A growing body of evidence supports a potential link between autism spectrum disorder (ASD) and gender dysphoria, yet few studies have looked at sex differences in the co‐occurrence of gender diversity and ASD. The aim of this study was to characterize sex differences in gender‐diverse expressions and identities, as well as gender‐related concerns, in youth with ASD. Parents of youth with ASD ages 6–21 (n = 163) completed an online questionnaire about their child's gender expression and identity. Sex‐typed behaviors during childhood were measured using the Gender Identity Questionnaire (GIQ). Semi‐partial Kendall correlations and chi‐square tests were used to compare gender non‐conformity, gender‐diverse identities, and gender‐related concerns between sexes. Sex‐based differences in mean GIQ score and individual GIQ items were evaluated using a linear regression and semi‐partial Kendall correlations, respectively. All regressions and correlations controlled for child age. Parents of girls were more likely to report child appearances and mannerisms that were less concordant with their child's birth sex. Based on parent‐report, girls had lower mean GIQ scores, indicating greater cross‐gendered/fewer same‐gendered behaviors in childhood. Lastly, parents of girls with ASD were more likely to report that their daughters experienced anxiety due to gender‐related concerns and discomfort during puberty than parents of boys. These findings suggest that girls with ASD seem more likely have gender‐diverse preferences, mannerisms, and appearances that fall outside of traditional gender norms. Gender‐related concerns appear to be a source of real distress in girls with ASD, highlighting the need for individualized support, especially during puberty.

中文翻译：

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自闭症谱系障碍青少年性别差异表达和身份的性别差异

越来越多的证据支持自闭症谱系障碍（ASD）和性别焦虑症之间的潜在联系，但是很少有研究关注性别多样性和ASD并发中的性别差异。这项研究的目的是在ASD青年中表征性别差异表达和身份中的性别差异，以及与性别相关的关注。ASD年龄为6-21岁的青少年的父母（n= 163）完成了有关孩子的性别表达和身份的在线调查问卷。使用性别认同问卷（GIQ）来衡量儿童时期的性别行为。使用半局部Kendall相关性和卡方检验来比较性别不符合，性别多样化的身份以及性别之间的性别相关问题。分别使用线性回归和半局部Kendall相关性评估了GIQ平均得分和单个GIQ项目中基于性别的差异。所有回归和相关都针对儿童年龄进行了控制。女孩的父母更有可能报告与孩子的出生性别不太一致的孩子的外表和举止。根据父母的报告，女孩的平均GIQ得分较低，表明儿童时期的跨性别/较少的同性行为。最后，患有自闭症的女孩的父母比男孩的父母更有可能报告其女儿由于性别相关的担忧和青春期期间的不适而感到焦虑。这些发现表明，患有自闭症的女孩似乎更有可能具有性别多样化的偏爱，举止和外表，而这超出了传统的性别规范。性别相关的担忧似乎是自闭症女孩真正的困扰，突出了需要个性化支持的需求，尤其是在青春期。