Grant: Project Grant

Approximately 2% of Canadians are autistic. Timely autism diagnosis is critical to improve service connection and social support. Conventionally, assigned males at birth (AMAB) are four times more likely to be diagnosed with autism than assigned females at birth (AFAB). The under-recognition of autistic AFAB people is partly due to limitations of current autism measures to capture behavioural differences between AMAB and AFAB autistic people. In addition, although autism presents more commonly in trans and gender diverse (TGD) than cisgender (cis) people, there are almost no data on how autism measures perform across gender diversity status. In fact, most autism measures were developed with predominantly AMAB people with unknown gender diversity status. This 'cis-male spotlight' likely biased autism measurements for a long time. To address these inequities, we will examine how autism measures perform across sex-gender intersections and revise the items to be more accurate and to overcome current sex and gender biases in the recognition of autism. To do this, we will use a 3-phase multi-method approach to (1) systematically test how current autism measures and items perform across intersections of birth-assigned sex and gender identity; (2) use community-based participatory research (that is, partnering with autistic people and their parents from the outset) to review these findings and collaboratively revise items across existing measures; and (3) evaluate the revised item-sets to determine whether they accurately capture autistic traits across sexes and gender identities. This study, the first of its kind, aims to mitigate longstanding biases in autism measures for adolescents and adults and to move the field towards more equitable recognition of autism across sexes and genders.