Abstract
Prior work has revealed sex/gender-dependent autistic characteristics across behavioural and neural/biological domains. It remains unclear whether and how neural sex/gender differences are related to behavioural sex/gender differences in autism. Here, we examined whether atypical neural responses during mentalizing and self-representation are sex/gender-dependent in autistic adults and explored whether ‘camouflaging’ (acting as if behaviourally neurotypical) is associated with sex/gender-dependent neural responses. In total, N = 119 adults (33 typically developing males, 29 autistic males, 29 typically developing females and 28 autistic females) participated in a task-related functional magnetic resonance imaging paradigm to assess neural activation within right temporo-parietal junction and ventromedial prefrontal cortex during mentalizing and self-representation. Camouflaging in autism was quantified as the discrepancy between extrinsic behaviour in social–interpersonal contexts and intrinsic status. While autistic men showed hypoactive right temporo-parietal junction mentalizing and ventromedial prefrontal cortex self-representation responses compared to typically developing men, such neural responses in autistic women were not different from typically developing women. In autistic women only, increasing camouflaging was associated with heightened ventromedial prefrontal cortex self-representation response. There is a lack of impaired neural self-representation and mentalizing in autistic women compared to typically developing women. Camouflaging is heightened in autistic women and may relate to neural self-representation response. These results reveal brain-behaviour relations that help explain sex/gender-heterogeneity in social brain function in autism.
Highlights
Autism is a neurodevelopmental condition characterized by early-onset social-communication difficulties alongside heightened stereotyped behaviours, narrow interests, insistence on sameness and idiosyncratic sensory responsivity
We examined whether atypical neural self-representation and mentalizing responses within ventromedial prefrontal cortex (vMPFC) and right temporo-parietal junction (RTPJ) are sex/gender-dependent in autism and whether camouflaging, as we provisionally operationalized, is associated with such social brain function
We identified sex/genderdependent neural activation patterns: whereas autistic men showed reduced vMPFC self-representation and RTPJ mentalizing responses compared with typically developing (TD) men, autistic women showed no significant differences from TD women
Summary
Autism is a neurodevelopmental condition characterized by early-onset social-communication difficulties alongside heightened stereotyped behaviours, narrow interests, insistence on sameness and idiosyncratic sensory responsivity. One important stratifier is sex/gender (Lai et al, 2015, 2017a). A 4–5:1 male:female ratio of autism prevalence has been consistently reported, in clinical samples (Fombonne et al, 2011). There are two important implications from this updated sex/gender ratio. Autistic females tend to be under-recognized clinically, unless there are coexisting behavioural, emotional, or cognitive difficulties (Duvekot et al, 2017; Dworzynski et al, 2012). There is still a clear male-preponderance, even after accounting for biased ascertainment. This indicates that variables and mechanisms associated with sex and gender may be important modulating factors behind the aetiologies and developmental mechanisms of autism (Werling, 2016)
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