Neural self-representation in autistic women and association with ‘compensatory camouflaging’

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. N=119 adults (33 typically-developing [TD] males, 29 autistic males, 29 TD females, and 28 autistic females) participated in task-fMRI paradigms to assess neural activation within right temporo-parietal junction (RTPJ) and ventromedial prefrontal cortex (vMPFC) during mentalizing and self-representation. Camouflaging in autism was quantified as the discrepancy between extrinsic behaviour in social–interpersonal contexts and intrinsic status. Whilst autistic men showed hypoactive RTPJ mentalizing and vMPFC self-representation responses compared to TD men, such neural responses in autistic women were not different from TD women. In autistic women only, increasing camouflaging was associated with heightened vMPFC self-representation response. There is a lack of impaired neural self-representation and mentalizing in autistic women compared to TD 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.