发展阶段。在儿童早期，我们的团队和其他人已经确定了社会动机(SM)和 限制和重复行为(RRB)是自闭症男性和女性的区别特征。它 还假设这些差异是自闭症的潜在机制 伪装。对自闭症性别差异研究的另一个关键是对性别和性别多样性的研究。一个 多项国际研究发现，自闭症青少年的性别多样性比率较高， 成人，自闭症女性的发病率可能更高。还没有研究描绘出这些变化的轨迹 相互交织的特征(性别、性别、伪装)在一起或在儿童早期。代表们， 需要进行纵向研究来阐明先前的发育和病因学意义 观察性别差异，并描述儿童早期的性别多样性和伪装。 我们将在两个站点(UNC和CHOP)之间进行加速纵向设计(ALD) 140名神经典型(NT)儿童和140名自闭症儿童的样本，按性别平均分配，年龄在4至8岁之间，在5个国家招募 在四个时间点上进行了研究。ALDS已被确定为一种很有前途的研究方法 发展自闭症和招募难以接触到的群体。这一多地点的努力将使我们能够招募到足够的 自闭症女性检查与年龄和性别相关的发展轨迹。我们的团队处于独特的地位，可以 研究生理性别(Harrop，Parish-Morris)和性别(Strang，Harrop)如何影响年轻人的发展轨迹 自闭症儿童通过多模式措施(家长报告、直接观察、眼球跟踪)进行探测 横断面观察ASD的性别差异的机制。 我们的研究有两个目标：目标一：评估生物性别对发展轨迹的影响 年幼的自闭症儿童。我们将加班探索表型和机械性性别差异，重点是SM 和RRB。我们还将绘制伪装行为标记的出现图表。目标二：描述 自闭症儿童生理性别与性别一致性/不一致性的轨迹。我们会 通过父母和自我报告，确定自闭症儿童和NT儿童性别差异的早期迹象。我们会 还要研究性别在预测SM和RRBs中的作用，以及要理解的常见表型变量 出生时的生物性别(目标一)和性别(目标二)如何不同地预测自闭症青年的发展轨迹。 这个R01项目将绘制出新出现的ASD症状、生物学性别、 以及儿童早期的性别。这项工作将为性别敏感筛查方案提供信息，并为 对性别和性别敏感的干预措施，以更好地满足自闭症女性的需求。

PROJECT SUMMARY Autism spectrum disorder (ASD) is diagnosed at a rate of four males to one female. Autistic females are diagnosed later than males and present with a nuanced profile of strengths and weaknesses that vary by developmental stage. In early childhood, our team, and others, have identified social motivation (SM) and restricted and repetitive behaviors (RRBs) as distinguishing features between autistic males and females. It has also been hypothesized that these differences serve as potential mechanisms that underlie autistic camouflage. Also critical to the study of sex differences in ASD is the study of gender and gender diversity. A number of international studies have identified higher rates of gender diversity in autistic adolescents and adults, with potentially higher rates in autistic females. No study has charted the trajectories of these interwoven characteristics (sex, gender, camouflaging) together or in early childhood. Representative, longitudinal studies are required to elucidate the developmental and etiological significance of previously observed sex differences and to characterize gender diversity and camouflaging in early childhood. We will conduct an Accelerated Longitudinal Design (ALD) across two sites (UNC and CHOP) in a sample of 140 neurotypical (NT) and 140 autistic children, equally split by sex, aged 4 to 8 recruited in 5 cohorts and studied over four timepoints. ALDs have been identified as a promising methodology to study development in ASD and recruit hard to reach groups. This multi-site effort will enable us to recruit sufficient autistic females to examine age- and sex-linked developmental trajectories. Our team is uniquely positioned to study how biological sex (Harrop, Parish-Morris) and gender (Strang, Harrop) impact the trajectories of young autistic children through multimodal measures (parent-report, direct observation, eye tracking) that can probe the mechanisms that underlie cross–sectionally observed sex differences in ASD. Our study has two aims: Aim One: Evaluate the impact of biological sex on developmental trajectories of young autistic children. We will probe phenotypic and mechanistic sex differences overtime, focusing on SM and RRBs. We will also chart the emergence of behavioral markers of camouflage. Aim Two: Characterize trajectories of congruence/incongruence between biological sex and gender in young autistic children. We will identify early signs of gender diversity in young autistic and NT children through parent and self-report. We will also examine the role of gender in predicting SM and RRBs and common phenotypic variables to understand how biological sex at birth (Aim One) and gender (Aim Two) differentially predict trajectories in autistic youth. This R01 project will chart the dynamic interplay between emergent ASD symptomology, biological sex, and gender in early childhood. This work will inform sex-sensitive screening protocols and provide evidence for sex- and gender-sensitive interventions to better address the needs of autistic females.