ASD signs & gender

Trogluddite said:

My apologies - I did indeed misread what you intended by "tidy".

I do not think it was so much a case of you having “misread” what I meant by “tidy” ~ as I had failed to give it the appropriate contextual relevance, so sorry for that as that was actually my failing in that respect.

Trogluddite said:

And whatever criticisms I might have, I certainly welcome concrete examples of current research.

Likewise, very much.

Trogluddite said:

Indeed, I take a keen interest in your posts for both the sources you link to and your own insightful analysis of their cont

I find everyone’s posts and insights equally intriguing ~ with yours being for my tastes particularly good in terms of writing style and post length.

My apologies - I did indeed misread what you intended by "tidy". And whatever criticisms I might have, I certainly welcome concrete examples of current research. Indeed, I take a keen interest in your posts for both the sources you link to and your own insightful analysis of their contents.

To suggest an epistemic injustice in diagnosis, is not equivalent to suggesting a female semiotic signifier.

I am not sure where your assertion that there are two presentation groupings originates - perhaps you could provide a link?

Given the heterogeneous nature of autism - and its presentation - I would argue that there are numerous presentations.

The epistemic injustice I refer to consists of an unjust deficit of credibility owing to gender prejudice. This is not the same as referring to a semiotic signifier.

There is also a hermeneutical marginalisation due to the under representation of the lived experience of a large contingent of the autistic population. Where requisite concepts are not sufficiently communicated and thereby result in hermeneutical injustice.

I would further suggest it is the semiotic signifiers of ‘empathy’, ‘social interaction’ and ‘aloofness’ that are to blame for the misdiagnosis of many women, not the referencing of these signifiers.

I accept that the gender bias goes back all the way but believe we are merely compounding the error. From a linguistic/semiotic perspective, by labelling one presentation type as female you have created a signifier that epitomises potential confirmation bias, i this case both consciously and subconsciously.

We know that there are two presentation groupings - we know the historical information for the gender bias in diagnostic number -for that exact same reason the second presentation group became known. We know that despite each presentation type having a far larger preponderance of one gender making up its members - neither is gender exclusive. 

To therefore label either presentation with a gender signifier is then just factually inaccurate and misleading.

That the majority of individuals presenting with type a = Male & type b = female  is not doubted but given what er know about the history that may well be precisely because of this conceptualisation of gender.

It is the presentation of sufficient indicators that determine diagnosis, of either type - gender not being a criterion.     

Trogluddite said:

But surely this highlights exactly the point that I was getting at (and I presume Vervain also). The diversity of autism expression is anything but "tidy". Or to put it more strongly; hardening of the categories excludes those who don't fit neatly into the pigeon-holes.

I did not mean that the answer given to the question was tidy in summing it all up but tidy as a single facet of a multifaceted consideration, i.e., one of many perspectives to ponder, as the question I responded to was about research, so I gave two examples, and a sociological frame of reference to consider the matter from as well perhaps ~ without exclusions of or for any other frames of reference.

The gendering of autism has existed since its earliest clinical descriptions, and has more recently been compounded by Simon Baron-Cohen’s “extreme male brain theory.” Feminist scholars have rejected this as gender stereotyping masquerading as science.

The effect of excluding female narratives from autism studies has resulted in the under diagnosis of autism and inappropriate diagnoses of social anxiety, bipolar disorder and schizophrenia.

The persistence of the myth that autistic individuals lack ‘theory of mind’, together with the addition of the intersectionality of gender clichés, has only exacerbated clinical misdiagnosis.

Given the higher than average occurrence of trans and non-binary individuals among the autistic community (40% by some estimates) the notion that autism is a mainly male condition is being increasingly questioned.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546643/

Deepthought said:

And the following answer to the question is methinks very tidy indeed

But surely this highlights exactly the point that I was getting at (and I presume Vervain also). The diversity of autism expression is anything but "tidy". Or to put it more strongly; hardening of the categories excludes those who don't fit neatly into the pigeon-holes.

The above hypothesis is certainly a very convincing explanation for the phenemonon of sex disparities in diagnosis, and may well be the most prevalent cause. Indeed, I subscribe to it myself. However, it seems to be becoming an orthodoxy at the expense of a more nuanced picture, and has nothing at all to offer those autistic people such as myself, Vervain, and many others whose expression of autism does not fit the idealised hypothetical cases.

There also seems to be some conflation of sex (biological) and gender (social-identity), which does not seem wise when one is hypothesising about the effects of the social environment, and is likely to exclude autistic people for whom these are not cognate or who's gender identity is non-binary. And there is an implicit assumption that the cultural values, stereotypes, and traditions of western, predominantly Anglo-Saxon, societies can be extrapolated to all autistic people - which is highly questionable (for example, for societies or immigrant communities with less individualistic, honour-bound social traditions).

Additionally, there is the problem that the research relies on cohorts who are already diagnosed by existing formal criteria (a rather confounding circular problem, to be sure). The researchers have also decided in advance that they are looking for sex differences, so their research can tell us nothing about the variances within each sex. Research which finds only what it sets out to look for should always be viewed with greater than usual scientific skepticism, IMHO. The conclusions are not necessarily wrong in broad strokes, but I don't see enough mention of the limitations of their scope, nor what confounding environmental or biological factors require further investigation.

Despite the occasional qualifier thrown in here and there, all three examples are written in language which reinforces the idea of a neat separation between the sexes (or genders, if only the researchers could decide which they mean) which may be distinguished by predictably differing sets of traits. My interpretation of Vervain's post, and the thrust of my own, was precisely to question this "tidiness" and to wonder what negative consequences of it might be carried along with any advantages. Sadly, I am not in a position to conduct such research, but I have spoken to enough autistic people who do not fit the "tidy" hypothesis that I believe it excludes a significant number of people and offers only a partial explanation for many more.

Vervain said:

Is there any research being done on this?

Here is a couple of research based articles worth a ponder:

Girls and Boys with Autism Differ in Behaviour, Brain Structure

https://med.stanford.edu/news/all-news/2015/09/girls-and-boys-with-autism-differ-in-behavior-brain-structure.html

Comparison of Males and Females with ASD: Gender Differences in People with Autism Spectrum Disorder

https://pro.psychcentral.com/child-therapist/2019/11/comparison-of-males-and-females-with-asd-gender-differences-in-people-with-autism-spectrum-disorder/

And the following answer to the question is methinks very tidy indeed:

WHY IS THERE A DIFFERENCE BETWEEN MALE AND FEMALE AUTISM DIAGNOSIS?

Ciel Garza

The short answers are sexism, stereotypes, and conditioning [actually programming].

Girls are typically getting compliance training from moment 1 - something autistic people are particularly vulnerable to. They're gently but firmly pressured to yield to the people around them and not take up too much space.

By contrast, boys are typically encouraged to be rambunctious and loud and draw attention and do things.

As a result, boys tend to:

Stick out more when they're quiet and withdrawn.

Be more vocal about discomfort and quicker to throw a fit

Be more prone to act without considering how people around them will feel

Be more willing to grab the center of attention and infodump

And lots of other things that add up to “display autistic patterns more visibly, and behave in ways that can look like autistic patterns even if they're not.”

By contrast, most of the autistic girls and women I've known have had excellent social toolkits and pretty good neurotypical masks, because those were survival traits. When they slipped, their problems were more likely to be attributed to personal failure. Autistic boys tend to the path of “make it unpleasant to make me do unpleasant things,” while autistic girls lean more strongly to “stay off your radar so you don't ask me to do the thing.” Not unlike allistic kids, really.

Further, Asperger's original research, which defined the medical thinking in some deep ways, was primarily on boys. So boys set the patterns that doctors learned to look for.

So girls don't display their symptoms as visibly, and are more likely to actively hide them. So they get referred to doctors less often. And then they fit the expected pattern less, and their social skills look better, so they get diagnosed less. Which feeds perception of it as a ‘boys’ condition’ which means they get referred to doctors less…

https://www.quora.com/Why-is-there-a-difference-between-male-and-female-Autism-diagnoses?share=1

Bravo! - your position makes perfect sense to me. Indeed, I have also cautioned people about stereotyping the diversity of reactions that we display to the friction between our autistic traits and environment. I have no doubt that there is much truth in the hypothesis that the gender biases of wider society influence how autism expresses itself, but this alone is far too simplistic, and shows woeful disregard for personality traits, family background, sexuality, differing cultural traditions, and the diversity of underlying perceptual and cognitive traits which autistic people experience.

I have spoken to many autistic people who identify as male and who's behavioural traits fit the stereotype of "female presentation", and I fit that stereotype very closely myself. It is no surprise to me that most of us were diagnosed later in life, often after decades of misdiagnosis and/or misleading rationalisations for chronic mental health problems - just as many females have experienced. Likewise, I have spoken to autistic people who identfy as female, yet who more closely fit the traditionally recognised "autistic behaviours" (itself a flawed concept, IMHO - our internal perceptions and cognition may be innately "autistic", but behaviours are always mediated by environment).

I am all in favour of research into why females, or members of any other demographic, are under-represented amongst those diagnosed with autism; but it is vital that such research is not systemically biased by a-priori assumptions about how autism might manifest itself in members of those groups.

It does a disservice to all autistic people to merely replace one set of stereotypes with another.