Autistic Traits, Empathizing-Systemizing, and Gender Diversity

Previous research indicates a link between autism and transgender and gender-diverse identities, though the association is not yet fully understood. The current study examined autistic traits (Autism Spectrum Quotient [AQ]), empathizing (Empathizing Quotient-Short [EQ-S]), and systemizing (Systemizing Quotient-Short [SQ-S]) in a sample of 89 adults and aimed to test whether gender-diverse individuals exhibit cognitive profiles consistent with predictions derived from the Extreme Male Brain (EMB) theory. As most research has considered only cisgender people, we recruited a more diverse sample by contacting > 200 UK LGBTQ+ organizations and posting on social media. A range of non-cisgender identities (e.g., transgender male, transgender female, non-binary, genderqueer, transmasculine) and non-heterosexual orientations (e.g., bisexual) were represented, and participants were categorized into one of four groups: (1) assigned female at birth but does not identify as female (transgender AFAB) (n = 32), (2) cisgender female (n = 21), (3) assigned male at birth but does not identify as male (transgender AMAB) (n = 18), and (4) cisgender male (n = 18). After controlling for age and autism diagnostic status, transgender AFAB participants had marginally higher AQ scores, and significantly higher SQ-S and systemizing-relative-to-empathizing (D) scores, compared with the cisgender female group. No such differences were detected between the transgender AMAB and cisgender male groups. Our findings are broadly in line with predictions derived from the EMB theory, though as no transgender AFAB participants reported being heterosexual, it was not possible to determine whether these effects relate specifically to gender identity, to sexual orientation, or to both.

Sex Differences in Autism Spectrum Disorder: a Review

PURPOSE OF REVIEW

Neurodevelopmental disorders disproportionately affect males. The mechanisms underlying male vulnerability or female protection are not known and remain understudied. Determining the processes involved is crucial to understanding the etiology and advancing treatment of neurodevelopmental disorders. Here, we review current findings and theories that contribute to male preponderance of neurodevelopmental disorders, with a focus on autism.

RECENT FINDINGS

Recent work on the biological basis of the male preponderance of autism and other neurodevelopmental disorders includes discussion of a higher genetic burden in females and sex-specific gene mutations or epigenetic changes that differentially confer risk to males or protection to females. Other mechanisms discussed are sex chromosome and sex hormone involvement. Specifically, fetal testosterone is involved in many aspects of development and may interact with neurotransmitter, neuropeptide, or immune pathways to contribute to male vulnerability. Finally, the possibilities of female underdiagnosis and a multi-hit hypothesis are discussed. This review highlights current theories of male bias in developmental disorders. Topics include environmental, genetic, and epigenetic mechanisms; theories of sex chromosomes, hormones, neuroendocrine, and immune function; underdiagnosis of females; and a multi-hit hypothesis.

Default Mode Hypoconnectivity Underlies a Sex-Related Autism Spectrum

Background

Females and males differ significantly in the prevalence and presentation of autism spectrum conditions. One theory of this effect postulates that autistic traits lie on a sex-related continuum in the general population, and autism represents the extreme male end of this spectrum. This theory predicts that any feature of autism in males should 1) be present in autistic females, 2) differentiate between the sexes in the typical population, and 3) correlate with autistic traits. We tested these three predictions for default mode network (DMN) hypoconnectivity during the resting state, one of the most robustly found neurobiological differences in autism.

Methods

We analyzed a primary dataset of adolescents (N = 121, 12–18 years of age) containing a relatively large number of females and a replication multisite dataset including children, adolescents, and adults (N = 980, 6–58 years of age). We quantified the average connectivity between DMN regions and tested for group differences and correlation with behavioral performance using robust regression.

Results

We found significant differences in DMN intraconnectivity between female controls and females with autism (p = .001 in the primary dataset; p = .009 in the replication dataset), and between female controls and male controls (p = .036 in the primary dataset; p = .002 in the replication dataset). We also found a significant correlation between DMN intraconnectivity and performance on a mentalizing task (p = .001) in the primary dataset.

Conclusions

Collectively, these findings provide the first evidence for DMN hypoconnectivity as a behaviorally relevant neuroimaging phenotype of the sex-related spectrum of autistic traits, of which autism represents the extreme case.

Similarly Expanded Bilateral Temporal Lobe Volumes in Female and Male Children With Autism Spectrum Disorder

BACKGROUND

Autism spectrum disorder (ASD) is more prevalent in male than female individuals. Very few studies have examined sex modulations of brain anatomical differences between individuals with ASD and typically developing (TD) individuals, especially in children. The current study aimed to identify sex-dependent and/or sex-independent neuroanatomical mechanisms underlying ASD.

METHODS

Magnetic resonance imaging data were acquired from the Autism Brain Imaging Data Exchange. A 2 (diagnosis) × 2 (sex) design was used. Subjects whose ages were between 6 and 20 years were included for analysis, with matched full-scale IQ between groups for each dataset. The resulting effective numbers of subjects were 36 female subjects with ASD, 54 TD female subjects, 182 male subjects with ASD, and 172 TD male subjects. Twenty independent gray matter (GM) and 20 white matter (WM) volume sources were estimated using source-based morphometry.

RESULTS

Among all the independent GM and WM sources, none of them showed a significant diagnosis by sex interaction. One GM source of the bilateral inferior and middle temporal lobe showed a significantly larger volume in ASD than TD individuals and in male than in female subjects. This diagnosis effect was age sensitive and was present only in participants between 8 and 14 years of age.

CONCLUSIONS

Only sex-independent, large-scale neuroanatomical alterations could be observed in children with ASD. The directionality of bilateral temporal GM alterations was in line with the prediction of the extreme male brain hypothesis, supporting the view that similar neurobiological mechanisms may drive sexual dimorphism and the onset of ASD.