Published on 12, July, 2020
With the increase in realisation that many women with autism often receive late diagnosis (often after several misdiagnoses) it seems odd to see the result.ing effects which I worry are repeating the mistakes of the past.We are reiterating the importance of gender as the determining factor of how the condition manifests. My lived experience says otherwise. - indeed by ascribing "autistic gender norms" in reverse you can pretty much summarise my journey to diagnosis. I would argue that there is a different way of interpreting the information that makes more sense to me based on my lived experience and the disparate expressions of gender (in fluidity, rejections of ascribed roles etc) within the community.What is termed Female ASD categorised by Masking, observational assessment leading to trial and error (fake it till you make it approach) is more about extrovert personalities seeking to fit in and adapting seeking to pre-empt and avoid problems leading to internalising challenges where as the signs traditionally observed which led to the current gender imbalance are active external reactions to present internal challenges. Active external reaction/Meltdown vs Inactive external Reaction/Shutdown if we continue to gender the two main presentation types we only see two out of four quadrants of the xy graph.NT Societal understanding of gender roles and associated traits led us to where we are - by thinking about male and female autism we will continue to have late or no diagnoses for those like me who whilst male have the lived experience of "Female" ASD.Is there any research being done on this?Hope that makes sense and interested to hear thoughts.
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
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.