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Obtaining and maintaining employment can be a challenge for autistic adults and learning challenges may be related to vocational outcomes in this population. The present study sought to evaluate the Learning Needs Screening Tool to identify autistic job seekers who may benefit from additional services to obtain employment. A total of 401 autistic adults participated in this study. Internal consistency of Learning Needs Screening Tool items was evaluated. A principal component analysis was then completed to understand the measure's factor structure and evaluations of external validity were completed. Evaluation of the screening items of the Learning Needs Screening Tool revealed high internal consistency. Three factors (Orthography, Arithmetic, and Retrospective Learning and Service Receipt) emerged. Overall, 56% of the sample screened positive on the Learning Needs Screening Tool, indicating a history of learning challenges. Analysis of history of special education receipt and vocational outcomes showed strong external validity for the measure. Results support the utility of the Learning Needs Screening Tool as a possible screening tool to evaluate learning challenges in autistic job seekers. As those who screened positive were more likely to have no vocational/educational activities, knowledge of retrospective learning needs may help vocational counselors identify autistic adults who need greater supports when seeking and obtaining jobs.

Age at autism diagnosis is associated with sex assigned at birth (hereafter, "sex"), such that girls/women are more likely to be delayed or "missed" entirely in the diagnostic process compared to boys/men. Later diagnosed individuals, especially girls/women, demonstrate increased anxious/depressive symptoms. Data on autistic youth from clinic-based (n = 1035; 22.9% assigned female) and sex-balanced research-based (n = 128; 43% assigned female) samples were probed via regression-based mediation models to understand relationships between diagnostic age, sex, and symptoms of anxiety/depression. We hypothesized diagnostic age would mediate the relationship between sex and anxious/depressive symptoms. In both samples, later diagnostic age predicted greater anxious and depressive symptoms, and sex did not directly predict anxious symptoms. In the clinic-based but not the research-based sample, individuals assigned female at birth were later diagnosed than those assigned male, and there was a significant indirect effect of sex on anxious and depressive symptoms through diagnostic age, such that those assigned female and later diagnosed experienced greater symptoms. Within the research-based sample only, sex predicted depressive symptoms. The present study provides an important impetus for further evaluating the implications of diagnostic timing, enhancing tools for recognizing autism in individuals assigned female at birth, and grounding research with real-world ascertainment strategies.

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.