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In autism, increased symptom severity typically relates to reduced adaptive functioning (daily living, social, and motor skills). Yet, some individuals exhibit high adaptive functioning despite pronounced symptoms (“adaptive resilience”), while others show the reverse (“adaptive vulnerability”). This study examined the neuroanatomical correlates of adaptive resilience/vulnerability, potential sex mediation, and links to mental health. Structural MRI data from 359 autistic individuals (101 females, 258 males; aged 6–30) were analyzed. Residuals from regressing symptom severity on Vineland Adaptive Behavior Scale scores indexed resilience/vulnerability. These residuals and their interaction with sex were related to cortical thickness via general linear modeling. Significant effects emerged in the left middle frontal gyrus, pars opercularis/triangularis, and sex interactions in the precuneus, superior parietal, and fusiform regions. More females were “resilient,” who also showed higher anxiety but not depression. Findings suggest sex moderates neuroanatomical profiles of adaptive outcomes, possibly reflecting masking-related effects.