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

项目摘要 自闭症谱系障碍（ASD）的诊断率为四名男性对一名女性。女性自闭症患者 比男性诊断晚，并呈现出细微差别的优势和劣势， 发育阶段在儿童早期，我们的团队和其他人已经确定了社会动机（SM）， 限制和重复行为（RRB）作为自闭症男性和女性之间的区别特征。它 也有人假设，这些差异是自闭症的潜在机制， 伪装对ASD性别差异研究的另一个关键是性别和性别多样性的研究。一 一些国际研究发现，自闭症青少年的性别多样性比例较高， 成年人，在自闭症女性中可能更高。没有研究描绘出这些的轨迹 交织在一起的特征（性，性别，年龄）或在幼儿期。代表， 需要进行纵向研究，以阐明以前的发展和病因学意义， 观察到的性别差异，并在幼儿期的性别多样性和发育特点。 我们将在两个站点（ESTA和CHOP）进行加速纵向设计（ALD）， 140名神经型（NT）和140名自闭症儿童，按性别平均分配，年龄4至8岁，在5个招募样本 在四个时间点进行研究。ALD已被确定为一种有前途的研究方法 ASD的发展和招募难以接触的群体。这种多地点的努力将使我们能够招募足够的 自闭症女性研究年龄和性别相关的发展轨迹。我们的团队具有独特的优势， 研究生物性别（Harrop，Parish-Morris）和性别（斯特朗，Harrop）如何影响年轻人的轨迹 自闭症儿童通过多模式措施（父母报告，直接观察，眼动跟踪），可以探测 横截面观察到的ASD性别差异的机制。 我们的研究有两个目的：目的一：评估生物性别对发展轨迹的影响 自闭症儿童的故事我们将探讨表型和机械性别差异的时间，重点是SM 和RRB。我们还将绘制伪装行为标记的出现。目标二：描述 孤独症儿童生理性别与性别一致/不一致的轨迹。我们将 透过家长及自我报告，找出自闭症及新界儿童性别差异早期迹象。我们将 还研究了性别在预测SM和RRB以及常见表型变量中的作用，以了解 出生时的生理性别（目标一）和性别（目标二）如何不同地预测自闭症青少年的轨迹。 这个R 01项目将描绘出ASD新生儿发育学，生物性别， and gender性别in early早childhood童年.这项工作将为性别敏感的筛查方案提供信息，并为以下方面提供证据： 对性和性别问题有敏感认识的干预措施，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.