# Sex, Gender, and Camouflage in Autism Spectrum Disorder: A Multimodal, Accelerated Longitudinal Design

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2022 · $667,468

## Abstract

PROJECT SUMMARY
 Autism spectrum disorder (ASD) is diagnosed at a rate of four males to one female. Autistic females
are diagnosed later than males and present with a nuanced profile of strengths and weaknesses that vary by
developmental stage. In early childhood, our team, and others, have identified social motivation (SM) and
restricted and repetitive behaviors (RRBs) as distinguishing features between autistic males and females. It
has also been hypothesized that these differences serve as potential mechanisms that underlie autistic
camouflage. Also critical to the study of sex differences in ASD is the study of gender and gender diversity. A
number of international studies have identified higher rates of gender diversity in autistic adolescents and
adults, with potentially higher rates in autistic females. No study has charted the trajectories of these
interwoven characteristics (sex, gender, camouflaging) together or in early childhood. Representative,
longitudinal studies are required to elucidate the developmental and etiological significance of previously
observed sex differences and to characterize gender diversity and camouflaging in early childhood.
 We will conduct an Accelerated Longitudinal Design (ALD) across two sites (UNC and CHOP) in a
sample of 140 neurotypical (NT) and 140 autistic children, equally split by sex, aged 4 to 8 recruited in 5
cohorts and studied over four timepoints. ALDs have been identified as a promising methodology to study
development in ASD and recruit hard to reach groups. This multi-site effort will enable us to recruit sufficient
autistic females to examine age- and sex-linked developmental trajectories. Our team is uniquely positioned to
study how biological sex (Harrop, Parish-Morris) and gender (Strang, Harrop) impact the trajectories of young
autistic children through multimodal measures (parent-report, direct observation, eye tracking) that can probe
the mechanisms that underlie cross–sectionally observed sex differences in ASD.
 Our study has two aims: Aim One: Evaluate the impact of biological sex on developmental trajectories
of young autistic children. We will probe phenotypic and mechanistic sex differences overtime, focusing on SM
and RRBs. We will also chart the emergence of behavioral markers of camouflage. Aim Two: Characterize
trajectories of congruence/incongruence between biological sex and gender in young autistic children. We will
identify early signs of gender diversity in young autistic and NT children through parent and self-report. We will
also examine the role of gender in predicting SM and RRBs and common phenotypic variables to understand
how biological sex at birth (Aim One) and gender (Aim Two) differentially predict trajectories in autistic youth.
 This R01 project will chart the dynamic interplay between emergent ASD symptomology, biological sex,
and gender in early childhood. This work will inform sex-sensitive screening protocols and provide evidence for
sex- and gender-se...

## Key facts

- **NIH application ID:** 10488255
- **Project number:** 5R01HD103895-02
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Clare Elizabeth Harrop
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $667,468
- **Award type:** 5
- **Project period:** 2021-09-14 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10488255

## Citation

> US National Institutes of Health, RePORTER application 10488255, Sex, Gender, and Camouflage in Autism Spectrum Disorder: A Multimodal, Accelerated Longitudinal Design (5R01HD103895-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10488255. Licensed CC0.

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