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Abstract

Being female and autistic is poorly understood, but is autism really 'rare' in females? Historically, autism has been associated with traditionally masculine features and stereotypes of behaviour, with some believing autism only occurred in males [1]. This leads scientific enquiry to the critical question of whether there are more males living with autism or, conversely, do females on the autistic spectrum present differently to males and, therefore, are at risk of remaining undiagnosed?.
90 Journal of Intellectual Disability - Diagnosis and Treatment, 2017, 5, 90-95
E-ISSN: 2292-2598/17 © 2017 Lifescience Global
Women & Girls on the Autism Spectrum: A Profile
Wenn B. Lawson*
ACRC, The University of Queensland, C/O PO Box 5033, Warrnambool, Vic. 3280, Australia
Abstract: Being female and autistic is poorly understood, but is autism really ‘rare’ in females? Historically, autism has
been associated with traditionally mascul ine features and stereotypes of behaviour, with some believing autism only
occurred in males [1]. This leads scientific enquiry to the critical question of whether there are more males living with
autism or, conversely, do females on the autistic spectrum present different ly to males and, therefore, are at risk of
remaining undiagnosed?
Keywords: Autism, Females, Presentation, Diagnosis, Gender.
Traditionally, over the last decade, only 1 female to
every 3 or 4 males has received a diagnosis of autism.
Often, females who are readily diagnosed as autistic
have tended toward the severe end of the spectrum,
being ‘classically’ autistic or having ‘Kanner’ type
autism with intellectual disability; or Autism level 3 [1-
3]. Even though Hans Asperger’s work eventually
opened doors to a deepening awareness of autism as
a spectrum, his original work was only with males [4].
Essentially, the question is, are there more males
living with autism or do females on the autistic
spectrum present differently to males? What we are
beginning to appreciate is the profile of autism’s impact
upon females is often different to that seen in males
(e.g. [5-8].
Sex and gender, both in biological sex and in
gender identity, are both concepts which are expressed
along a spectrum. However, this spectrum isn’t linear,
but circular. This understanding, and complexity, is
often over looked when it comes to autism. We have
been taught to believe chromosomes equal either XX
for females or XY for males. However, reality is
significantly more complex (http://www.who.int/
genomics/gender/en/index1.html).
Females differ in how they choose to express their
gender across different contexts and domains such as
physical presentation, communicative style and
behavior. This expression can vary between being
ultra-feminine, to the point of expressing almost
exaggerated femaleness, to almost resenting any hint
of stereotypical femininity where individuals live as
tomboys, even if they have XX chromosomes. Many
also lie between these two extremes. Research argues
*Address correspondenc e to this author at the ACRC, Long Pocket Campus,
The University of Queensland, PO Box 5033, Warrnambool, Vic. 3280,
Australia; E-mail: wenbe @bigpond.com
gender identity is not so much about chromosomes, as
it is about gender identity in the brain, but being female
and having different chromosomes to males and
different neurobiology than males will impact the profile
of autism in females. However, does this mean autism
presents differently to that seen in males, but may also
vary according to where a female ‘sits’ on the gender
spectrum [9,10]?
Until recently the idea of females having a different
profile of autism characteristics received very little
attention [11]. However, according to Lai, et al. as cited
in Moyse, et al. p. 187 [12]:
girls who appear to be cognitively able or
appear to have better communication
skills may have been under-diagnosed”.
As well as being underdiagnosed or miss-diagnosed
with a mental health issue (Social Phobia; Depression;
Borderline Personality Disorder and so on) the needs
of females are being over looked and their difficulties
aren’t being understood [11].
Yet, despite this there is an increasing amount of
literature that discusses the differences in females
compared to males [12-19]. However, this is failing to
translate into practice. Although changing long-time
attitudes for practitioners, takes time, this is an
emerging need that warrants urgent attention. There
are many misconceptions about how autism looks and
this is getting in the way of seeing autism’s different
impact according to an individual’s cis-gender, or
otherwise.
In the past [20], details of the triad of impairments
that affected those with autism, were richly described.
The triad are listed as impairments of social interaction,
impairments of social communication and impairments
of social imagination [21]. However, the DSM-5 [2] has
now combined the three domains into two: issues with
Women & Girls on the Autism Sp ectrum Journal of Intellectual Disability - Diagnosis and Treatment, 2017, Volume 5, No. 3 91
social interaction and communication, as well as rigid
behaviours domains. Possibly the DSM-5, that has
drawn previous areas together as opposed to seeing
them separated (previous versions, for example, listed
Asperger’s syndrome, Pervasive developmental
disorder not otherwise specified (PDDNOS) and others,
as separate conditions) may not have helped here. We
are encouraged to view autism as a spectrum of
difficulty but, when so much is pooled within the same
pond, the danger is individual experiences can be over
looked.
The other issue that may be contributing to
misconceptions and reduced research attention on
females and autism, is the theory that autism is
influenced prenatally by testosterone leading to an
extreme male brain (EMB) [22]. However, while this
has predisposed many clinicians to think of autism only
as a predominantly male disposition, it has also meant
they have missed’ the signs of autism in females and
given, due to their bias of thinking autism is the result
of an EMB, a mental health diagnosis instead.
Research has shown that although there is some
evidence that an EMB may impact autism in females,
this is not the case for males in autism [23], and how it
impacts on the female brain is still being debated.
For example, research by Carter et al. [6] shows
female toddlers with autism being less socially
competent than the boys. They are also better at non-
verbal problem-solving than the boys.
The findings revealed a statistically
significant interaction between child sex
and cognitive domain (verbal versus
nonverbal) and child sex and the 5 Mullen
Scales of Early Learning (Visual
Reception, Fine Motor, Expressive
Language, Receptive Language, and
Gross Motor), indicating that girls and
boys with ASD show different cognitive
and developmental profiles. Consistent
with the expectation that boys would show
more advanced development, boys
evidenced stronger verbal and motor
skills, particularly once differences in
visual reception were covaried. Controlling
for language level, girls evidenced
significantly stronger skills in visual
reception, or the nonverbal problem-
solving domain. In addition, boys were
described as having more advanced social
functioning than girls.” P. 94.
As Bjorne [24] has pointed out:
This all runs contrary to Baron-Cohen's
idea of the male brain. Or, if you wish, the
girls are more male than the boys. Given
the fact that there are so very few studies
addressing the cognitive profiles of autism
from a gender perspective, it is important
that the popular accounts are modified
somewhat by more rigorous studies
Personal Communication.
If we look at the profile for many females, it seems
they may not have the same communicative difficulties
which typically trigger investigation into a potential
diagnostic referral for males.
Females on the spectrum often experience
Alexithymia. This means describing how they feel in
social situations is hard and this may lead to an
increase in their level of avoidance behaviours such as
complaints of headaches, stomach aches or incidents
of school refusal.
Autism is known to be a communication disorder.
Some females appear to communicate well, having
good eye contact and appropriate body language. Any
discrepancy is likely put down to bad manners, lacking
in discipline, or to the individual being strong willed or
extremely shy. However, the very names we give to
these behaviours should give us a hint that all is not
well. We need to look beyond the behavior and ask
certain questions. For example, is this behavior being
used out of frustration due to not comprehending social
norms; social expectations or processing social
‘instincts’?
In cognitively challenged female individuals with a
low IQ, autism operates at the severe end of the
spectrum and is rarely questioned. But, in high
functioning female individuals the double X
chromosome often gives them the feminine ability to
mask their difficulties; copy behaviour in social settings
that suggests they have an understanding and the true
nature of the effort this takes is not seen. Therefore,
when they appear not to understand or exhibit
‘challenging behaviour,’ they are thought of as being
naughty, difficult or attention seeking. How do these
females who society expects to be socially competent,
cope in a world that expects them to be able to read
body language, be friendly, sociable and happy in a
group, understand the hidden curriculum (the unspoken
rules of human interaction) and perform in society at
the expected level, manage their daily lives?
92 Journal of Intellectual Disability - Diagnosis and Treatment, 2017, Volume 5, No. 3 Wenn B. Lawson
With answers also not reflecting a deeper social
understanding, providing only a basic understanding,
lacking in social comprehension, cognition and
awareness as seen in their peers of typical developing
age, it must take significant courage to simply attempt
these interactions.
According to Attwood [5] girls fly under the radar as
they learn to develop coping mechanisms, may have
the ability to mask their social inadequacies through
copying or mimicking those around them and often
have passionate interests that are in line with typically
developing females. They also are more able to learn
and adhere to the social rules, learning acceptable
behaviours for certain situations. This is effective in
many situations, but often negatively affects the mental
health of many girls, with an increase in anxiety due to
the fear of rejection.
Girls become women and the expectations on
women only increase with social expectations
becoming highly complex.
Marshall [25] suggests the cultural expectations for
females to participate in social communication such as
chit-chat, small talk and gossip, is exhausting for those
with high functioning autism. There is also a lack of
social understanding which leads to confusion around
things such as teasing, bullying and bitchiness often
displayed by typically developing teens. Many high
functioning female teens on the autism spectrum prefer
to have their one, or select small group, of friends and
become anxious in large group situations. Facial
expressions of this group may not match their moods,
often saying they are fine and looking happy on the
outside but withdrawing internally. Females also tend to
be more passive-aggressive in their behavior and use
avoidance as a way of coping with the social demands
placed upon them. They may also blame others,
internalize their feelings or develop co-morbid
conditions such as anxiety, depression, eating
disorders or hyperactivity. As well as not being able to
communicate with their peers, this group also struggles
to understand the hierarchies within a societal structure
and can get into trouble with adult’s due to the way
they speak with them.
Nichols, et al. [16] state girls on the spectrum
present subtle differences in their behavior, when
compared to their typical peers. For example, they are
often able to answer questions about social situations,
social communication and friendships but are slower to
process the information. This would present great
difficulty in understanding the conversations that go on
between teenage girls within a group situation. Girls on
the spectrum often struggle at school in the
unstructured social play time. They may want to have
friends but lack the ‘innate’ knowledge and skills to
make and keep them [5]. Girls with autism are often
excluded from play and the social play that happens at
school, meaning they then miss out on the necessary
skills to help shape their identity [12].
If having difficulty navigating the teenage years is
hard for typically developing children how much more
so is it for girls with high-functioning autism? [25, p.37]:
Girls on the autism spectrum are more
likely to come to the attention of health
professional’s due to difficulties with
anxiety, depression, eating disorders,
behavioural problems and/or social skills
challenges. The presenting problem then
becomes the ‘diagnosis’, with the larger
picture and explanation for feeling
“different” being missed”.
Yaull-Smith [26] suggests girls with autism have a
desire to please and fit in which makes them:
hypersensitive to the environment,
vulnerable and easily manipulated, so they
are conditioned to conform to the social
norm but, as a result risk losing a sense of
identify- not least because social etiquette
and mores change and develop over time
and because a large part of conformity for
girls, in particular, is to please others (p
30).
As a result of being a girl on the spectrum and also
having to contend with the societal pressures placed
upon girls throughout the teenage years, their physical,
mental and emotional health suffers. This road is often
fraught with difficulty, misunderstanding and anxiety for
the girl involved. It is important that for parents of girls
on the spectrum they provide space, a place of safety
within the home for the young person to feel they can
truly be themselves and to always show respect and
love towards them. A colleague of mine, in
conversation, suggested that during this time, role play,
meditation, yoga and understanding as well as
teaching the understanding of social communication
along with their feelings, could offer some support.
In many societies women are expected to marry,
have a family, run a household and often some form of
Women & Girls on the Autism Sp ectrum Journal of Intellectual Disability - Diagnosis and Treatment, 2017, Volume 5, No. 3 93
employment too. The DSM-5 [2] for the first time,
includes sensory issues in the criteria housing autism.
Women must face many challenging changes to their
bodies, including menstruation, growing through
puberty into the curves and shapely form of
womanhood. The expectation is ‘she will cope. It’s
natural, it’s happened to all women since time began,’
and so on. But, if an individual can’t cope with these
changes, the different smells, feelings and
expectations, they may decide these won’t happen to
them. I have met females who decide not to grow up,
so they continue to act like a child, stop eating to
restrict their growth and employ any other behavior
they believe will keep them from such a fate.
Then there’s the issue of sexuality and keeping
safe. For some female’s this is a major issue. Some
have little understanding of sexual etiquette, even if
they have a normal IQ. The literal, black and white
thinking processes in autism might mean if someone
says: ‘can you have sex with me’ the person may reply
‘yes’ because they perceive the question to mean ‘is it
possible for you to have sex with me?’ This is literal
thinking that fails to negotiate the bigger picture.
An edited summary of some issues for females on
the autism spectrum offered as, truth or myth.
Given to me by Katy Reid, a parent to two autistic
daughters.
1 She’s too social to be autistic’ because she
has friends or wants to have friends so she can’t
be autistic - MYTH
2. She looks at me when I speak to her, so she isn’t
autistic- MYTH. Girls may have good eye contact
3. Girls follow the rules less likely to act out due
to need to please others (Often True).
4. Girls will mimic others so they blend in but, their
difficulties are often overlooked because of this
(Often True).
5. Girls may find communicating their feelings
unavailable to them and will become mute within
the classroom - TRUE
6. Girls may not want to be the center of attention
or have the spotlight on them - TRUE
7. Girls may have a love of technology, horses,
animals, and friends - TRUE
8. Girls may live their lives through others and find
personal autonomy allusive - TRUE
9. Girls live with severe anxiety (Often True)
10. Girls often have performance issues and won’t
settle for less than perfect (Often True)
11. Girls may be unable to stop certain behaviours
such as having to twirl or spin. They may pick at
their fingers, scrunch up their toes or face or
have to twitch, all seemingly involuntary (Often
True)
12. Girls may need to tune into their cues and follow
strictly to know what comes next (Often True)
13. Girls may find it difficult to process lots of
information at once. They need to do one thing
at a time (Often True, unless connected to
interest)
14. Girls need consistency, structure and continuity
(Usually True)
15. Girls exhibit rigid behaviours and resist change -
TRUE
16. Routine is very important to girls and if it
changes they need to have this visually
explained or written down - TRUE.
17. Girls find body language and facial expressions
difficult to read - TRUE.
18. Girls often have an inability to understand jokes
or make jokes that others don’t understand -
TRUE
19. Girls need to have others explain, in many
different ways, what is happening and how
things work (Often True)
20. LOTS and LOTS of questions about life are often
repeated and answers may fail to make sense
(Often True)
21. Girls show an inability to move on and let
negatives go, they fixate on things and don’t
know how to process them or let it go (Often
True)
In school Girls are often missed as they appear to
be conforming. The teachers and professionals don’t
see the issues that are going on at home, the lack of
94 Journal of Intellectual Disability - Diagnosis and Treatment, 2017, Volume 5, No. 3 Wenn B. Lawson
sleep, the outbursts, the lack of understanding.
Professionals would benefit from listening to the
parents and parents benefit from taking notes and
documenting what is happening [27-30].
The above is a tentative outline of what may be
happening for females on the autism spectrum. It is not
exhaustive or complete by any means. Not all females
will fit every aspect of the above descriptions.
When an autistic individual is interested, GAMMA is
enabled [31] and autistic females (like the males) are
motivated to do more than they might do otherwise.
Utilizing interests and strengths is the best way forward
in autism. Finding ways to explore the hidden
curriculum of any social society is made so much
easier and available when individuals can access it via
their interests. When individuals on the spectrum are
not interested, motivation is switched off. Working
together within individual interest is the remedy for this.
It is imperative professionals consider autism in girls as
an option, rather than only diagnosing various mental
health issues. Of course, these can co-occur, but may
not be the foundational issue so much as a secondary
one.
It seems that whatever one’s gender if the individual
is ‘somewhere’ on the spectrum of autism their thinking
and problem-solving abilities differ from that of the
typical world. However, just because one is different or
arrives at an understanding by taking a different rout,
this doesn’t mean there isn’t value in their processing
or problem-solving attributes. It makes no sense to say
just because they didn’t do it typically, the way they did
something is wrong. But, if females are losing
confidence, failing to thrive, appear to have a thought
disorder, are being very literal, showing signs of
demand avoidance and so on, the professional should
consider the wider option of an autism assessment.
Autism presents in all genders across the human
condition and is not only a male prerogative.
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HELPFUL WEB SITES
https://t aniaannmarshall.wordpress.com/2013/03/26/moving-towards-
a-female-prof ile-the-unique-characteristics-abilities-and-talents-of-
asperwomen-adult-women-with-asperger-syndrome/
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https://www.youtube.c om/watc h?v=i4zMeIZfU-s
https://www.youtube.c om/watc h?v=IvhiW7ilTDk
Received on 26-08-2017 Accepted on 20-09-2017 Published on 17-10-2017
DOI: https://doi.org/10. 6000/2 292-2598.2017.05.03.4
© 2017 Wenn B. Lawson; Licensee Lifescience Global.
This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License
(http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in
any medium, provided the work is properly cited.
... In recent publications, including by the author [27], the words masking and camouflaging are used to explain why females on the spectrum have remained invisible, and do not figure in either historical or recent statistics. Initially, it was reasoned that they failed to show in the data because autism was predominantly a male condition [28]. ...
... Unfortunately, though, in the longterm, these behaviours and strategies which lead to females remaining unidentified as autistic, can often lead to their mental health being negatively impacted. As a result, females are more often misdiagnosed with other issues such as depression, personality disorders, social phobia, eating disorders and anxiety disorders, than are autistic males [27,31,32]. They are also much more likely to have these as comorbidities [27]. ...
... As a result, females are more often misdiagnosed with other issues such as depression, personality disorders, social phobia, eating disorders and anxiety disorders, than are autistic males [27,31,32]. They are also much more likely to have these as comorbidities [27]. This could mean the psychological issues may be noticed and treated, but the underlying autistic cause may not be addressed, compromising the ability to create sustainable and positive mental health and identity outcomes. ...
Article
Full-text available
This paper highlights the role of terminology, such as camouflage and masking, commonly used in autism research. The author suggests researchers question assumptions around language commonly used to check it is fully representative of the autistic position. Being autistic often means being very literal. This literality means it is very important for researchers-particularly non-autistic researchers-to design research questions in a way that will gather accurate information often underlying autistic understanding. Words are powerful tools and lead to beliefs and positions held. Adaptive morphing in autism (currently referred to as camouflage or masking) infers a response, not of deceit, but one that is biological and not necessarily chosen. The author of this paper suggests masking, as a choice to deceive, is quite different from adaptive morphing for safety.
... Los estudios sugieren que las mujeres TEA analizan los comportamientos sociales de los demás y encuentran formas de enmascarar su autismo. Estas formas de "camuflaje" pueden funcionar como factor protector a nivel social, pero contribuyen al infradiagnóstico si estas mujeres se encuentran con profesionales que consideran que no cuadran en el perfil esperado, es decir, pasan "por debajo del radar" (Lawson 2017;Zener, 2019). Estos intentos de camuflar su condición pueden traer también otras dificultades como problemas de identidad ("no sé quién soy realmente"), elevados niveles de ansiedad y una enorme fatiga, que hace que en muchas ocasiones prefieran o necesiten estar a solas para liberar la sobrecarga Westwood, Mandy, Simic y Tchanturia, 2018). ...
... Las chicas con autismo tienen un alto deseo de complacer y de encajar, por lo que son hipersensibles a las demandas del entorno y fácilmente manipulables, con elevados deseos de cumplir las normas sociales (Lawson, 2017;Yaull-Smith, 2008). En este contexto no es infrecuente que algunas pacientes con el doble diag-nóstico nos cuenten en consulta que éste fue uno de los detonantes de su trastorno alimentario: el deseo de encajar en una sociedad que ensalza la delgadez guiadas por el pensamiento mágico que dice que una vez sean delgadas, serán aceptadas y todos sus problemas se solucionarán. ...
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La relación entre el Trastorno del Espectro Autista (TE) y la Anorexia Nerviosa (AN) ha suscitado un creciente interés dadas las altas tasas de comorbilidad y la necesidad de adaptar los tratamientos existentes a esta población, ya que presentan peores resultados en los tratamientos estándar para el trastorno de conducta alimentaria. En este artículo se realiza una revisión descriptiva de diferentes aspectos relacionados con los TEA y la AN tratando de ofrecer una perspectiva sobre el tema que pueda ser de utilidad para la práctica clínica. En él se abordan aspectos epidemiológicos y perfiles neuropsicológicos, se profundiza en las parti-cularidades del diagnóstico en estos casos y se exponen las propuestas de tratamiento. Abstract The relationship between Autism Spectrum Disorder (ASD) and Anorexia Nervosa (AN) has raised a growing interest given the high comorbidity rates and the need to adapt existing treatment to this population, since they present worse results in standard treatments for eating disorders. In this article, a descriptive review of different aspects related to ASD and AN is carried out, trying to offer a perspective on the topic that may be useful for clinical practice. It covers epidemiological aspects and neuropsychological profiles, deepens the particularities of the diagnosis in these cases and presents treatment proposal.
... Como ya hemos mencionado, los Trastornos del Espectro Autista (TEA) no han estado hasta ahora en el foco de atención de la Antropología, por lo que para poder contextualizar y construir buena parte de nuestro trabajo hemos tenido que acudirsiempre con una mirada crítica a fuentes bibliográficas y documentales de la Psicología, al ser esta disciplina la que cuenta con los profesionales e investigadores más vinculados al estudio del Autismo y Asperger. Para ello hemos consultado las obras de Artigas-Pallares et al. (2012), Cowhey (2005), Cuxart & Fina (2001), Lawson (2017, Lahoza (2013), Belinchón et al. (2008) o Barthelemy et al. (2005). Además contaremos con la visión de psicología andrógina que plantea Sandra Bem (1974) y que Aguíñiga y Sebastián (1987) revisan. ...
Thesis
Many women with Asperger Syndrome get older without an accurate diagnosis. Receiving an adequate and early diagnosis offers the possibility of continuing the life cycle with a better quality of life and being aware of one’s own support needs. Until now, anthropology has not turned its attention to the situation of women affected by this syndrome, and even less to the difficulties they face in the process of diagnosing it, usually in conditions of inequality with respect to those affected by men. To carry out this investigation we have counted on the testimonies of women (with Asperger Syndrome) and their families, and of psychologists related to the autistic field.). We will account for the interconnections that exist. Key words: Anthropology, Asperger, Late diagnosis, Discrimination, Gender.
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One of the most consistent findings in autism spectrum disorder (ASD) research is a higher rate of ASD diagnosis in males than females. Despite this, remarkably little research has focused on the reasons for this disparity. Better understanding of this sex difference could lead to major advancements in the prevention or treatment of ASD in both males and females. In October of 2014, Autism Speaks and the Autism Science Foundation co-organized a meeting that brought together almost 60 clinicians, researchers, parents, and self-identified autistic individuals. Discussion at the meeting is summarized here with recommendations on directions of future research endeavors.
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This article presents the findings of ethnographic case studies of three girls on the autistic spectrum attending mainstream primary schools and illustrates the difficulties they experience and the ways in which these are often unrecognised. The observations of the girls and subsequent individual interviews with their mothers, class teachers, SENCO’s and ultimately themselves, reveal the personal adjustments the girls make in response to the hidden curriculum and the ways in which these go unnoticed, effectively masking their need for support, and contributing to their underachievement in school. The research also identifies a misunderstanding of autism in girls by some teachers that contributes to a lack of support for their needs, despite their diagnosis. Teachers need to understand how autistic girls present, and how they learn, if they are to recognise the need to illuminate the hidden curriculum. The implications of these findings are that without this awareness autistic girls in mainstream settings are also at risk of limited access to the known curriculum and of social isolation.
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Biological causes underpinning the well known gender dimorphisms in human behavior, cognition, and emotion have received increased attention in recent years. The advent of diffusion-weighted magnetic resonance imaging has permitted the investigation of the white matter microstructure in unprecedented detail. Here, we aimed to study the potential influences of biological sex, gender identity, sex hormones, and sexual orientation on white matter microstructure by investigating transsexuals and healthy controls using diffusion tensor imaging (DTI). Twenty-three female-to-male (FtM) and 21 male-to-female (MtF) transsexuals, as well as 23 female (FC) and 22 male (MC) controls underwent DTI at 3 tesla. Fractional anisotropy, axial, radial, and mean diffusivity were calculated using tract-based spatial statistics (TBSS) and fiber tractography. Results showed widespread significant differences in mean diffusivity between groups in almost all white matter tracts. FCs had highest mean diffusivities, followed by FtM transsexuals with lower values, MtF transsexuals with further reduced values, and MCs with lowest values. Investigating axial and radial diffusivities showed that a transition in axial diffusivity accounted for mean diffusivity results. No significant differences in fractional anisotropy maps were found between groups. Plasma testosterone levels were strongly correlated with mean, axial, and radial diffusivities. However, controlling for individual estradiol, testosterone, or progesterone plasma levels or for subjects' sexual orientation did not change group differences. Our data harmonize with the hypothesis that fiber tract development is influenced by the hormonal environment during late prenatal and early postnatal brain development.
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Due to the predominance of boys diagnosed with autism spectrum disorders (ASD), girls are rarely studied independently. Research specifically focusing on play and social-communication in girls with ASD is extremely varied. We were interested in whether girls with ASD demonstrated equivalent social-communication and play skills in early childhood relative to boys, using two measures focused on the specific quantification of these variables. We also examined whether the associations between developmental variables and social-communication and play differed by gender. Forty girls with ASD were individually matched to 40 boys based on ASD severity. Our results suggest that girls and boys were more similar than different, however they also raise questions about the potential differential associations between development and requesting ability in girls and boys with ASD.
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In autism, heterogeneity is the rule rather than the exception. One obvious source of heterogeneity is biological sex. Since autism was first recognized, males with autism have disproportionately skewed research. Females with autism have thus been relatively overlooked, and have generally been assumed to have the same underlying neurobiology as males with autism. Growing evidence, however, suggests that this is an oversimplification that risks obscuring the biological base of autism. This study seeks to answer two questions about how autism is modulated by biological sex at the level of the brain: (i) is the neuroanatomy of autism different in males and females? and (ii) does the neuroanatomy of autism fit predictions from the 'extreme male brain' theory of autism, in males and/or in females? Neuroanatomical features derived from voxel-based morphometry were compared in a sample of equal-sized high-functioning male and female adults with and without autism (n = 120, n = 30/group). The first question was investigated using a 2 × 2 factorial design, and by spatial overlap analyses of the neuroanatomy of autism in males and females. The second question was tested through spatial overlap analyses of specific patterns predicted by the extreme male brain theory. We found that the neuroanatomy of autism differed between adult males and females, evidenced by minimal spatial overlap (not different from that occurred under random condition) in both grey and white matter, and substantially large white matter regions showing significant sex × diagnosis interactions in the 2 × 2 factorial design. These suggest that autism manifests differently by biological sex. Furthermore, atypical brain areas in females with autism substantially and non-randomly (P < 0.001) overlapped with areas that were sexually dimorphic in neurotypical controls, in both grey and white matter, suggesting neural 'masculinization'. This was not seen in males with autism. How differences in neuroanatomy relate to the similarities in cognition between males and females with autism remains to be understood. Future research should stratify by biological sex to reduce heterogeneity and to provide greater insight into the neurobiology of autism.
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Four times as many males are diagnosed with high functioning autism compared to females. A growing body of research that focused on females with autism spectrum disorder (ASD) questions the assumption of gender invariance in ASD. Clinical observations suggest that females with ASD superficially demonstrate better social and emotional skills than males with ASD, which may camouflage other diagnostic features. This may explain the under-diagnosis of females with ASD. We hypothesised that females with ASD would display better social skills than males with ASD on a test of friendship and social function. One hundred and one 10- to 16-year-olds (ASD females, n = 25; typically developing (TD) females, n = 25; ASD males, n = 25; TD males, n = 26) were interviewed (using the friendship questionnaire (FQ)) with high scores indicating the child has close, empathetic and supportive relationships. One parent of each child completed the FQ to assess whether there are differences in perception of friendships between parents and children. It was found that, independent of diagnosis, females demonstrated higher scores on the FQ than males. Further, regardless of gender, children with ASD demonstrated lower scores than TD children. Moreover, the effect of ASD was independent of gender. Interestingly, females with ASD and TD males displayed similar scores on the FQ. This finding is supported by clinical reports that females with ASD have more developed social skills than males with ASD. Further research is now required to examine the underlying causes for this phenomenon in order to develop gender-appropriate diagnostic criteria and interventions for ASD.
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This study investigates the experiences of adolescent girls with autism spectrum disorders (ASD) during adolescence. Semi-structured interviews were conducted with three mother-daughter dyads and two additional mothers. A range of issues were highlighted covering physical, emotional, social and sexual domains. Some of these issues were similar to those experienced by boys with ASD during adolescence, such as negative implications of late diagnosis, challenges of transitioning to and coping with high school, 'hands-on' role of parents into adolescence, difficulties adjusting to the increased demands of adolescent hygiene routines, and the importance of learning personal boundaries in interactions with others. Other issues discussed were of particular relevance to adolescent girls with ASD, such as difficulties socialising with neurotypically developing girls, sex-specific puberty issues, and sexual vulnerabilities. This study highlights an important research area and is a preliminary step towards understanding the experiences of adolescent girls with ASD and their families.
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Asperger syndrome is one of the pervasive developmental disorders, diagnosed behaviorally and characterized by social impairments and rigid and repetitive interests or behaviors paired with relatively preserved cognitive and verbal facilities. This chapter describes the diagnostic concept and the clinical manifestation of the disorder, as well as guidelines for diagnostic assessment and intervention. Existing research is reviewed within the areas of epidemiology, etiology and pathophysiology, treatment and intervention, and outcome. In closing, future directions for treatment and research are discussed.
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Introduction The pathophysiological basis for repetitive and stereotyped interests in autism spectrum conditions (ASC) has been related to difficulties with shifting attention. For example, to engage socially depends upon being able to attend (note) the physical, cognitive, emotional and sensory aspects of ‘self’ and of ‘other’. Exchanging information from divided attention (broader interests), depends upon GAMMA connectivity. GAMMA connectivity is powered down in ASC, but this can be remediated artificially or by using individual ‘interest’. The aim of this critical review is to discuss the pathophysiological basis for inattention and the new Diagnostic and Statistical Manual of Mental Disorders related to ASC. Conclusion Repetitive, single and focused ‘interests and behaviour’ in ASC are more to do with how attention is processed and less to do with lacking in ‘theory of mind’.
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Background This study examines the social relationships of elementary school children with high-functioning autism, focusing on how gender relates to social preferences and acceptance, social connections, reciprocal friendships, and rejection.Method Peer nomination data were analyzed for girls with and without ASD (n = 50) and boys with and without ASD (n = 50). Girls and boys with ASD were matched by age, gender, and IQ. Each child with ASD was matched by age and gender to a typically developing classmate.ResultsConsistent with typically developing populations, children with ASD preferred, were accepted by, and primarily socialized with same-gender friends. With fewer nominations and social relationships, girls and boys with ASD appear more socially similar to each other than to the same-gender control group. Additionally, girls and boys with ASD showed higher rates of social exclusion than their typically developing peers. However, boys with ASD were more overtly socially excluded compared to girls with ASD, who seemed to be overlooked, rather than rejected.Conclusions Our data suggest a number of interesting findings in the social relationships of children with ASD in schools. Like typically developing populations, children with ASD identify with their own gender when socializing and choosing friends. But given the social differences between genders, it is likely that girls with ASD are experiencing social challenges that are different from boys with ASD. Therefore, gender is an important environmental factor to consider when planning social skills interventions at school.