Later autism diagnosis is associated with increased mental health risks. Understanding disparities in diagnostic timing is important to reduce psychiatric burden for autistic people. One characteristic associated with later autism diagnosis is female sex assigned at birth. However, literature to date does not characterize, differentiate, or account for gender identity beyond assigned sex at birth. 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. Three independent cohorts representing different ascertainments were examined: a research-recruited academic medical center sample ( N = 193; 8.0–18.0 years); a clinic-based sample ( N = 1550; 1.3–25.4 years); and a community-enriched sample ( N = 244, 18.2–30.0 years). The clinic-based and community-enriched samples revealed disparities in diagnostic timing: 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. Birth-sex, gender identity, and gender diversity may each uniquely relate to disparities in autism diagnostic timing. The influence of ascertainment strategies, particularly in studies examining assigned sex at birth or gender identity, should be considered.Lay AbstractLater autism diagnosis is associated with risk for mental health problems. Understanding factors related to later autism diagnosis may help reduce mental health risks for autistic people. One characteristic associated with later autism diagnosis is female sex. However, studies often do not distinguish sex assigned at birth and gender identity. Gender diversity may be more common in autistic relative to neurotypical people, and autism is more common in gender-diverse populations. We studied age at autism diagnosis by sex assigned at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. We studied three separate autistic samples, each of which differed in how they were diagnosed and how they were recruited. The samples included 193 persons (8.0–18.0 years) from a research-recruited academic medical center sample; 1,550 people (1.3–25.4 years) from a clinic-based sample; and 244 people (18.2–30.0 years) from a community-enriched sample. We found significant differences in the clinic-based and community-enriched samples. People assigned female sex at birth were diagnosed with autism significantly later than people assigned male at birth. People of female gender were diagnosed significantly later than people of male gender. Gender-diverse people were diagnosed significantly later than cisgender people. Sex assigned at birth, gender identity, and gender diversity may each show unique relationships with age of autism diagnosis. Differences in how autistic people are diagnosed and recruited are important to consider in studies that examine sex assigned at birth or gender identity. More research into autism diagnosis in adulthood is needed.

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性别、出生时指定性别和性别多样性：了解自闭症诊断时间差异的窗口

较晚的自闭症诊断与心理健康风险增加有关。了解诊断时机的差异对于减轻自闭症患者的精神负担非常重要。与后来的自闭症诊断相关的一个特征是出生时指定的性别。然而，迄今为止的文献并未描述、区分或解释出生时指定性别之外的性别认同。相对于神经正常人，自闭症患者的性别多样性可能更常见，并且自闭症在性别多样化人群中所占比例过高。我们分别通过出生时指定的性别、性别认同和性别多样性（性别多样化与顺性别）状态来检查自闭症诊断年龄。对代表不同确定的三个独立队列进行了检查：研究招募的学术医疗中心样本（N = 193；8.0-18.0 岁）；基于临床的样本（N = 1550；1.3–25.4 年）；以及社区富集样本（N = 244，18.2–30.0 岁）。基于诊所和社区的样本揭示了诊断时间的差异：出生时被指定为女性的人、女性和性别多样化的人被诊断出患有自闭症的时间明显晚于出生时被指定为男性的人、男性和性别不同的人。分别是顺性别者。出生性别、性别认同和性别多样性都可能与自闭症诊断时间的差异有独特的关系。应考虑确定策略的影响，特别是在检查出生时指定性别或性别认同的研究中。Lay 摘要后期自闭症诊断与心理健康问题的风险相关。了解与自闭症后期诊断相关的因素可能有助于降低自闭症患者的心理健康风险。与后来的自闭症诊断相关的一项特征是女性。然而，研究通常不区分出生时指定的性别和性别认同。相对于神经正常人，自闭症患者的性别多样性可能更常见，而自闭症在性别多样化的人群中更常见。我们分别根据出生时指定的性别、性别认同和性别多样性（性别多样化与顺性别）状态研究了自闭症诊断年龄。我们研究了三个独立的自闭症样本，每个样本的诊断方式和招募方式都不同。样本包括来自研究招募的学术医疗中心样本的 193 人（8.0-18.0 岁）；来自临床样本的 1,550 人（1.3-25.4 岁）；以及来自社区丰富样本的 244 人（18.2-30.0 岁）。我们发现基于临床的样本和社区丰富的样本存在显着差异。出生时被指定为女性的人被诊断出患有自闭症的时间明显晚于出生时被指定为男性的人。女性的诊断时间明显晚于男性。性别多样化的人的诊断时间明显晚于顺性别的人。出生时指定的性别、性别认同、性别多样性可能与自闭症诊断年龄存在独特的关系。在检查出生性别或性别认同的研究中，必须考虑自闭症患者的诊断和招募方式的差异。需要对成年自闭症诊断进行更多研究。