{"doi":"10.31234/osf.io/kc6ax","title":"Gender, assigned sex at birth, and gender diversity: Windows into diagnostic timing disparities in autism","abstract":"Objective: Later autism diagnosis is associated with increased mental health risks. Thus, understanding factors related to disparities in diagnostic timing is important to reduce psychiatric burden for autistic people at disproportionate risk for mental health problems. “Sex” has captured attention in relation to differences in timing in autism recognition and diagnosis. However, literature to date does not characterize, differentiate, or account for gender identity beyond assigned sex at birth. Consideration of gender is key, as gender diversity may be more common in autistic relative to neurotypical people, and autism is proportionally overrepresented in gender-diverse populations. We examined age at autism diagnosis by assigned sex at birth, gender identity, and gender diversity (gender-diverse vs. cisgender) status, separately.Method: Three independent autistic cohorts representing different ascertainments were examined: a research-recruited academic medical center sample (N=193; aged 8.0-18.0y); a clinic-based sample (N=1550; 1.3-25.4y); and a community-enriched sample (N=244, 18.2-30.0y).Results: Disparities in diagnostic timing were observed in the clinic-based and community-enriched samples: people assigned female at birth, people of female gender, and gender-diverse people were diagnosed with autism significantly later than persons assigned male at birth, persons of male gender, and cisgender persons, respectively.Conclusion: Sex at birth, gender identity, and gender diversity may each uniquely relate to disparities in diagnostic timing of autism. The influence of ascertainment strategies, particularly in studies examining assigned sex at birth or gender identity, should be considered. Further research into autism diagnosis in adulthood and the role of sociodemographic factors is needed.","journal":"PsyArXiv (OSF Preprints)","year":2023,"id":391282,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9516,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":764199,"name":"Allison B. Ratto","orcid":"0000-0002-9387-8044","position":1,"is_corresponding":false},{"id":285318,"name":"Allison Jack","orcid":"0000-0002-7792-6464","position":2,"is_corresponding":false},{"id":1163602,"name":"Alexis Khuu","orcid":"0000-0001-9313-083X","position":3,"is_corresponding":false},{"id":1163603,"name":"Jessica V Smith","orcid":"0009-0002-4097-0653","position":4,"is_corresponding":false},{"id":1164005,"name":"Sean Duane","orcid":null,"position":5,"is_corresponding":false},{"id":436594,"name":"Ann Clawson","orcid":"0000-0002-8669-0086","position":6,"is_corresponding":false},{"id":92387,"name":"Nancy Lee","orcid":"0000-0002-6663-0713","position":7,"is_corresponding":false},{"id":673607,"name":"Alyssa Verbalis","orcid":"0009-0005-5513-0472","position":8,"is_corresponding":false},{"id":285321,"name":"Kevin A. Pelphrey","orcid":"0000-0001-5407-2577","position":9,"is_corresponding":false},{"id":299742,"name":"Lauren Kenworthy","orcid":"0000-0001-5887-8463","position":10,"is_corresponding":false},{"id":436595,"name":"Gregory L. Wallace","orcid":"0000-0003-0329-5054","position":11,"is_corresponding":false},{"id":299738,"name":"John F. Strang","orcid":"0000-0002-0950-6177","position":12,"is_corresponding":false},{"id":586959,"name":"Goldie A. McQuaid","orcid":"0000-0003-3614-616X","position":0,"is_corresponding":true}],"reference_count":69,"raw_metadata":null,"created_at":"2026-07-19T01:18:42.653719Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}