Are the diagnostic rates of autistic females increasing? An examination of state-wide trends.

BACKGROUND: Autism has been considered a 'male-dominant' condition. However, recent research suggests that autistic females are underdiagnosed, misdiagnosed, and later diagnosed. Females may also have different and more nuanced behavioral profiles. To examine diagnosis rates of females, we used 20 years of state-wide data to characterize historical trends in the diagnosis of autism in females to determine whether the proportion of females diagnosed with autism has changed over time. METHODS: Data were drawn from 10,247 participants (males = 8,319, females = 1928) who received an autism diagnosis between 2000 and 2021 from state-wide autism centers associated with the University of North Carolina TEACCH Autism Program. RESULTS: The rates of females diagnosed with autism increased at a greater rate compared with males. Age of diagnosis remained consistently higher for females. Late diagnosis (defined as 13+) increased over time across both males and females, however, was more commonly associated with females, particularly those with co-occurring intellectual disability. CONCLUSIONS: Our results indicate that the proportion of females diagnosed with autism has increased steadily over a 20-year period, which likely reflects greater societal knowledge of how autism may manifest differentially in females.

Sex Differences and Parent-Teacher Discrepancies in Reports of Autism Traits: Evidence for Camouflaging in a School Setting.

The purpose of this study was to examine sex differences and informant discrepancies in parent- and teacher-reports of autism traits. Data were drawn from the Simons Simplex Collection to create a sex-matched sample of autistic youth (N = 388; 4-17 years). Included participants had both parent and teacher reports of autistic traits from the Social Responsiveness Scale (SRS). Within each sex group, parent and teacher raw SRS scores were compared. Scores within each informant group (parent/teacher) was assessed for sex differences. Predictors of parent-teacher discrepancies were examined. Despite no sex differences in parent-reported autistic traits, teachers reported males as having more autistic traits compared to females. Parents of females reported significantly more autistic traits than teachers across multiple domains. Being older and female were significant predictors of increased parent-teacher discrepancy for multiple domains. These results suggest discrepancies between the observed autistic traits for females at home and school and builds on the growing body of literature highlighting potential camouflaging across development in autistic youth: parent-teacher discrepancies may reflect ways that autistic females are overlooked by teachers due to conscious changes in behavior or gender-based expectations of female characteristics. Discussion of discrepancies on an individual basis may therefore alleviate potential long-term consequences of camouflaging.

ChatGPT: Artificial Intelligence as a Potential Tool for Parents Seeking Information About Autism.

Autism Spectrum Disorder has seen a drastic increase in prevalence over the past two decades, along with discourse rife with debates and misinformation. This discourse has primarily taken place online, the main source of information for parents seeking information about autism. One potential tool for navigating information is ChatGPT-4, an artificial intelligence question and answer-style communication program. Although ChatGPT shows great promise, no empirical work has evaluated its viability as a tool for providing information about autism to caregivers. The current study evaluated answers provided by ChatGPT, including basic information about autism, myths/misconceptions, and resources. Our results suggested that ChatGPT was largely correct, concise, and clear, but did not provide much actionable advice, which was further limited by inaccurate references and hyperlinks. The authors conclude that ChatGPT-4 is a viable tool for parents seeking accurate information about autism, with opportunities for improvement in actionability and reference accuracy.

Sex Differences in the Developmental Trajectories of Autism Spectrum Disorder.

Purpose of Review: Females and males are disproportionately diagnosed with autism, a sex difference that has historically represented this neurodevelopmental condition. The current review examines lifespan developmental trajectories of autism based on sex to elucidate behavioral phenotypic differences that may contribute to differential rates of diagnosis. Recent Findings: We review sex differences in diagnostic criteria: social communication and restricted interests/repetitive behaviors (RRBs). Results suggest RRBs are more indicative of a diagnosis in males, whereas social differences are more indicative of a diagnosis in females. Factors contributing to a later diagnosis in females include social strengths (camouflaging) and diagnostic overshadowing. Summary: Sex differences in diagnostic criteria may contribute to differential rates of identification in males and females. Sex differences are most pronounced when assessing naturalistic social communication instead of reliance on standardized measure. Numerous future directions are identified including increasing samples of sub-threshold autistic females and evaluating longitudinal sex differences.

Effects of social complexity and gender on social and non-social attention in male and female autistic children: A comparison of four eye-tracking paradigms.

Eye tracking has long been used to characterize differences in social attention between autistic and non-autistic children, but recent work has shown that these patterns may vary widely according to the biological sex of the participants and the social complexity and gender-typicality of the eye tracking stimuli (e.g., barbies vs. transformers). To better understand effects of sex, social complexity, and object gender-typicality on social and non-social gaze behavior in autism, we compared the visual attention patterns of 67 autistic (ASD) and non-autistic (NA) males (M) and females (F) (ASD M = 21; ASD F = 18; NA M = 14; NA F = 14) across four eye tracking paradigms varying in social complexity and object gender-typicality. We found consistency across paradigms in terms of overall attention and attention to social stimuli, but attention to objects varied when paradigms considered gender in their stimulus design. Children attended more to gendered objects, particularly when the gender-typicality of the object matched their assigned sex. These results demonstrate that visual social attention in autism is affected by interactions between a child's biological sex, social scene complexity, and object gender-typicality and have broad implications for the design and interpretation of eye tracking studies.

How autistic adults' priorities for autism research differ by gender identity: A mixed-methods study.

BACKGROUND: Recent studies suggest that the funding breakdown of autism research in the United States may not align with stakeholder priorities. Furthermore, the majority of stakeholder-engaged research involves parents of autistic individuals rather than autistic adults themselves, who may have differing perspectives on research and funding priorities. Women and non-binary adults have been historically underrepresented in autism research. OBJECTIVES: The goal of the current study was to examine the autism research priorities of a group of autistic adults, with a particular focus on how these priorities are influenced by one's gender identity. DESIGN: A concurrent mixed-methods design was used for this study. METHODS: Seventy-one autistic adults (n = 18 men, n = 29 women, n = 24 non-binary adults) completed an online survey regarding the current funding landscape for autism research. Participants ranked the main research topics of the Interagency Autism Coordinating Committee (IACC) and identified top-priority research areas through free-text responses. Response themes were analyzed using content analysis and compared with the existing topic rankings. RESULTS: Overall rankings of IACC research areas had a near inverse relationship with the amount of funding per research area. Main themes of stakeholder-generated research topics included "Characterization," "Societal Change," "Well-Being & Trauma," "Diagnosis & Healthcare," and "Accessibility & Services." There was a relatively high overlap between topics identified by the IACC and by the stakeholder-generated topics. Subtle but important differences in topics arose based on gender, with women and non-binary adults identifying topics that were not identified by autistic men. CONCLUSION: Unique priorities generated by those typically excluded from autism research development underscore the importance of co-creating research with underrepresented stakeholders impacted by this work. The current study echoes the growing movement in the field of autism research to center autistic perspectives at every stage of research, including the establishment of funding priorities.

Autism Prevalence and the Intersectionality of Assigned Sex at Birth, Race, and Ethnicity on Age of Diagnosis.

PURPOSE: An official autism diagnosis is required to access timely intervention and is associated with better long-term wellbeing and mental health. Certain demographic characteristics, such as being female or a racially or ethnically minoritized youth, have been associated with significant diagnostic lag. However, it remains unclear how assigned sex, race, and ethnicity interact with each other in predicting the prevalence and age of autism diagnosis. METHODS: To examine the interactions between assigned sex, race, and ethnicity, we used data from the National Survey of Children's Health (NSCH; 2016 > 2021). RESULTS: One in 38 children had an autism diagnosis and 3.8 males were diagnosed per 1 female. Hierarchical linear regressions yielded diagnostic delays in some females, particularly those who were non-Hispanic white, Black, and Asian. Ethnic and racial minority children had significantly earlier diagnoses than white and non-Hispanic children when not accounting for sex. CONCLUSION: This study demonstrates slight increases in reported autism prevalence, a diagnostic lag in some autistic females that was strongly associated with ethnicity, and earlier diagnoses in racial and ethnic minority youth, a finding that may be explained by factors associated with phenotypic differences. This study has important implications for the diagnosis of minority autistic youth, particularly females and females who are non-Hispanic, who may experience a greater propensity for diagnostic delays.