"There are a number of theories that might explain why more men and boys than women and girls get an autism diagnosis," suggests the National Autistic Society.
The NAS rationale, Gender and Autism, is that there are as many autistic females as males but due to difficulties in being recognized and diagnosed large numbers of girls and women "fly under the radar" and miss out on ASD diagnosis.
This theory has become common currency in autistic theory and practice.
Underlying the theory, variously, is that;
This is a lengthy piece looking at current research into a "Female Autism" and despite Francesca Happe in the recent Channel 4 show Are You Autistic? claiming there's "little research in this area" I can promise you there is a mindboggling number of "studies" specific to a "female Autism" phenotype, camouflaging, diagnosis, underreporting, clinicians, etc. Mindboggling numbers of them. So I've merely covered the key 'studies' that the NAS link to and a detailed analysis of a web seminar by William Mandy, one of the key exponents of the Female Autism Phenotype (FAP).
I quote individual women and critique their statements, as all the research ultimately relies on self reporting, and in no way are they meant as personal attacks but merely questioning of the foundations of their thinking on Autism and women.
Whilst I argue that the belief in this uniquely female Autism is simply a confirmation bias on the part of the clinicians discussed I, of course, have my own confirmation bias, that the whole idea is nonsensical. Though the burden of proof is ultimately not on me I'll point out the numerous inconsistencies, confusions and just plain silly assumptions and conclusions inherent in this approach to Autism and women. That's my disclaimer. So what's the evidence for a....
A typical example of these ideas are present in a statement for the NAS by Emily Swiatek co-presenter on Channel 4s recent TV programme, Are You Autistic?:
"Since getting my diagnosis when I was 28, I’ve made it my mission to help raise awareness of autism in women and girls. After all, if I couldn’t spot it in myself after nearly 10 years of working with autistic people, it would make sense that your general person wouldn’t be able to spot it in themselves. The stereotyped narratives we have around autism are still so strong, and the media often reinforces those."
As I argued in a previous post, doesn't anyone else find this odd? You can reach 28 years old (in our current Autistic-aware culture) without someone, including yourself, noticing that you might just have a neurological disorder that severely affects social interaction, communication and imagination? In fact you work with autistic people but still don't recognize their behaviours in yourself? Even stranger, was she masking while unaware for her first 28 years that she was autistic? That makes no sense. Yet she masks now consciously that she's diagnosed?
Of course, the NAS position above on 'female Autism' covers all these bases, even though they often conflict. She wouldn't have known she was autistic because the descriptors describe typical male behaviours, Emily masks her behaviours, her behaviours are invisible so they weren't picked up by teachers, or indeed anyone else, including herself, because she's female, Autism presents differently in her compared to males and to other females who don't mask because they're genetically different for some reason.
Of course, for anyone skeptical of this theory huge questions arise.
I'll get onto masking but first, what are the behaviours unique to female autistics that differentiate them from their male peers? This is a question that haunts me as you can read reams of 'studies,' 'research' (inverted commas for reasons you'll see) personal testimonies, blogs, etc. but all you hear is that females present differently and they learn to camouflage their behaviours. What behaviours?
I've tried to find something on Emily Swiatek, as an example, that describes her autistic behaviours, which she argues she masks. In a piece on buzzfeed, for instance, she tells us:
"“I am quite eloquent, I can chat to people – my job is all about communication and meeting new people every day,” says Emily Swiatek, 29, who was diagnosed with autism spectrum disorder (ASD) last year. “When you look at those surface points, I think [the diagnosis] can be quite hard to understand.”"
Yes. It is hard to understand. If one doesn't fit the descriptors for difficulties in social communication, imagination or interaction, what are the masked behaviours then?
"Before her autism diagnosis, Swiatek accumulated a “rubbish bin” of different diagnosed conditions, including borderline personality disorder, an eating disorder, and anxiety. “There was a point where I had about 10 different diagnoses on my file,” she told BuzzFeed News.
Well, anxiety is a common descriptor used in discussions of 'female Autism' but anxiety itself is not an Autism descriptor, it is a descriptor of Anxiety, the psychological condition that has its own DSM descriptors Generalized Anxiety Disorder. If you're autistic then anxiety is an inevitable co-morbid. But it isn't Autism. Just as Anorexia or depression or personality disorders (for instance, dissociation) are descriptors of personality disorders, depression and Anorexia. Again, very common as co-morbids for Autistics. So what are Emily's autistic behaviours that just didn't fit her diagnoses of eating disorders, etc.?
"Until the signs were finally picked up, Swiatek, who lives in London and has worked as an employment training consultant for an autism charity for four years, was among an unknown number of women in the UK left struggling, sometimes personally and sometimes professionally, without a name for the challenges they face." my italics
What challengers? What signs? What are these signs? Why haven't they got a name?
This piece is quite typical of the discussion of masking and female Autism. On Are You Autistic? no one ever explains what behaviours the women are masking. If they aren't the same descriptors that males experience what are they?
Hannah, for instance, who was diagnosed autistic and researches Autism helpfully explains here what the difference is between male and female Autism...
This is typical of the argument.
To quote: "Females have this natural drive to fit in socially and the symptoms they have aren't stereotypically "autistic" so things like making eye contact, females tend to be OK with, their repetitive and obsessive interests tend to be quite normal things, and also they have this natural drive to fit in socially so they feel more compelled to make friends and try to mimic others to fit in and try and be accepted."
It is, from a biological standpoint, utterly bizarre to suggest that females are biologically programmed to fit in socially better than males. That's just silly. If indeed, women are driven to 'fit in' better then that would have to be gendered. It can't be a natural biological process. In your DNA to be more sociable? That makes no scientific sense. But if it were gendered, that makes no sense either if Autism is characterized by not following socialized (gendered) roles (much more on this below).
But what then are these unique female descriptors? Well, in all discussions we find out what they are not. They are not the typical Autism descriptors of problems in social interaction, eye gaze, behavioural difficulties, communication difficulties. This isn't just that they present differently but that they don't have these characteristics. So what are the female characteristics then? And if they're not all these key autistic descriptors, then why would you have to mask them (or "mimic others" as you already appear like others)?
If obsessive interests are of normal things how does one differentiate that from "normal" (neurotypical) obsessive interests? After all we all do have obsessive interests, right? The usual answer is that autistic people take these interests to extreme lengths. But what is extreme? Aren't all teenage girls obsessed with pop stars or ponies or YA fiction or, I dunno what teenage girls are obsessed with. As a boy I was obsessed with football, but then my brain grew and I became obsessed with art films (I have an encyclopaedic knowledge of Japanese cinema) and literature (I obsessively read through the Penguin classic catalogue...I literally had their paper catalogue). I'm not autistic.
Hannah clarifies what Female Autism is in a blog post at aspie.com:
"I lived for 23 years with no idea of the condition I had in my brain. That condition was Asperger’s Syndrome. I battled through my life with a number of separate psychiatric labels, each representing only small parts of my difficulties: Generalised Anxiety Disorder, Borderline Personality Disorder, Obsessive Compulsive Personality Disorder, Depression... you get the gist. To be given the label of Asperger’s eased my inner conflict massively; I finally had an umbrella term where all these difficulties could make sense."
This is why I'm writing about this subject and find the whole thing so disturbing. Hannah had loads of psychiatric diagnoses then was finally diagnosed autistic. An "umbrella term where all these difficulties could make sense." Except none of those psychiatric conditions meet the descriptors for Autism. It's why they aren't Autism. That's how syndromes (clusters of symptoms) work. Autism is not an umbrella term for psychiatric illnesses. You may well experience these psychiatric conditions if you're autistic but they aren't Autism. If one understands Autism as an umbrella term for a large group of psychiatric conditions you understand nothing about Autism. Autism is not psychological, for a start. Worryingly, Hannah is doctoring in Autism Research and lectures on "The Science of The Mind" yet doesn't appear to realize that Autism is not a psychological condition and her psychiatric conditions are not Autism. I find this unsettling.
This is how the idea of Female Autism works. Autism in women is being redefined to be all these psychiatric conditions rolled into one in a handy bitesized term, Autism. It has nothing to do with Autism because females are biologically different so they experience Autism in a completely different way. Then they mask their symptoms. Symptoms of which, we still have no idea what they are. Can Hannah clarify what these unique 'symptoms' are?
"It is fair to say that my ‘special interests’ are centred more on people than things."
Well, that goes against Autism descriptors. I forget, sorry, this is Female Autism. Where Autism is apparent in being just like non-autistic people.
"One of the ways I have learnt to cope with my impairments is to monitor others around me, and learn how to ‘fit in’ through imitation."
What impairments? Eye contact, social interaction, interest in others, all present and correct. So how is this Autism?
If one acts just like others with eye contact and social interaction what is there to imitate?
"As I have gotten older this has moved into the more complex realm of Psychology, and understanding why people behave the way they do. I figured people are no different really to learning how to use a computer; we all have inputs and outputs. I tackle my own thoughts, feelings and behaviours with the same sort of obsessive rigour as scientists trying to find a particular vaccine in the midst of a pandemic, which is how I ended up doing a PhD studying autism in females."
What? I can guarantee I have no USB ports and I still have no disc drive, HDMI or headphone jack. Computers, humans, is a silly analogy. We're nothing like computers. We have feelings, emotions, thoughts, behaviours, a part of our brains is like computers. Scientific rigour?
What are these female autistic behaviours?
"I wanted to know if I was alone, why it took me so long to get a diagnosis, and how I had managed to adapt so well socially despite my impairments. What I have learnt so far is that there are hundreds of females out there in the same position as me, all wonderfully unique and kind human beings with bucket loads of empathy; not what the media teaches us autistic individuals look like!...The condition lends itself to quite an egocentric perspective, so I am having to consciously think ‘can I really speak for everyone here?’ and learn about the different experiences other people with autism have had."
What impairments? Yes, speak for everyone. Tell us about these impairments that aren't the same as male autistics.
"Whilst the majority of feedback I have received from the work has been positive, it appears you cannot become too big on the internet before trolls start attacking you, which has been the hardest hurdle to face. Being told by people who do not know you and have only read an article that you are a fraud and cannot possibly have the condition hurts, especially when you came to the club quite late and have lived with those doubts all your life. If the research was not so personal to me then perhaps I would be able to take these knocks on the chin, but that is the nature of the beast."
Well I don't mean to sound like an evil troll and I wouldn't say a word if you could just describe your behaviours that define your Autism so that I have an understanding of what you're talking about. Dear Hannah, I've read your blogs and you suggest you have no difficulties with eye contact, you're sociable, in fact the only thing you describe at length is meltdowns and they aren't an Autism descriptor, I don't even know what they are because the way you describe them is that you get very tired and upset. I'm not personally attacking Hannah, I'm not trolling, I genuinely want to know what her impairments are that she masks.
One can go to her blog aspertypical and really she's making her own bed by having posts on the anxiety of travelling, her "toddler style tantrum" meltdowns, how mindfulness is stressful. Is this Female Autism?
And when she does write on Female Autism we get her own study Understanding the Research: Undiagnosed Autism Spectrum Disorder in Women where we get some students taking the AQ (Autism Quotient) screener and the EQ (empathy Quotient) which isn't used as a screener and she found:
"Lots of females who scored above the criteria but who didn’t have a diagnosis! More specifically about 8.7% of the females we tested, compared to 6.5% of the males. [sic]"
I get 45 out of 50 on the AQ. So. It means nothing. Self reporting isn't science, of course. The EQ would skew any data anyway, assuming that the women and men involved followed "typical" gender patterns (women are more empathic than men...socially gendered, not biologically).
She writes a post An informal rant about individual differences in autism and why the extreme male brain theory should be axed in which she irrationally argues:
"I think the fundamental problem of why we cannot understand the difference between males and females with autism is because we look at the condition as a overriding layer of a person’s self, and do not consider that whilst this does colour a lot of our thinking and behaviours, there is still the influence of personality, external inputs such as society, gender, past experiences, birth order, star signs, past lives (too far!?)."
We should diagnose people autistic by looking at their individual personalities and wider sociology? That really makes no sense. You can't diagnose people based on their own personal characteristics. That really is meaningless as star signs. Imagine defining depression individually by personality rather than descriptors. Happy depressives?
Aha, indeed, she clarifies this:
"The point is we are all individual and unique already, and the autism mixes in with that. For example, when you see two people experiencing depression they may appear nothing alike."
Wow. If you can't work out the difference between depression descriptors and a person's individual personality then we really really are in trouble if you're teaching The Science of the Mind. I mean, depression is always characterized by low mood, low motivation, sleep disturbance, etc. It varies by severity in degrees but you can't be a happy outgoing depressive, right? But you can be an outgoing Autistic with none of those pesky male-centric descriptors apparently:
" This is why we become stuck with the very strict criteria of what autism is and what it looks like. We have a set off core symptoms that should be found in anyone with autism (social communication problems and restricted and repetitive behaviours), our mistake is to believe that these should look the same in everyone. "
What? How can a symptom or descriptor look different in different people? Severity can be different but the actual symptom will be the same.
"It would be a much easier diagnosis if they did, but can we say that just because someone makes good eye contact they cannot be autistic? "
Yes.
"No, because there are many factors that make people more or less prone to make eye contact. The impairment is with social communication as a whole, and this may be something a person struggles with internally more than externally."
Difficulties with eye contact is a core descriptor. If you do make typical eye contact there's no reasons why you wouldn't experience socialization in the same typical way. We read other's via eye gaze and eye contact, the reason why Autistics have difficulty understanding others' motivations or thoughts and why social communication is difficult for Auties all stems from difficulties in eye gaze/contact. That is, the difficulties with social communication, interaction and imagination are all directly linked to poor eye contact.
"What happens if you get an extremely extraverted [sic] autistic person? Will this look the same as an extremely introverted autistic person? What if you have an autistic person who has 5 brothers, compared to one who is an only child? Are they able to socialise better with their peers and be less rigid and self-orientated? The point is that impairments can be expressed in hundreds of different ways depending on an individual."
Clearly, distressingly, Hannah doesn't understand what Autism is. Extroverted Auties? What? How can one be extroverted whilst having 'deficiencies' in social imagination, communication and interaction? Autism is characterized by 'social impairments' it doesn't matter if you have 600 siblings. It won't magically make your impairments vanish. This is bizarre. It goes on much in this vain, completely misunderstanding what Autism is, a neurological syndrome not a personality type.
Of course, we still don't actually find out from her blogs what this female Autism manifests as, merely what it isn't. Male Autism. Or autism, as it's generally known.
The whole discussion reminds me, weirdly, of the video game GTAIII and the radio station Chatterbox...no really...Jeff calling in about the Rockford Rally...compare and contrast with the descriptions of Female Autism...
But what is it about, Jeff?
Here's a lecture by Hannah Belcher on Female Autism telling us all the things that Female Autism isn't...
Except oddly at 8:20 she argues that males and females both experience Autism as:
Social and emotional impairments
Language and Communication Impairments
Problems with Flexibility of the thoughts.
Collectively known as the Triad of Deficits or Impairments. In the DSM these are Difficulties in Social Interaction, Communication and Imagination, the core to Autism diagnosis. So how then are women going undiagnosed if they exhibit these same core symptoms (that oddly, Hannah claims she doesn't).
Well because boys present these problems in hyperactivity, "more repetitive stereotypical behaviours" and "more challenging behaviour." Whereas females exhibit "anxiety and depression" and "better socializing ability, friendships, social mimicking and motivation."
So Autism isn't different for women, claims Hannah in this talk. It presents differently. That I would agree with. But this is not what these female Autistics, or indeed the NAS, are arguing. They argue that their Autism is fundamentally different, because it's not the same as male Autism. So which is it? Different Autism or different presentation?
Though then assuming that it presents differently because either Autism in women is different or that women can mimic is problematic as, as ever, how do you know this? If it's from women who have been diagnosed then these same women should experience the triad of impairments. So why, over and over, do those women not discuss those impairments, in fact claim they don't have them, because those are male impairments? Why do they continue to mask them if they don't have them? How do they mask them so well that they "appear normal"? Especially when some women don't mask, for some inexplicable reason.
I completely agree that females present differently to males. This isn't biological, per se, of course, it isn't biologically in me as a male to act more violently, say. In reading on diagnosis the overwhelming suggestion is that young males are referred because of anti-social behaviour at school.
It makes sense when reading Autism descriptors, repetitive interests and behaviours don't fit well with school curriculum. The boy gets frustrated. The boy reacts in anti-social ways. Teachers notify parents, parents see doctors, etc. This should, in theory, be the same for girls, in my argument, though...
Having argued that gender should not affect Autistics as gender is a social construct and as such, Auties should not conform to gender roles because socialized norms are inducted through social interaction, communication and imagination, mostly through our parents and peers, why then Mr Desmoulins would boys be picked up as Autistic and girls not? The obvious answer to the NAS and the above mentioned female Auties is masking. But masking makes no sense for the questions I raise above. A much simpler answer is that it is indeed gendered. However, not in the case of the autistic child.
Society is gendered, school is like a form of hyper-gendered reality where we learn our gendered roles not just socially but in the way the curriculum is set out and most importantly, the way schools engender learning.
Sociologist Pierre Bourdieu argued that girls do better at school because they are taught to be "docile." To Bourdieu docility doesn't just mean conforming to gender roles but that the school system itself is passive (think sitting behind a desk rote-learning) and girls are taught from birth to be passive while boys are taught to be active. While this is mostly socialized it is also quite literally instilled, did your parents not treat you and your siblings differently dependent on your gender?
Even if you're autistic supposedly 'lacking' in typical social skills you will still react like anyone to direct actions and instructions. For instance, typically in the home, boys are more likely to be allowed to go wild, to have more space, to be freer in where and when they roam, many things are unladylike, cliche but still underlying many of our relations with our children/parents. Autistics may not pick up on 'invisible' social cues but typically Autistics have a strong sense of right and wrong, if autistic children are told something is wrong then this they take quite literally. It's wrong for girls to act in certain ways. Like boys, basically. So, whilst autistic individual do not pick up on invisible gender cues (preferring gendered toys, particular dress, etc.) they will, just like us Neurotypicals (NTs) respond to direct gendered instructions (don't make a noise, don't run around like that, etc.).
These gendered differences are most apparent in the school yard (see the Female Autism 'study' below) where gendered home roles are reinforced. Boys dominate space with large scale games, football or large scale "rough and tumble" games, etc. Girls typically congregate in smaller groups, their games are much smaller scale. The boys games are generally organized whereas girls games tend to have less rules and whilst boys play in large groups typically, girls tend to be on the periphary of school playgrounds, often interacting without playing games. It's why typically boys do not communicate emotionally whereas girls learn to through this interaction. Boys tend to be more active, action over thought or emotion. It's therefore quite easy to see why a syndrome characterized by aloneness and confusion of social norms would be far more apparent in boys in this social setting (see study below).
Furthermore, when anyone discusses presentation of symptoms by gender they forget that the autistic child is not the person involved in the observation of autistic 'symptoms.' The NAS single out teachers as not noticing the symptoms in girls and they then, in a post hoc fallacy, assume it must be something in the girls or what the girls do or don't do that makes them go unnoticed. No one thinks that a teacher, well versed in instilling gender divisions in children via the school system, having parents that instilled these gender roles, perhaps having their own children in whom they instil these gender roles, would have internal biases about gendered behaviour. Take into account biology too in the sense that boys are bigger and stronger,it therefore seems logical that the bad behaviour of boys, or unusual behaviour (say not taking part in large scale games like football but standing apart) would be more noticeable to teachers (or indeed parents). It's not that girls hide it, it's that teachers don't recognize it and their own bias.
Proving the point. From a study cited by the NAS, "The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder":
"This study examined the extent to which gender-related social behaviors help girls with autism spectrum disorder to seemingly mask their symptoms. Using concurrent mixed methods, we examined the social behaviors of 96 elementary school children during recess (autism spectrum disorder = 24 girls and 24 boys, typically developing = 24 girls and 24 boys). Children with autism spectrum disorder had average intelligence (IQ ⩾ 70), a confirmed diagnosis, and were educated in the general education classroom. Typically developing children were matched by sex, age, and city of residence to children with autism spectrum disorder."
This is what passes for science in Autism research, someone standing around observing kids playing in a schoolyard (there are other names for this kind of behaviour, of course). But what does this cutting edge research find? Well, it's Female Autism confirmation bias in action. Instead of looking at the way the children were socialized into playing, the 'study' instead ignores sociology completely and argues:
"The results indicate that the female social landscape supports the camouflage hypothesis; girls with autism spectrum disorder used compensatory behaviors, such as staying in close proximately to peers and weaving in and out of activities, which appeared to mask their social challenges. Comparatively, the male landscape made it easier to detect the social challenges of boys with autism spectrum disorder. Typically developing boys tended to play organized games; boys with autism spectrum disorder tended to play alone. The results highlight a male bias in our perception of autism spectrum disorder. If practitioners look for social isolation on the playground when identifying children with social challenges, then our findings suggest that girls with autism spectrum disorder will continue to be left unidentified."
So socialized boys games involve actively taking large spaces in organized groups. And shock horror, autistic boys do not take part in these because to be part of an organized group you would have to learn the socialized rules. They stand out like a sore thumb.
Girls stay in close proximity and weave in and out of activities, usually one assumes then with no organized rules, it's obvious that they would be less likely to be picked up. It has nothing to do with the girls hiding their Autism by masking strategies and everything to do with the way that society is gendered. This is a sociological phenomena where boys control space, girls are hemmed in, in the wider world we see the same actions happen with manspreading.
"The results highlight a male bias in our perception of autism spectrum disorder. If practitioners look for social isolation on the playground when identifying children with social challenges, then our findings suggest that girls with autism spectrum disorder will continue to be left unidentified."
So the bias is in the observer not unique descriptors in the children. Isn't this obvious? This doesn't confirm camouflaging at all, it confirms that boys and girls act differently, play differently and that socialized roles around space dictate that boys are easier to spot.
This is a strange constant self-fulfilling prophecy based on a pre-conceived notion that there is a unique Female Autism confirmation bias. On the Buzzfeed article: "Richard Mills, lead researcher of Research Autism UK, has seen the issue of undiagnosed women on the spectrum come up “again and again” over the years," and clarifies the issues:
"Mills, who previously worked for the NAS, says he became aware of the extent of the problem after conducting a study of women in secure hospital units in the early 2000s. “We found an overrepresentation of undiagnosed autistic women,” he says. “That got us thinking, How many had been missed?”
Woah, stop there. You found lots of undiagnosed autistic women in psychiatric hospitals? You have to be quite disturbed to be placed in secure hospitals, how woulds you untangle schizophrenia from Autism? I'd love to know. After all, for most of Autism's history Autism was considered a form of schizophrenia.
"In 2010, Mills and colleagues put on the first conference specifically for women on the spectrum. “We could have filled it 10 times over,” he says, “it was unbelievable.”"
Odd that there are so many undiagnosed women yet it sounds like there's lots of diagnosed women.
"Clinicians and experts are only just beginning to realise how differently girls on the spectrum can present compared to boys and how that impacts getting a diagnosis. Mills won’t be drawn on the medical profession, but notes that GPs are often simply “not looking for autism in girls”."
This both conforms to the NAS position that girls present differently and my own argument, that adults aren't looking at boys and girls without preconceived ideas of gender roles. It's not that GPs aren't "looking for autism in girls" but they are not looking for the "girls" in girls. And that would not be unique, of course, to male GPs. We're all indoctrinated into our ideological gendered assumptions. It's important to note that Mills here is talking about presentation of autistic characteristics, not having different characteristics. If lack of diagnosis of women is based on presentation then why assume that it's something the girls are doing to hide their Autism rather than look at why girls go unnoticed. If they are.
Mills: "Key traits of autism in girls are still not clear – if they exist at all. While boys, for example, have been noted to develop fixations with unique hobbies, or be socially withdrawn, girls on the spectrum often defy these seemingly established manifestations.
“Boys might line things up, girls might collect things,” Mills says. "In older girls we tend to have seen girls gravitating towards older girls, fixing on older girls, or pop stars, or particular pop groups, this kind of thing." While these “fixations” can be be “all-consuming and socially isolating”, he says, they can also be "difficult to untangle from normal development." My bold and italics
Baffling isn't it?
"Researchers have also found that a significant number of diagnosed girls develop an ability to mimic the behaviour around them, but often at a huge personal cost.
As Povey puts it: “Imagine a young girl who is really lost in this world, doesn’t understand how other people act, doesn’t get all the other sort of hidden social intricacies going on around her.
"What seems to happen is they therefore look at the girls who seem to be doing it best and almost copy that, without understanding what’s happening underneath and peoples’ motivations.
“So often they are almost the most perfect girls, but there is all this panic going on underneath the surface.""
Now, this is problematic if you have a syndrome characterized by social deficits. Imagine you're autistic. Or perhaps you are. Now you don't follow socialized rules (these we NTs learn unconsciously), you supposedly can't place yourself in others' minds, you're not driven to communicate your thoughts, feelings or behaviours, so why would you think, hmm let's observe those idiots doing idiot things, I'll copy their idiot behaviours and pass myself off as an idiot like one of them? Your new chums (who have had years to perfect their communication skills, mind, yet you are presumably doing it mechanically in the moment) )mysteriously don't recognize you doing this, even though there must've been a point before you did start to mimic and you were doing bizarre behaviours that weren't idiotic, and even you don't recognize yourself mimicking. After all, the women mentioned above didn't know they were autistic until adulthood so how could they have known that they were so different that they had to consciously mimic others? How can you consciously do something you're unaware of? It makes no sense. If masking were the fact that autistic girls, aware of their difference, try to copy their NT peers consciously, in order to fit in then yes, that would make sense. But then it would also make sense that they would be hopeless at it. Such copying, or socialization is all carried out unconsciously by NTs, to have to learn these skills manually over a very limited time period would surely be impossible, mannerisms, body language, communication, and so on. Most autistic women claim they begin to do this masking around puberty when it becomes very noticeable that they are different. So they've presumably had many years of not masking among their peers. They have to learn these skills that take years unconsciously for NTs and no one notices they were autistic. Ever.
This makes no sense.
You spend years being bemused by others' actions or according to the women above, you don't at all, in fact no one notices, you behave normally, too normally and that's why you don't get noticed. Then one day, after having been bullied, perhaps sexually assaulted or coerced, watched just about every media portrayal of girls that don't seem to be like you, feel intense pressure to conform to these ideals and you get depressed, maybe try to control your environment by controlling your body, you get anxious, social life as a young woman is terribly constricting and difficult, you get socially anxious, you get diagnoses of BPD, anorexia, anxiety, depression, you get drugs, you get counselling, but you still feel terrible because these social factors outside of your control still make life difficult. Then one day you hear of a disability, online maybe, on a blog by a woman just like you, seemingly 'normal' yet she too tells of having all these social struggles until...you hear of this wonder thing that isn't actually a disability but a kind of gift, you get to join groups with other young women, you can write your own blog about your struggles with this gift you didn't know you had, you don't seem to have this disability gift others tell you, but you don't seem like you have this gift that makes you unique, connected, disabled with all the extras that come with it (I get a bus pass!) because you've always pretended not to have it, in fact you didn't know you had it until you saw that other young women experienced the same problems as you then they found they had this gift, but because you don't seem like you have this gift at all you get all the great things the gift offers without any nasty side effects, like neurological behaviours you can't control. You get a diagnosis. You can now march forward as an autistic woman and you don't have to conform to all those expectations, any time you don't like something, it's understandable because you're autistic, any time you appear just like others to others, it's because you're masking. Pity, admiration, wow, you seem so...uh, can I say normal? Everything now makes sense.
There's a piece on the BBC It all made sense when we found out we were autistic. What made sense? When I've discussed this idea of female Autism masking online others have asked "but why would women want to be diagnosed autistic?" Well, apart from what I've suggested above, it makes things all make sense, it seems. What all the women mean is that it makes sense why they were depressed, felt bad, got bullied, felt anxious, were often sexually abused (see study below), suddenly all the things that socially so many women go through in our patriarchal society and irrational peer based schooling makes sense. I'm autistic. I'm different. Not only that, but you're unique. And special. You're disabled (that's legally) but with Female autism you appear completely normal thanks to masking and no one knows. Except all those people that bullied and abused you because magically they could see beneath your mask.
Hannah's one of the six women on the piece, you do find the same people popping up again and again, Carly Jones is in everything female autistic whilst still appearing like some kind of hypernormal being from the planet Woman, and of course there's a living to be made from this for all of these women, if you're a cynic. I'm a cynic.
Hannah once again talks about her Autism without magically talking about Autism:
"Women and girls often have a natural drive to fit in socially, and so the symptoms they present with aren’t stereotypically ‘autistic’." So what are they then? We get the idea of what they're not.
"For example, they might find making eye contact difficult. I know I did. I’ve learned to count it out. I will look away for a few seconds and then back."
Oh dear. I'm afraid I did just literally slap me head. Difficulties with eye contact in Autism is not just eye contact. Depressives, anxious people use less eye contract typically but they can still process body language. Hannah suggests she doesn't have social imagination difficulties above.
"I’ve watched people carefully and studied psychology to degree level to get me to the point where I can now act quite naturally."
Sigh. So apparently regurgitating the theories of BF Skinner makes you somehow get past autistic descriptors. This is just so weird.
The rest of her piece is about her psychological conditions, anxiety and depression.
Whereas Jasmine, a fellow female autistic in the BBC piece, for some inexplicable reason tells us:
"I genuinely thought I was an alien.
It sounds silly but that was the only thing my childhood brain could comprehend.
When I was a baby people thought I was deaf. But I wasn’t deaf, I just wasn’t paying attention.
Then as a toddler, it was like I was always thinking logically and the other kids were just being reckless.
Why would I want to get splinters up my bum from a wooden slide in the playground?"
Dear god, a female autistic describing Autism descriptors! Hallelujah, bells ringing, blah blah.
Why have you not masked Jasmine to the point where no one would have noticed any of this? Why why why? Why did you continue to think others' behaviour was crazy and not just act like them magically to fit in?
Jasmine continues:
"When teachers put me on the spot and asked me questions, my brain totally shut down. It needed extra time to process what they were saying...I did have dyspraxia [a condition affecting physical co-ordination].
Doing my stand-up, I don’t feel as awkward as I do talking to people socially. It feels really natural to be up there performing.
I don’t have to talk to anyone specifically. I am talking at people. I think that’s the difference.
I’m not constantly thinking, ‘When can I chime in? When is my time to talk? Would it be rude if I said this?’
I take my dogs on stage. They give me extra comedy material.
I also feel calmer being able to stroke them while performing.”
Now isn't it weird that Jasmine should describe all these classic Autism characteristics yet she's a woman. Why doesn't she talk about her brilliant masking skills? In fact, why does she highlight that she was bullied at school because of her difference? Why doesn't she just list things that she's not? Male things. Though, I'm gonna throw one out there with no evidence, I bet she doesn't feel like she's a woman. Female maybe but I bet there's been a bit of gender confusion. Well, it would naturally (really naturally) follow that one would be confused about your gender if you don't follow gendered socialization. More on this later.
Then there's Amanda who tells us:
"To be honest, I don’t really have any friends. People that I call friends are those I’ve met through work or on a Facebook group. But I don’t have any actual friends who I would go out anywhere with.
I don’t like people coming round my house. It’s like my little sanctuary. It probably sounds a bit weird."
Why Amanda? Why aren't you artificially sociable (you can go home later and have a meltdown)? Why can't you mask being wonderfully normally sociable?
"My husband’s quite sociable and gets on with everybody - so he’ll go to parties without me. He lets me know they’re happening, but leaves the decision up to me. Ninety-nine per cent of the time I won’t go.
He used to get upset when I refused to go - but now he knows I’m not rejecting him. I just know I can’t put myself in a situation where I’d be very uncomfortable."
Amanda, you can't be Female Autistic, you're far far too autistic for a female. You should just be anxious and spend your time in Primark masking your unnameable autistic symptoms (meltdowns).
This piece is really letting the - Female Autism strange unique descriptors that no one can say what they are - side down. But what about Claire, 35 years old psychologist? Can she bring us back to Female Autism reality by not describing anything autistic in herself and when getting diagnosed everything made sense, all the things that made sense before now suddenly make a different sense?
"“‘There’s no way I can be autistic and a clinical psychologist,’ I thought." she thought.
‘It’s incompatible because autistic people don’t have empathy.
So if I’m autistic it means I can’t be empathic.’
That’s the level of naivety I had at that time."
But Claire, you don't need empathy to be a psychologist, everyone knows that (except psychologists but that's because the condition means they simply can't empathise with anyone who isn't a psychologist).
How does Claire's empathic Autism that she didn't recognize at all until aged 35 present?
"I had a bit of a light bulb moment one day in a lecture theatre during my psychology training. We were being taught about different conditions - including autism.
I thought, ‘Oh my gosh that sounds really like me. That is really freaky.’"
Ah yes, the old "that sounds like me moment." It's the core trait based internet female oh my god that sounds like me internet not male Autism Autism trope. Where a few vague traits sounds like me. It's how Barnum statements work, psychic cold readings, star signs, blah blah:
Do you have a tendency to be critical of yourself? You have a great deal of unused capacity which you have not turned to your advantage. While you have some personality weaknesses, you are generally able to compensate for them. Your sexual adjustment has presented problems for you. Disciplined and self-controlled outside, you tend to be worrisome and insecure inside. At times you have serious doubts as to whether you have made the right decision or done the right thing. You prefer stability to change but become dissatisfied when hemmed in by restrictions and limitations. You pride yourself as an independent thinker and do not accept others’ statements without satisfactory proof. You have found it unwise to be too frank in revealing yourself to others. At times you are extroverted, affable, sociable, while at other times you are introverted, wary, reserved. Some of your aspirations tend to be pretty unrealistic. Security is one of your major goals in life."
Barnum statements rely on the basis that:
you believe the analysis applies only to you
you believe in the authority of the evaluator
the analysis lists mainly positive traits
And of course it's horseshit because it's everyone (see more below).
"But some of it didn’t fit," says Claire. Let me guess, the social interaction, communication and imagination deficits bits?
"I think there’s a great desire in girls to be social, and autism diagnoses are often based on male traits."
Uhuh.
"So girls and women say, ‘No. I don’t have many issues with wanting to be social."
Right.
"By saying that, they’d lose points on the diagnostic measures."
Yep, that's how diagnosis works.
"There were missed clues when I was younger."
If only there were some kind of autistic Poirot to seek out these girl children who don't present Autism as Autism.
"I went to high school in the US, and so some of the quirky traits that make me ‘me’, were not seen as being odd or bizarre."
Huh? Americans are all autistic?
"They were seen as belonging to the Scottish girl - culturally attributed rather than individually attributed."
Ah, the Scottish are all autistic? Is she, I mean just to clarify, suggesting that being Scottish can be mistaken by Americans for being autistic?
"I also love fantasy fiction. I used read and read and read. I got lost in The Lord of the Rings. I would dress up as an elf. I went to Comic Con meetings."
Autism. Doesn't that mean that everyone who loved Lord of the Rings is autistic? About 2/3rds of the planet. Not me, I fucking hate that childish drivel.
"That was my way of escaping.”
From what? Being Scottish? Is this perhaps a key definer of this Female Autism? To be fair, I thought the key descriptors of this magical Female Autism based on the myriad blogs, articles, 'research' pieces and ahem, studies I've read were being:
There's three other women who describe being a woman and all the social crap that comes with being a woman in a patriarchal society. Female Autism.
Oh there is Maura who clarifies exactly what female Auties are masking when they aren't masking the triad of impairments descriptors because these are male-centric...
"I'm now 50. Six years ago I was diagnosed with Asperger syndrome, a form of autism. Like many women, this came after the diagnosis of my son, Darragh.
If it wasn't for this, I'd have gone through the rest of my life unaware of why I felt different.
As a child I'd felt as though everyone but me had been given a manual on how to behave around other people.
I was more comfortable around pets. Because I performed well academically and masked my anxiety, I flew under the radar."
See how these ideas become common currency without any annoying stuff like evidence or facts..."flying under the radar." This comes from Francesca Happe via Judith Gould via uh...nothing (see it repeated below). Just put it on repeat.
So Maura masked her anxiety. But anxiety is not a descriptor for Autism. Hmmm.
"When my autism was identified, it felt like taking off a corset I didn’t know I’d been wearing."
Huh? As mixed metaphors go...Suddenly all the debilitating restrictions I'd been feeling without knowing suddenly made sense.
"I understand now that I have a brain that processes sensory and social information differently from most other people.
I can take better care of myself by managing my social energy and avoiding sensory overload. I have found a sense of identity."
It's just astrology gibberish isn't it that's repeated ad nauseum. I didn't know I was autistic but then when I was referred and diagnosed suddenly it all made sense, all the things I'd never noticed before I suddenly noticed even though I can't say what they are.
"Women do not need to fear a diagnosis - it may help explain so much."
Look, if any women undiagnosed are out there weirdly reading this and not angry with me for questioning the Female Autism masking no actual symptoms thing with a reasoned argument then I can diagnose you for just one shiny 50p piece. No, I'll do it for free. You are a woman and it sucks because of us, men. Sorry about that, I didn't make it, blame god or Theresa May (she isn't to blame but fuck it, she's horrible). If you fit the Autism descriptors then you're autistic.
Maura concludes cryptically:
"I am living the life I want to live.
I have an interesting and rewarding career in Northern Ireland's civil service alongside supportive colleagues who accept me as I am.
I've continued writing about autism and disability and had several articles published. I've co-authored a book along with some of my autistic sisters from around the globe, some of whom have become close friends.
Most importantly, my diagnosis has enriched my personal relationships and made me a more confident mother."
Was she not living the life she wanted to live before the diagnosis of something she didn't know she was? Did no one accept her at work before her diagnosis. "You weirdy, Maura, with your...um...undiagnosed Autism that even you don't know about which is weird because you don't know about it yet we've all treated you like a weirdy with that whole hand stimming animal noise thing you feel compelled to do, the strange processing where you stare blankly then answer ten minutes later, the whole talking incessantly about your special interest..." said a work colleague once.
"Autistic sisters" oh dear.
How does diagnosis of Autism make you a more confident mother? How does it enrich personal relationships? Who knows?
Back to Buzzfeed again and Emily Swiatek highlights a key issue in this new Female Autism:
"In Swiatek's experience, it became difficult for professionals to untangle traumatic life events from her biological condition. “You sort of become defined by that,” she says."
Indeed, as we'll see with the NAS piece on gender, a recurring theme is Trauma. No trigger warnings as I'm not going in depth about trauma but I will be briefly discussing how sexual abuse and rape interact with Autism diagnosis in women. In fact the two seem to be inextricably linked in a kind of chicken/egg symbiotic relationship. Meaning, if you're a female Autie the chances appear to be extremely high that you will experience some form of sexual abuse, almost certainly because of key descriptors of Autism, being less able to read signs of danger, others' motivations, etc. which is not suggesting in any way that victim/survivors are in any way responsible (I feel a need to state the obvious). However, women in general are very likely to experience some form of sexual abuse/assault (take your pick of figures anywhere between around 20 to 40% of women). As PTSD symptoms are almost impossible to disentangle from Autism descriptors, are autistic women more likely to be abused or are abused women more likely to be diagnosed autistic? Or both? Or neither... as Swiatek suggests:
"“I think when you are an 'Aspie' growing up,” Swiatek says, “you are so used to getting things wrong, so you are always trying to be the good girl. When someone will reward you for that in any way, because you don’t have the in-built safety mechanism necessarily, it can mean you are much more vulnerable.”"
The problem with unravelling that is that all young women are vulnerable and, of course, in that fearless young way, tend to not realize their vulnerability. So young women are more likely to be sexually assaulted, because of the way our society is still structured and women are more prone to generalized anxiety, depression, suicide, eating disorders. All have similar trait manifestations as Autism but are clearly psychological. Indeed, one might say that it's worse for women now in a hyper sexualized media saturated world. However, Autism is clearly neurological not psychological. There are very clear descriptors and very clear behavioural manifestations (repetitive behaviours like stimming, difficulties with eye gaze, clumsiness (dyspraxia), processing difficulties, difficulties understanding your emotions or feelings (alexithymia)) which differentiate it from these psychological disorders. Though, of course, these aren't magically present in the Female Autism being described here so...
"Swiatek says: "It’s really annoying, because where are the kind of awesome, confident women?""
Ah yes, awesome confidence. Is that a symptom?
"We don’t tend to see them."
Except in all these articles, blogs, TV shows, everywhere...
"Swiatek feels there is an absence of support and resources for those women who are aware of their condition. “I found it is pretty hard to know where to go, and I think we are not necessarily addressing it as a country," she says. “A lot of the [support] groups tend to be very focused on male presentations of Asperger's or women with that more classic autism that fits more of the male presentations: There’s not much for [an] intelligent, quite confident, sociable person.”"
This is just nuts isn't it? What support is she talking about? Resources? Again, this is why it's great getting an Autism diagnosis (not being autistic), you get loads of free stuff and everyone says "you're so awesomely confident." If you want to join a support group I can point you to loads of female groups. No, simply pop "Autism Female Group" in google. To meet lots of other women diagnosed autistic who don't have that "more classic autism," that one with symptoms.
Furthermore, Swiatek says she was unaware she was autistic. So none of this statement makes sense, not knowing where to go for help, resources, etc..
TRAITS
But what about traits? I mean, why bother with DSM or ICD-10 descriptors when you have, like, you know, traits, of like Autism?
In an interview for autisticuk: Swiatek says of the in depth study for Channel 4's Are You Autistic? (this will become an Autism factual science research fact):
"It’s really cool that the study showed this too -47,000 out of 87,000 potentially autistic responses were women."
I repeat from previous blog, we don't know how many women responded in the survey, if 90% of respondents were women then the 47,000 shows a very low rate. Bloody stupid science and reason getting in the way of confirmation biases.
But, say I'm a woman who doesn't fit the DSM descriptors at all but read someone's blog online talking about their autistic traits (anxiety, anorexia, depression, liking ponies a lot) what should I do? Does it necessarily involve breathing?
Swiatek: "I think my first piece of advice for people who are thinking about obtaining a diagnosis would be to stop, breathe [gaaaaa] and take a moment. It can feel really confusing and overwhelming when you first start looking into autism..."
No, only Female Autism.
".. .After that, I’d suggest doing some research and start listing the traits of diagnosis that you relate to."
There are no traits in the diagnostic descriptors. There are descriptors. Say, difficulties with social communication. Traits might be not understanding the purpose of small talk, not mirroring other's behaviour, confusion about conversation cues, etc.
But what if weirdly no one has ever noticed this unusual neurological syndrome presented by behaviours like physical or verbal stimming, not understanding social cues, processing difficulties etc.?
"You might want to ask friends, family or partners for their observations, although be aware that sometimes it can be hard for the people around us to say these things. Unfortunately, there are still a lot of stereotypes but that’s why asking people close to you to watch the show is a great opportunity to start to change those ideas."
Do you think I'm autistic mum?
No.
Why not?
You don't have any of the core descriptors in the DSM 5 of 2013 or the WHO ICD-10 fro 2010
But what if they're just not up to date with a new kind of Autism only presenting in females where you don't have any of those symptoms but get really anxious.
Do you get anxious?
Sometimes.
Oh my love, you might be autistic. I'm a terrible mother, how have I never seen this before?
That's the end of that brilliant play I just wrote. I'm taking it on Broadway one day I hope. I see Meryl Streep as the mother and Claire Danes playing Temple Grandin as the daughter.
Right, I've spoken to my mum, made a list of traits, what next?
"Once you have your list, you can start pursuing a diagnosis. In the UK, we can go straight to our GPS (I think that means GPs not global positioning system though you're just as likely to get a diagnosis from your car tracking) and ask for a referral for a diagnosis."
Yeah, good luck with that.
"Sadly, as was mentioned on the show, waiting lists can be long..."
That's because there's so many women waiting with their own trait list they got from a blog on the internet.
"...and there’s not always the expert knowledge in diagnostic teams – this is why so many of us haven’t been diagnosed already."
Ah, the expert knowledge to spot Female Autism, the Autism with none of the calories of Autism.
Actually, have you not wondered how you can diagnose Autism in women who don't exhibit any autistic symptoms? The only reference to this ever ever anywhere is in a Tony Attwood piece repeated by Judith Gould and then ad nauseum elsewhere:
"Unenlightened diagnosticians perceive someone who appears able and who has reciprocal conversation and who uses appropriate affect and gestures as not fulfilling the criteria set out in the international classification systems. Therefore a diagnosis is missed. It is only by asking the right questions, taking a developmental history, and observing the person in different settings, that it becomes clear that the individual has adopted a social role which is based on intellect rather than social intuition."
Crazy huh? Right questions? Surely we have diagnostic tools for that? Developmental history? Where from? From parents? From those being diagnosed? Hmmm reliable. Observing in different settings? You have to stalk them?
But what if you're rich and want to bypass the NHS and basically buy your Autism diagnosis?
"You may wish to peruse a private diagnosis if you have the means to do so and want a quicker process – I personally got diagnosed at the Lorna Wing centre and had an incredibly positive experience."
The Lorna Wing Centre at the NAS offer diagnosis here, the lead consultant is Judith Gould, who has propagated the Female Autism trope, I think this is what is called a self fulfilling prophecy. Madness.
The Swiatek piece concludes: "One of the most important things to know is that within the autistic community, we are very welcoming of people who self define as autistic because of the systemic issues people face in accessing diagnosis. The “official” diagnosis helps a lot of us have that peace of kind and self understanding that can be so essential for our wellbeing, but ultimately, it isn’t the diagnosis itself that makes us autistic. If you’re autistic, you’re autistic – it’s the way your brain is wired and that won’t change."
Except you aren't autistic. Well, not that "classic" male autistic, but the new Judith Gould masking something or other behaviours Autism. The problem with this is that as more and more females are diagnosed this way Autism becomes this syndrome where you don't have any of the behaviours linked to Autism but mask (anxiety?) and that is just complete madness. What will happen to all those women who actually exhibit Autism? We'll need to do away with the spectrum and go back to the old longitudinal categorization. Autism with severe Learning Disabilities, Profound Autism, Asperger's, Female Autism.
The National Autistic Society, who co-produced the show, Are You Autistic?, have a helpful guide to why women go undiagnosed Theories to explain the gender split.
First up is "the female Autism phenotype." One hears this often mentioned in the debate about diagnosis of females. A phenotype is essentially observable behaviours based on the interactions of environment and genes. So the argument runs that there is "a female-specific manifestation of autistic strengths and difficulties, which fits imperfectly with current, male-based conceptualisations of ASD." Not just that women mask or that women present differently but that Autism actually appears differently in women on both a behavioural and genetic level. No one can explain why this would be specific to Autism (no other syndrome is differentiated by sex). More importantly, there's no evidence that Autism is genetic. Literally zero evidence. That's not to say it isn't genetic but to argue that there's a female genetic component to a syndrome that we don't even know is genetic is pretty weird. And then, even weirder, it's only apparent in some women. For some inexplicable reason, those women who exhibit Autism don't have the female autism phenotype.
Considering Autism descriptors are all about brain functions it would appear logical to believe Autism is neurological but that doesn't follow that it's genetic. There are many studies suggesting links to pre-natal, birth and post natal complications. Lack of oxygen for the baby during these complications appears to be a common denominator. One of Asperger's four case study children definitely had that birth complication.
The NAS piece on gender difference cites one 'study': The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype.
The study is in the Journal of Autism Developmental Disorders. And as a study it's laughable. The first problem is in the opening abstract:
"We used Framework Analysis to investigate the female autism phenotype and its impact upon the under-recognition of autism spectrum conditions (ASC) in girls and women. Fourteen women with ASC (aged 22–30 years) diagnosed in late adolescence or adulthood gave in-depth accounts of: ‘pretending to be normal’; of how their gender led various professionals to miss their ASC; and of conflicts between ASC and a traditional feminine identity."
Framework analysis in this setting is asking women about their experiences in order to confirm a pre-conceived idea that there is a specific phenotype linked to a specifically female form of Autism. Ah science. Don't actually bother with genetics just get some self reporting data.
The 'study' is of fourteen late diagnosed women. Fourteen women is a ridiculously small sample size for any study.
The "pretending to be normal" trope comes from the title of a memoir by Lianne Holliday Willey, it's become a common currency term in the masking debate, well I say debate but no one except, uh, me? seems to debate it at all. LHW suggests in her memoir that she learnt to mimic others to get by socially even though she didn't seem to need to. Here's a taster from LHW's memoir:
“Simply put, within AS, there is a wide range of function. In truth, many AS people will never receive a diagnosis. They will continue to live with other labels or no label at all. At their best, they will be the eccentrics who wow us with their unusual habits and stream-of-consciousness creativity, the inventors who give us wonderfully unique gadgets that whiz and whirl and make our life surprisingly more manageable, the geniuses who discover new mathematical equations, the great musicians and writers and artists who enliven our lives. At their most neutral, they will be the loners who never now quite how to greet us, the aloof who aren't sure they want to greet us, the collectors who know everyone at the flea market by name and date of birth, the non-conformists who cover their cars in bumper stickers, a few of the professors everyone has in college. At their most noticeable, they will be the lost souls who invade our personal space, the regulars at every diner who carry on complete conversations with the group ten tables away, the people who sound suspiciously like robots, the characters who insist they wear the same socks and eat the same breakfast day in and day out, the people who never quite find their way but never quite lose it either.”
So it's weird that Holliday-Willey is none of these things isn't it?
Here she explains that as a child she "had a little bit of Autism."
The biggest problem with the study is the anti-science basis that it starts from. That there are lots of women going undiagnosed because the ratio of male-female diagnosis is so wide. This is a faulty hypothesis for any study. An assumption that because women are less likely to be diagnosed with Autism must mean that women aren't getting diagnosed enough is not a healthy scientific base for any study. No one assumes that loads of males are going undiagnosed for eating disorders despite a 10 to 1 ratio (see below). I won't go in depth into the study because it will just be page after page of a quote then pointing out how nonsensical the whole approach is. Suffice to just see the aims of the study:
"Given the above, in order to advance the study of ASC gender differences we conducted a study with three key features. First, we aimed to investigate directly not only the nature of the female autism phenotype, but also how it impacts upon risk of a girl and/or woman’s ASC going unrecognised."
How can you investigate a phenotype, interactions of genes and environment on behaviour without looking at genetics? How do you analyze a phenotype if the behaviours aren't present because of masking? Surely if we have no idea what this phenotype is how could we know how it impacts on not getting diagnosed? This is madness. A genetic component that we've invented and we recognize by asking those we diagnose ourselves based on it to self report symptoms of the component we've invented and why they didn't get diagnosed...it's like a bad trip, man.
"Second, we recruited women with ASC whose autistic difficulties had gone unrecognised in infancy, childhood and early adolescence. We reasoned that such late-diagnosed individuals would be more likely to exemplify elements of the female autism phenotype that are under-represented in samples of those identified in a timely fashion, and can provide insights into how such characteristics led to them being missed by clinical services.
This approach is supported by the recent finding that the gender ratio in adult ASC clinics is lower (two males to one female) than in child and adolescent services (five males to one female), suggesting that later-diagnosed samples are most likely to include a representative sample of females with ASC (Rutherford et al. 2016)."
Where to start. Right, this logic runs thus:
Some females are diagnosed in infancy, childhood and adolescence. They are diagnosed because they are less likely to "exemplify elements of the female autism phenotype" or in other words, they exhibit the characteristics of Autism. For some inexplicable reason there is a genetic component in some women who don't exhibit autistic characteristics, this is "the female autism phenotype" which isn't present in the pre-adult women diagnosed. And round and round. The women who mysteriously do have this unique genetic component have different autistic characteristics to both males and early diagnosed women. We're going to research how these characteristics that female autism phenotypical women have which don't conform to the DSM/ICD-10 descriptors go completely unnoticed. Uh, because they aren't the characteristics of Autism?
The most interesting point is that women go unrecognized until adulthood. This is confusing on several levels. We'll see later that observable autistic traits become more manifested in women as they get older (i.e. at 7 years old they are less noticeable, by the age of 16 women are more noticeable than men, see Mandy et al below). Now this makes no sense on several levels. Firstly, if girls learn to mask around puberty (the common story from quotes below is around the time of the move from primary to secondary education, aged around 11) then their autistic symptoms should become less noticeable with age not more noticeable. Secondly, the FAP is characterized by traits not descriptors and the traits are interchangeable with psychological conditions, anxiety, depression, eating disorders, all of which manifest in females in the teenage years. It's natural thus that girls would be diagnosed anxious, depressed, etc. Thirdly, if autistic traits do increase in women with age how come all the women in the blogs or shows like Are You Autistic? don't exhibit autistic traits?
And in yet another brilliant piece of confirmation bias, we've seen an increase in late diagnosed women, based on these strange new characteristics that aren't in the DSM and look, there's many more than the younger women who are diagnosed using the actual descriptors for Autism, proving thus that there are loads of undiagnosed women with this magical phenotype.
It's just head banging bonkers.
"Third, we took an inductive (i.e., data-driven) approach, conducting a qualitative investigation."
Ah science. This means self reporting in informal interviews (some on the internet!). This is complete nonscience.
"Our aim was not to test hypotheses about the female autism phenotype by formally comparing males and females. Rather, we sought to generate new ideas and deepen understanding of key concepts, such as ‘camouflaging’ (Barker and Pistrang 2015). This work is designed to yield novel, well-defined hypotheses about the female autism phenotype to guide future quantitative investigations; and to promote the development of measures that capture female as well as male manifestations of ASC."
What utter drivel. Bizarrely, the reference to Barker and Pistrang is from their book "Research Methods in Clinical Psychology: An Introduction for Students and Practitioners." Which as far as I can see is exactly what it says it is in the title, about research methods, so I can't see why the 'study' is suggesting Barker and Pistrang write about camouflaging in that book. It's about research and analysis of data. Very odd.
New ideas about camouflaging? I have one, it doesn't exist. Or is it just camouflaged?
It's weird that if you write about this magical new Female Autism and I wrote blogs on it back at the start in 2011 you hear the same magical thinking again again. It's always future leaning, in some time in the magical future we'll be able to carry out "quantitive investigations." Of course, if we continue to diagnose adult women based on this phenotype hypothesis then the evidence will be self generating. Give it time and women with our dynamic new formula magical Female Autism Phenotype will easily outnumber women diagnosed using Autism criteria, we can then make both qualititive and quantitive data based on this thing we've invented.
The measures to capture adult females who don't have any of the characteristics of Autism has been there since Judith Gould's 2011 piece Misdiagnosis or Missed Diagnosis for the National Autistic Society.
Of course, repeating myself in this hall of mirrors, The Lorna Wing Centre at the NAS is one of the few centres specializing in diagnosing adult females. Who is the consultant psychologist there? Judith Gould.
I bet you're wondering why women are referred there, huh? For having difficulties with social communication, imagination and interaction or other autistic descriptors perhaps?
It's just a bizarre self fulfilling prophecy.
But what are the unique behaviours associated with this female autism phenotype? Surely in a study of said women it won't just be telling us what it's not and how the women really struggle to cope with their condition, right? Or maybe there'll just be even more bemusing conclusions like:
"The current study has sought to generate hypotheses about the presentation and challenges faced by women who meet diagnostic criteria for ASC, but who were not picked up in childhood. It should be noted that there is another group of females who have severe autistic-like difficulties (i.e., difficulties with social reciprocity, social communication, flexibility and sensory processing), but who do not actually meet diagnostic criteria for ASC (Dworzynski et al. 2012) . It is unclear whether such individuals should be included in studies of the female autism phenotype. One argument is that, because they do not qualify for a diagnosis, they cannot be considered representative of females with ASC. The contrary position is that they really do have ASC, but fail to meet criteria because current diagnostic criteria are insensitive to their more female-typical presentation."
Ha ha ha ha ha ha ha...this is how bonkers it is. We shouldn't include women who fit Autism descriptors in our study. The Dworzynski study found that "in the absence of additional intellectual or behavioral problems, girls are less likely than boys to meet diagnostic criteria for ASD at equivalently high levels of autistic-like traits. This might reflect gender bias in diagnosis or genuinely better adaptation/compensation in girls."
That is, even though presentation of criteria is the same boys are more likely to be diagnosed (aged 10-12 years). The assumption is gender bias or girls compensate better. Now, briefly here you have an argument about presentation of symptoms along with underlying assumptions by professionals of how those symptoms should manifest. Like everyone else I agree that females are more likely to go undiagnosed but crucially their behaviours are the same. This study found exactly that. There are 10 to 12 year old girls with the sets of behaviours that are actual Autism descriptors, difficulties with social reciprocity, social communication, flexibility and sensory processing. And the study on the Female Autism Phenotype is suggesting we shouldn't include them in the study of the female autism phenotype because they don't manifest the behaviours typical of the female autism phenotype but rather, they manifest behaviours typical of Autism. Is that not madness? we have to disqualify them from the study because they're, like, really autistic.
So, again, what are these behavioural manifestations of the female autism phenotype?
Really bloody good question.
"One element of the female autism phenotype that is elucidated by our analyses is the phenomenon of ‘camouflaging’, or ‘pretending to be normal’ (Holliday-Willey 2014)."
You know you're in trouble when you're quoting from a memoir. It might as well be "Marjory said on Twitter..."
" Efforts to camouflage were widespread but not universal in this sample. Participants spoke of making a deliberate effort to learn and use ‘neurotypical’ social skills, sometimes describing this as ‘putting on a mask’ (Baldwin and Costley 2015; Cridland et al. 2014). Our analyses suggest that the development of such neurotypical personas may rely on concerted and prolonged autodidacticism based on, for example, careful observation of peers, reading novels and psychology books, imitating fictional characters, and trial and error learning in social situations."
Hang on, even in your tiny sample of fourteen some still didn't mask? How many? Oh yeah, this is a qualititive study so there absolutely no data. Hmmm. For all we know it could have been 13 of them. But if they don't exhibit Autism like the girls excluded from the study but are masking. WHAT ARE THEY MASKING?
"We also identified unconscious elements to camouflaging that warrant further investigation, whereby women reported their social behaviour being copied from others around them without even realising they were mimicking in this way."
So how did they realize they were? That's surely a paradox. Unless they realize later in life that they unconsciously copied others and that dear friends is called socialization.
"The current analyses do not in any sense provide a definitive picture of camouflaging. Rather, we intend that the account of camouflaging given in the present paper, and other research reports of the phenomenon (e.g., Baldwin and Costley 2015; Cridland et al. 2014), be used to derive a precise and coherent conceptualisation of this construct."
Good luck with that.
"We believe that this camouflaging measure, at least initially, should rely on self-report, as by its very nature, camouflaging behaviour is often not obvious to observers."
Oh christ...
"Our data suggest that some of the challenges of being a female with ASC do not come directly from the individual’s autistic difficulties; but rather reflect how these difficulties play out within a culture that has specific expectations for females."
AAAAAAAAAAAAAAAAAAAAAAAAAAH
That's not Autism is though? That's being a woman in a patriarchal society....gaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
Ok, I'm calm.
"Some women in the sample reported a conflict between their desire to accept their autistic selves, and perceived pressures to fulfil traditional gender roles. "
But what the are these autistic self behaviours? Please tell me, I'm in pain here.
"For example, participants described feeling pressure to play certain traditional feminine roles (the wife, the mother, the girlfriend), and finding this incompatible with how they wanted to live as a person with ASC."
Huh? How does this ASC manifest then? Aren't all the women typically paraded out in these studies typically female because they don't appear autistic and can mask to appear completely 'normal'?
"Several women in our sample reported that their autistic social communication difficulties made it difficult for them to join and enjoy female peer groups, which they perceived as being more subtle and less forgiving of faux pas than male social groups."
What faux pas? What are these social communication difficulties if they aren't the descriptors in the male-centric DSM?
The 'study' just rambles on like this with nothing specific just generalized comments about these women not feeling something or other and this must be the Female autism Phenotype at work....
"Based on our investigation of the experiences of females whose ASC went unidentified in childhood and early/mid adolescence, we hypothesise that this phenomenon reflects both: (1) specific features of the female autism phenotype; and (2) characteristics of the systems that are designed to identify and help people with ASC. Reflecting this, we propose a model of the bias against recognising female ASC, for testing in future quantitative, deductive (i.e. theory-driven) studies. In terms of individual characteristics, we suggest that females who are especially invested in and skilled at camouflaging are at greater risk of their ASC going undetected (see also Baldwin and Costley 2015)."
Women who don't appear to manifest autistic behaviours are not likely to be diagnosed shocker!
Please, please put me out of my misery and tell me then how this phenotype manifests other than camouflaging...what are they camouflaging if it isn't autistic behaviours? You can't say the FAP manifests as camouflaging. Camouflaging what?
"Further, we hypothesise that the female tendency to have internalising (e.g., anxiety, depression) but not externalising (e.g., hyperactivity/impulsivity, conduct problems) difficulties is also a risk factor for non-detection of ASC... In addition we propose that greater social motivation (Sedgewick et al. 2015) and better non-verbal communication (Rynkiewicz et al. 2016), both characteristics of the female autism phenotype, should be investigated as factors that can lead professionals to rule out ASC as a possible diagnosis when a females with autistic difficulties presents for assessment."
So, they don't present like boys and they're socially motivated and have better body language skills than...? Who? Autistic males? Autistic females who manifest autistic behaviours? Your guess is as good as mine. Still, we're clearly never going to find out what this phenotype manifests as. Remember, a phenotype is a set of behaviours.
Instead it endlessly regurgitates camouflaging, professionals not recognizing it, need new descriptors to diagnose, blah blah without ever laying out what these descriptors could be.
"All but one reported clinically severe anxiety, and levels of distress were elevated, emphasising the importance of identifying women with ASC in order to provide support, including for co-occurring emotional difficulties. Most participants (8 of 14) explicitly stated that their lives would have been easier had they received their diagnosis earlier in life."
Anxiety, yeah but that isn't Autism. You get anxious because of your Autism. I point you back to GTAIII above. Trying to get an answer about what these behaviours relevant to the female autism phenotype is like trying to get Jeff to tell you what his rally is about.
"Pre-diagnosis, they recalled being misunderstood, with their autistic difficulties often labelled in very negative terms by peers and adults, for example as laziness or wilful defiance."
What autistic difficulties, Jeff?
"Most participants had experienced the eventual receipt of their diagnosis as helpful. Some stated that it had fostered a sense of belonging in a group of like-minded people, and that this had promoted a more positive sense of self. The Internet and social media appear to be especially important for enabling the existence of such communities. Thus, our findings suggest that another cost of missed diagnosis is that it denies people with ASC the opportunity to benefit from identifying with the autism community."
I have a plan. Why don't we just diagnose all women as autistic and then they can choose to join autistic support groups?
"We believe that our inductive, in-depth approach has generated some new insights into the female autism phenotype and its impact upon risk of missed diagnosis."
You keep on believing this girl, donchoo let nobody tell you different.
Having not told us what this female autism phenotype is, offering no evidence of its existence, we come to the conclusion. Here at last all is laid out for us. We finally 'get' where they're coming from and what this means and might mean to womankind the world over:
"In their account summarizing the priorities of autism research based on interviews with people with ASC, (Pellicano et al. 2014) stressed the need to understand why women with ASC ‘slip through the net’ and to identify ways to counter this gender-based inequity in current clinical practice. Our findings suggest that the attainment of these goals will require several courses of action. First, research to define the female autism phenotype must include the development of measures of camouflaging, so that this phenomenon can be studied quantitatively, increasing understanding of its prevalence and effects on diagnosis and wellbeing. Second, levels of knowledge about ASC and training needs of a range of healthcare and educational professionals, including those who do not specialize in ASC, should be investigated. This would lay the ground for the development of training programs about the female autism phenotype, to improve recognition and referral to appropriate services."
Oh fucking fuck fuck. So The FAP is camouflaging. Camouflaging what? Who knows? I'm guessing anxiety. How can you quantify behaviours you can't see? How could you possibly train professionals to recognize something you can't even describe in your own study beyond "they camouflage"? It's (being un-pc) just bloody mental.
In hans Asperger's study on "Autistic Psychopathy" he outlines in one paragraph how autistic children learn to function socially without the supposed abilities in communication, interaction and imagination:
"Here we come to an important insight: in autism there is a particular difficulty in mechanical learning, indeed there is an inability to learn from adults in conventional ways. Instead, the autistic individual needs to create everything out of his [sic] own thought and experience. More often than not this results in defective performance, even in the more able autistic individuals."
That makes sense.
The findings are here but it's worth showing what they found:
"There were no significant differences overall when looking at the broad social criteria for both the DSM-IV-TR and DSM-5 – this was not surprising and was consistent with findings from other studies."
That is, that boys and girls had the same, to put it in Judith Gould's words, "categorical" difficulties. So this shows that boys and girls have 'the same Autism' if you like. But they present differently, which is exactly what I've been saying:
"But the authors’ findings related to specific behaviours were more revealing:
• girls were better able to share interests, engage in reciprocal conversations, and use nonverbal gestures – if a child did not have impaired ability to share interests, that child was almost four times more likely to be a girl. If a child had some ability to engage in conversation, then that child was almost three times more likely to be a girl. And over one third of the girls had no impairment in their ability to integrate nonverbal and verbal communicative behaviours.
• girls presented with better imaginative play – 75% of girls fell into the “no impairment” or “somewhat impaired” categories of imaginative play
• both boys and girls had difficulties with friendships, but their problems manifested differently – girls were often able to initiate friendships but had difficulty maintaining them, whereas boys had difficulty with both initiating and maintaining friendships. Girls’ difficulty maintaining friendships was usually related to their need to control the play. Hiller et al. explain that because boys present with more significant problems with friendships, this might make their impairment more salient and easier to detect.
• girls were more likely to show some ability to regulate their behaviour in different situations – this
includes monitoring their voice and avoiding inappropriate comments or externalizing behaviours
• girls’ social behaviours were more likely to be coded as “somewhat impaired” than boys – this
means that these behaviours were not as overt or impaired as would be expected for a typical ASD
presentation. Less experienced clinicians may not see these ambiguous behaviours as signs of ASD,
and this could contribute to under-identification. despite girls’ better use of nonverbal communication, boys and girls demonstrated equal social understanding impairment – social understanding involves the ability to interpret and understand nonverbal behaviours. So girls’ use of nonverbal social gestures does not reflect their underlying understanding (Hiller et al., 2014)"
So girls were better than boys at social interaction. How much is that down to gender roles? In a school situation it is theoretically easier for girls to initiate these social roles. I should point out that the mean age of the children (the average age) was 8 years old. So these are (theoretically at least) pre-pubescent children. It's also important to question the validity of a teacher's observations, both from an environmental point of view (how on earth do you observe individual children in a large scale group dynamic) and their own social attitudes. I'm going to make a giant leap here based on a real-world assumption, that these are children in infant and primary schools so the likelihood is that the teachers are female (15% of primary teachers are male). Could there be gender assumptions there?
AS to "Restricted, repetitive behaviour criteria."
• fewer girls presented with restricted interests and lining up or sorting behaviours – Hiller et al. feel
that this may contribute to making ASD more difficult to identify in girls
• boys and girls presented with different types of fixations – boys often had fixated interests with video games, iPads or television, while girls had fixated interests around random objects like animals, rocks, shells, or books. Hiller et al. explain that girls’ more random obsessions may make them more unlikely to appear as the type of fixations that are associated with ASD. Furthermore, girls’ preoccupation with objects may interfere less with daily life than boys’ fixation on gaming or screens, and therefore girls’ fixations may be reported less often by parents.
• younger boys’ restricted interests often revolved around wheeled toys, and older boys’ (>7 years)
interests revolved around screens (gaming, TV, etc.)
• both younger and older girls’ interests were seemingly random"
That just confirms social gender roles surely?
Hiller et al is the only cited 'study' on repetitive behaviours.
"The behaviours of girls are often quite typical and gender stereotyped compared to males," argues Mandy.
Or Genie, who was kept locked in a room with no human contact as a child
"But what are they camouflaging though?" (another male coincidentally 45)
There's a strange wish to confirm that women are going undiagnosed among those diagnosing Autism. It's akin to leading questions in clairvoyance. Usually these involve what the 19th Century critic of clairvoyance,George Lewes, suggested were "leading questions, by intonations, by the hundred suggestions of voice and manner."
Psychics typically use cold reading techniques to turn vague statements into facts, also known as fishing.
Take for instance the recent Channel 4 show, Are You Autistic?. Francesca Happe, one of the psychologists who first led this female Autism revolution plays out two of her strange stories (situations where actors' intentions aren't theoretically clear to autistic people).
One is a bad song played by one actor, the other says yeah it was great. A white lie.
Happe then asks the female contestant on the show, Jo:
"So do you think he actually thought it was good?"
"Well possibly not, I didn't think it was good."
"But you can't be sure what he thinks."
Classic cold reading technique. "Well possibly not" becomes a key Autism descriptor of lacking Theory of Mind: ""but you can't be sure what he thinks." Did Jo say that? I wish to point out that I'm not saying Jo is or isn't autistic (though she doesn't exhibit or describe any autistic behaviours), merely pointing out how Francesca Happe's drive to diagnose women (over men, the other contestant, JP, clearly exhibits autistic traits) leads her to confirm her own bias by using techniques similar to cold reading, the skill used by clairvoyants.
In her diagnosis, Jo talks to Simon Baron-Cohen:
SBC: What would be the value of a diagnosis?
J: I think I need to know that I'm not just weird, or rude...
SBC: Which is what people have said?
J: Well I know that's how I can appear
SBC: But what you want to know is is there a reason why I behave differently?
J: I feel like I take on a role everyday, depending on where I am, if I'm doing the schoolrun I'm the mum with the schoolrun who engages in a bit of hi, how are you? type of thing. then when I go elsewhere I'm a different person but when I'm at home alone, that's nice because I don't have to put in an effort to be anyone I'm just content.
I found the transition from primary school to secondary school too huge. I did go to a normal kind of high school and I couldn't cope with it, it was too big and didn't really get on with anyone in my class. I remember being in the corridor when the bell went for another lesson and everyone just came out at once and went to go to their next room and I just felt god this is absolutely horrific, it was just really really overwhelming."
Now obviously this is only a snippet of her discussion with Baron-Cohen but this and her earlier description of going out to meet her friends at a cafe and other general descriptions of her life are typical of the new wave of Female Autistics who describe their social problems in vague ways that could conform to most of our lives. This is called the Forer Effect (or Barnum statements). Take stage magician, Derren Brown's truly expert version of the Forer effect, general statements you could apply to anyone and contrast and compare with the statements above by female autistics who magically mask their behaviours:
"You are a person prone to bouts of self-examination. This is in sharp contrast to a striking ability you have developed to appear very socially engaged, even the life and soul of the party; but in a way that only convinces others. You are all too aware of it being a façade.
This means that you will often be at a gathering and find yourself playing a part. While on the one hand you’ll be talkative and funny, you’ll be detaching yourself to the point where you will find yourself watching everything going on around you and feeling utterly unable to engage. You’ll play conversations back to yourself in your head and wonder what that person really meant when he said such-and-such — conversations that other people wouldn’t give a second thought to.
How have you learned to deal with this conflict? Through exercising control. You like to show a calm, self-assured fluid kind of stability (but because this is self-consciously created, it will create bouts of frustrated silliness and a delight in extremes, or at least a delight in being seen to be extreme). You most easily recognise this control in how you are with people around you. You have learned to protect yourself by keeping people at bay. Because in the past you have learned to be disappointed by people (and because there were issues with you adjusting to your sexuality), you instinctively keep people at arms’ length, until you decide they are allowed over that magic line into your group of close friends. However, once across that line, the problem is that an emotional dependency kicks in which leaves you feeling very hurt or rejected if it appears that they have betrayed that status.
Because you are prone to self-examination, you will be aware of these traits. However, you are unusually able to examine even that self-examination, which means that you have become concerned about what the real you is. You have become all too aware of façades, of sides of yourself which you present to the world, and you wonder if you have lost touch with the real and spontaneous you.
You are very creative, and have tried different avenues to utilize that ability. It may not be that you specifically, say, paint; it may be that your creativity shows itself in more subtle ways, but you will certainly find yourself having vivid and well-formed ideas which others will find hard to grasp. You set high standards for yourself, though, and in many ways are a bit of a perfectionist. The problem is, though, that it means you often don’t get stuff done, because you are frustrated by the idea of mediocrity and are wearied by the idea of starting something afresh. However, once your brain is engaged you’ll find yourself sailing. Very much this will likely lead to you having considered writing a novel or some such, but a fear that you won’t be able to achieve quite what you want stops you from getting on with it. But you have a real vision for things, which others fall short of. Particularly in your academic/college situation, you are currently fighting against restraints upon your desire to express yourself freely.
Your relationship with your parents (there is a suggestion that one is no longer around, or at least emotionally absent) is under some strain. You wish to remain fond of them but recent issues are causing frustration – from your side far more than theirs. In fact they seem unaware of your thoughts on the matter. Partly this is because there are ways in which you have been made to feel isolated from certain groups in the past – something of an outsider. Now what is happening is that you are taking that outsider role and defending it to the point of consciously avoiding being part of a group. This will serve you well in your creative and career pursuits. You have an enormous cynicism towards those who prefer to be part of a group or who exhibit any cliquey behaviour, and you always feel a pang of disappointment when you see your ‘close’ friends seeming to follow that route. Deep down it feels like rejection.
However, for all that introspection, you have developed a sensational, dry sense of humour that makes connections quickly and wittily and will leave you making jokes that go right over the heads of others. You delight in it so much that you’ll often rehearse jokes or amusing voices to yourself in order to ’spontaneously’ impress others with them. But this is a healthy desire to impress, and although you hate catching yourself at it, it’s nothing to be so worried about.
There’s also an odd feeling that you should have been born in a different century. You might be able to make more sense of that than I can.
There are some strong monetary shifts taking place at the moment. Both the recent past and what’s in store over the next few months represent quite a change.
You have a real capacity for deciding that such-and-such a thing (or so-and-so a person) will be the be all and end all of everything and be with you for ever. But you’d rather try and fail, and swing from one extreme to the other, than settle for the little that you see others content with.
Conclusion: It’s very interesting doing your reading, as you do present something of a conundrum, which won’t surprise you. You are certainly bright, but unusually open to life’s possibilities – something not normally found among achieving people. I’d say you’d do well to be less self-absorbed, as it tends to distance you a little, and to relinquish some of the control you exercise when you present that stylized version of yourself to others. You could let people in a little more, but I am aware that there is a darkness you feel you should hide (much of this is in the personal/relationship/sexual area, and is related to a neediness which you don’t like).
You really have an appealing personality – genuinely. Many thanks for doing this, and for offering something far more substantial than most."
My god, it's me. I'm autistic! It all makes sense. It's just socialized selves, what we all are to varying degrees. This is what the female autistics are describing, it's what the female autism phenotype is...it's just what we all do.
In 1844 Dr John Forbes, a critic of phrenology and homeopathy, attended a seance to observe the unique abilities of the psychic, Alexis Didier.
"The conduct ofAlexis throughout was altogether that of a man who was playing a deceptive part, and looking in all directions for help in his efforts to succeed in what was given him to do."
Forbes found "he and his friends made unconceded attempts to wheedle the party who gave the word, into conceding something as to help him in solving the problem."
Yet, Forbes failed to perceive "one single unequivocal example of his reputed powers."
Forbes argued spectators of Alexis and clairvoyance in general were either "totally unacquainted with the laws of evidence, or too enthusiastic of temperament to be guided by them."
Forbes criticized printed and oral accounts of clairvoyance because they were "utterly valueless, from being defective in exact and minute details." That belief in clairvoyance could be ascribed to "a proneness of faith, a faith which led observers to marvel at apparently successful demonstrations while ignoring numerous failures."
That sounds familiar?
Tony Attwood started the masking, my god there are huge swathes of women undiagnosed idea after diagnosing Lianne Holliday Willey and writing a foreword to her book, Pretending to Be Normal and later Safety Skills for Asperger Women. In the latter Attwood argues:
"Girls and women who have Asperger's syndrome are different, not in terms of the core characteristics but in terms of their reaction to being different. They use specific coping and adjustment strategies to camouflage or mask their confusion in social situations or achieve superficial social success by imitation or escaping into a world of fantasy or nature."
How does that gel with Hannah or Emily above who didn't even know they were autistic and don't have the same (male-centric) core characteristics? Poor old Tony, even he's been left behind as the paradigm has shifted so much. You don't now need these core characteristics, that's trad dad.
"In early childhood, probably long before a diagnostic assessment, a girl who has the characteristics of Asperger's syndrome will begin to know she is different to other girls. She may not identify with or want to play cooperatively with her female peers. Her thoughts can be that the play of other girls is stupid, boring and inexplicable. She may prefer to play alone so that she can play her way. Her interests can be different to other girls, not necessarily in terms of focus, but intensity and quality. For example, she may collect over 50 Barbie dolls and choose not to enact with her friends from the neighbourhood 'Barbie getting married' but arrange the dolls in particular configurations. There can be a determination to organise toys rather than share toys and also not play with toys in conventional ways. She may prefer non-gender specific toys such as Lego and not seek acquisitions related to the latest craze for girls her age to be 'cool' and popular. There can be an aversion to the concept of femininity in wearing the latest fashions or fancy or frilly clothing. The preference can be for practical, comfortable clothing with lots of pockets."
Revisiting Attwood I've realized that his initial ideas might be wrong (his blindspot is believing Liane Holliday Willey is autistic because she masks) but they still, at least, conform to the definitions of what Autism is. This is a long long way from women who don't have male-centric symptoms and mask their anxiety, can love boybands and make-up and act completely 'normal' so that no one notices and they don't even know themselves.
"Many girls and women who have Asperger's syndrome have described to clinicians and in autobiographies how they sometimes think they have a male rather than a female brain, having a greater understanding and appreciation of the interests, thinking and humour of boys. The girl who has Asperger's syndrome can be described as a 'Tom Boy' eager to join in the activities and conversations of boys rather than girls."
I remember this Autism, what we used to call Autism. It's still known as Autism but now most females don't exhibit any of these characteristics. Instead they appear just like other women. Odd huh?
Oddly though, Attwood does highlight sociological factors which might inhibit diagnosis of girls:
"When boys who have Asperger's syndrome make a social error, their response may be to become agitated and their clumsy and immature social play skills are quite conspicuous and annoying to peers and adults. There is recognition that this child needs an assessment and intervention. Girls are more likely to apologise and appease when making a social error."
This is exactly what I mean when I talk of "docility" above. Even though autistic girls may not follow typical socialized patterns because of the "triad of impairments" they are still taught to be docile, to act like women.
Attwood: "Peers and adults may then forgive and forget, but without realising that a pattern is emerging. However, the girl with Asperger's syndrome is increasingly recognising her social confusion and frequent faux pas. She may react by trying not to be noticed in a group, for others to be aware of her social confusion, preferring to be on the periphery of social situations. However, girls with Asperger's syndrome can be avid observers of human behaviour and try to decipher what they are supposed to do or say. Another strategy to having problems with social reasoning is by being well behaved and compliant at school so as not to be noticed or recognised as a different. A girl with Asperger's syndrome may suffer social confusion in silence and isolation in the classroom or playground..."
Unfortunately then Attwood goes off into flights of fantasy based on the experiences of Liane Holliday Willey, who pretends to be normal and succeeds with great aplomb. As many others have suggested, Holliday Willey's descriptions of her masking are simply the experiences of a young woman feeling pressure to conform to being a young woman, socialization (see Derren Brown's Forer experiment above). "Liane used imitation to become socially successful." She "figured out how to play the neurotypical game." So successful at the NT game that for some reason she still imitates a hyper-typical white middle class American woman to this day. Weird huh?
So Attwood also strangely suggests: "From my own extensive clinical experience and reading autobiographies, women who have Asperger's syndrome can be extremely sensitive to the emotional atmosphere at a social gathering. There is an almost 'sixth sense' for feelings within others of antagonism, fear and despair in group situations."
Attwood does, however, add: "Being a 'Tom Boy' in childhood, not being interested in fashion and femininity, make up and perfumes, as well as appreciating the logic of the male brain can lead to concerns regarding sexuality and gender identity."
It's logical that a syndrome characterized by impairments in social interaction would lead to either not conforming to gender stereotypes or feeling one was the wrong gender.
So it's weird then when masking is enacted by FAP Female Autistics gender doesn't become an issue anymore. Once again, this doesn't make any sense. If you're masking social skills you're not (god, I'm presuming here because it's such nonsense) actually miraculously "losing your Autism" but just pretending to not have the key social "impairments" of Autism. So why then would you, in adulthood, after diagnosis, not think, fuck this, I'm sick of pretending to be a model woman, I do not conform to socialized gender stereotypes, screw pretty make-up and pink things? Why would you continue to mask and conform to gender stereotypes?
Of course, underlying my whole rationale is that there are now huge swathes of women being diagnosed autistic that are not autistic. They don't exhibit key characteristics and claim they don't have key characteristics but are masking. They get anxious and have meltdowns. They're not picked up in childhood because teachers etc. don't recognize their symptoms because they are able to camouflage....the symptoms they don't have because there's a bias towards male symptoms...
Now, obviously, one could argue, well who gives a shit? If they're happy and they know it let them clap their hands (or not, they don't stim, that's mysteriously only male autistics and females who oddly don't mask for some unknown reason).
However...a big however...is that if Autism is now being defined in women as this new masking not having Autism descriptors Autism what about real autistic women? What the hell happens to them? Do they get diagnosed? After all, they aren't exhibiting Female Autism characteristics by the very nature of them exhibiting Autism characteristics. What about resources and support? All these Female Autistics who don't have any recognizable characteristics are also going to take that support, those resources, that are badly needed for real autistic women.
This new Female Autism will simply become the norm. Women who have had difficult life circumstances, bullying, depression, sexual abuse, social anxiety, anorexia, will be diagnosed autistic. This in turn becomes Autism. Though it has absolutely nothing to do with Autism. It's mad.
There are parallels with proposed laws around transgender here in the UK. Hadley Freeman in The Guardian points out the problems with a new changes to the Gender Recognition Act.
"Currently, anyone who wants to change gender needs to have lived in their chosen gender for two years and been diagnosed with gender dysphoria. If the changes go through, anyone will be able to declare they are a man or woman, regardless of whether they have made any actual changes to their lifestyle or body. This is known as “self-identification” and the reactions have borne out that Margaret Atwood line, “Men are afraid women will laugh at them while women are afraid men will kill them.” Men have largely ignored the issue, until it comes charging into their changing room, while a lot of women have argued that predatory men could now come into female-only spaces unchallenged."
Sex is biological, you're born male or female (there are rare complications such as intersex), you are socialized into gender (woman or man) and Transgender people typically don't feel they are the gender they've been socially assigned and the sex they were biologically born. You can't change your sex (despite the cliche sex change op nomenclature for gender realignment), the whole genetic xx/xy coding. Most of us liberals couldn't generally care a less how someone defines themselves, what they wear, or indeed their physical gender alignment. Except...it becomes problematic in real social settings. Hadley Freeman's (and many other women's) concerns around the changes to gender recognition are present in the present. A woman who was once identified as a man is still male. This becomes problematic in areas that are specifically defined as female; well woman centres, female only gyms or swimming pools, female toilets, etc. Of course, these areas are also known as areas for women (gendered) which confuses things more. It's not transphobic to be concerned by the implications of allowing males who identify as women into safe spaces allocated to females...or indeed women.
A similar issue rises with not only self identifying autistics but people who are diagnosed autistic under new, looser definitions of what Autism is. As more and more FAP women are identified by their mysterious non-symptomatic masking abilities what happens to women who are actually autistic? These FAP women come to dominate the space and control arguments around Autism whilst all the time obviously not being autistic. They set the agenda. Yet they are biologically not autistic.
Freeman argues:
"When a 19-year-old trans woman was elected a Labour woman’s officer last year, a Labour councillor explained that “lived experience as a woman” was not a pre-requisite to be a woman’s officer. Biology, too, has been deemed terribly passe. “Inclusive feminism,” Plaid Cymru’s Leanne Wood wrote when considering why self-identifying trans women should be allowed into women’s refuges, understands that “gender is a complex and deeply personal thing, and is about so much more than outdated ideas of biology.” On the day of this year’s Women’s March, trans model Munroe Bergdorf tweeted that to “center reproductive systems” at the demonstrations was “reductive and exclusionary”."
Oh how many times have I heard the argument that I have outdated notions on Autism because I believe that Autism is biological (neurological) and thus gender (socialized behaviours) is irrelevant. Uh, many times.
"There is understandable concern about being on the wrong side of history. But I’ll tell you what has never put anyone on the right side of history: shouting women down. Gender is a feeling and biology is a physical fact, and the reason women-only spaces exist is not to protect some special inner feminine essence, but because there are significant physical differences between male-born bodies and female-born ones, and the latter have long been at a disadvantage."
Female Autism is a feeling, Autism is a biological fact. But to argue this is to be on the wrong side of history.
The NAS rationale, Gender and Autism, is that there are as many autistic females as males but due to difficulties in being recognized and diagnosed large numbers of girls and women "fly under the radar" and miss out on ASD diagnosis.
This theory has become common currency in autistic theory and practice.
Underlying the theory, variously, is that;
- females present autistic 'symptoms' differently to males,
- that females mask their 'symptoms,'
- that their 'symptoms' are different,
- that female autistics epigenetic make up is different, that female autistics are genetically different to autistic males (beyond sex difference)
- the Female Autism Phenotype explains why some women go undiagnosed
- that Autism in females is underreported by teachers and undiagnosed by clinicians
- that women themselves don't know they are autistic because common descriptors are male-centric.
This is a lengthy piece looking at current research into a "Female Autism" and despite Francesca Happe in the recent Channel 4 show Are You Autistic? claiming there's "little research in this area" I can promise you there is a mindboggling number of "studies" specific to a "female Autism" phenotype, camouflaging, diagnosis, underreporting, clinicians, etc. Mindboggling numbers of them. So I've merely covered the key 'studies' that the NAS link to and a detailed analysis of a web seminar by William Mandy, one of the key exponents of the Female Autism Phenotype (FAP).
I quote individual women and critique their statements, as all the research ultimately relies on self reporting, and in no way are they meant as personal attacks but merely questioning of the foundations of their thinking on Autism and women.
Whilst I argue that the belief in this uniquely female Autism is simply a confirmation bias on the part of the clinicians discussed I, of course, have my own confirmation bias, that the whole idea is nonsensical. Though the burden of proof is ultimately not on me I'll point out the numerous inconsistencies, confusions and just plain silly assumptions and conclusions inherent in this approach to Autism and women. That's my disclaimer. So what's the evidence for a....
A FEMALE AUTISM
A typical example of these ideas are present in a statement for the NAS by Emily Swiatek co-presenter on Channel 4s recent TV programme, Are You Autistic?:
"Since getting my diagnosis when I was 28, I’ve made it my mission to help raise awareness of autism in women and girls. After all, if I couldn’t spot it in myself after nearly 10 years of working with autistic people, it would make sense that your general person wouldn’t be able to spot it in themselves. The stereotyped narratives we have around autism are still so strong, and the media often reinforces those."
As I argued in a previous post, doesn't anyone else find this odd? You can reach 28 years old (in our current Autistic-aware culture) without someone, including yourself, noticing that you might just have a neurological disorder that severely affects social interaction, communication and imagination? In fact you work with autistic people but still don't recognize their behaviours in yourself? Even stranger, was she masking while unaware for her first 28 years that she was autistic? That makes no sense. Yet she masks now consciously that she's diagnosed?
Of course, the NAS position above on 'female Autism' covers all these bases, even though they often conflict. She wouldn't have known she was autistic because the descriptors describe typical male behaviours, Emily masks her behaviours, her behaviours are invisible so they weren't picked up by teachers, or indeed anyone else, including herself, because she's female, Autism presents differently in her compared to males and to other females who don't mask because they're genetically different for some reason.
Of course, for anyone skeptical of this theory huge questions arise.
- If you mask behaviours you must surely have behaviours that would be very visible if you weren't masking, what are they then?
- Why would these behaviours present differently for autistic females alone yet not in other syndromes?
- How can Autism be genetically different in females if we don't know Autism is genetic?
- If girls mask their behaviours then teachers wouldn't be able to spot them but then at what point do girls start to mask?
- Surely there's a point at school before they begin to mask, would no one notice this radical change in behaviour?
- Why have caregivers not noticed the behaviours?
- If the autistic girl is masking at home where did she learn to mask from?
- If the behaviours are different in autistic girls and boys, women and men, why can't anyone list what the behaviours in females are?
- Why are they only ever defined as what they are not (male)?
- If the behaviours aren't the same then they won't present the same yet the argument is both that the behaviours are different or they don't present the same, which is it?
- How does one reach adulthood without knowing these behaviours are autistic (in our internet age)?
- How do the peers you learn to mask from not notice you are now masking when you weren't before?
- Why do some girls learn to mask and others not?
- Why do women continue to mask even after diagnosis or making it public?
- Why do those that mask never appear to exhibit autistic behaviours yet those that don't mask do?
- Is that proof of masking or a strange form of confirmation bias and cognitive dissonance?
I'll get onto masking but first, what are the behaviours unique to female autistics that differentiate them from their male peers? This is a question that haunts me as you can read reams of 'studies,' 'research' (inverted commas for reasons you'll see) personal testimonies, blogs, etc. but all you hear is that females present differently and they learn to camouflage their behaviours. What behaviours?
I've tried to find something on Emily Swiatek, as an example, that describes her autistic behaviours, which she argues she masks. In a piece on buzzfeed, for instance, she tells us:
"“I am quite eloquent, I can chat to people – my job is all about communication and meeting new people every day,” says Emily Swiatek, 29, who was diagnosed with autism spectrum disorder (ASD) last year. “When you look at those surface points, I think [the diagnosis] can be quite hard to understand.”"
Yes. It is hard to understand. If one doesn't fit the descriptors for difficulties in social communication, imagination or interaction, what are the masked behaviours then?
"Before her autism diagnosis, Swiatek accumulated a “rubbish bin” of different diagnosed conditions, including borderline personality disorder, an eating disorder, and anxiety. “There was a point where I had about 10 different diagnoses on my file,” she told BuzzFeed News.
Well, anxiety is a common descriptor used in discussions of 'female Autism' but anxiety itself is not an Autism descriptor, it is a descriptor of Anxiety, the psychological condition that has its own DSM descriptors Generalized Anxiety Disorder. If you're autistic then anxiety is an inevitable co-morbid. But it isn't Autism. Just as Anorexia or depression or personality disorders (for instance, dissociation) are descriptors of personality disorders, depression and Anorexia. Again, very common as co-morbids for Autistics. So what are Emily's autistic behaviours that just didn't fit her diagnoses of eating disorders, etc.?
"Until the signs were finally picked up, Swiatek, who lives in London and has worked as an employment training consultant for an autism charity for four years, was among an unknown number of women in the UK left struggling, sometimes personally and sometimes professionally, without a name for the challenges they face." my italics
SIGNS
This piece is quite typical of the discussion of masking and female Autism. On Are You Autistic? no one ever explains what behaviours the women are masking. If they aren't the same descriptors that males experience what are they?
Hannah, for instance, who was diagnosed autistic and researches Autism helpfully explains here what the difference is between male and female Autism...
To quote: "Females have this natural drive to fit in socially and the symptoms they have aren't stereotypically "autistic" so things like making eye contact, females tend to be OK with, their repetitive and obsessive interests tend to be quite normal things, and also they have this natural drive to fit in socially so they feel more compelled to make friends and try to mimic others to fit in and try and be accepted."
It is, from a biological standpoint, utterly bizarre to suggest that females are biologically programmed to fit in socially better than males. That's just silly. If indeed, women are driven to 'fit in' better then that would have to be gendered. It can't be a natural biological process. In your DNA to be more sociable? That makes no scientific sense. But if it were gendered, that makes no sense either if Autism is characterized by not following socialized (gendered) roles (much more on this below).
But what then are these unique female descriptors? Well, in all discussions we find out what they are not. They are not the typical Autism descriptors of problems in social interaction, eye gaze, behavioural difficulties, communication difficulties. This isn't just that they present differently but that they don't have these characteristics. So what are the female characteristics then? And if they're not all these key autistic descriptors, then why would you have to mask them (or "mimic others" as you already appear like others)?
If obsessive interests are of normal things how does one differentiate that from "normal" (neurotypical) obsessive interests? After all we all do have obsessive interests, right? The usual answer is that autistic people take these interests to extreme lengths. But what is extreme? Aren't all teenage girls obsessed with pop stars or ponies or YA fiction or, I dunno what teenage girls are obsessed with. As a boy I was obsessed with football, but then my brain grew and I became obsessed with art films (I have an encyclopaedic knowledge of Japanese cinema) and literature (I obsessively read through the Penguin classic catalogue...I literally had their paper catalogue). I'm not autistic.
Hannah clarifies what Female Autism is in a blog post at aspie.com:
"I lived for 23 years with no idea of the condition I had in my brain. That condition was Asperger’s Syndrome. I battled through my life with a number of separate psychiatric labels, each representing only small parts of my difficulties: Generalised Anxiety Disorder, Borderline Personality Disorder, Obsessive Compulsive Personality Disorder, Depression... you get the gist. To be given the label of Asperger’s eased my inner conflict massively; I finally had an umbrella term where all these difficulties could make sense."
This is why I'm writing about this subject and find the whole thing so disturbing. Hannah had loads of psychiatric diagnoses then was finally diagnosed autistic. An "umbrella term where all these difficulties could make sense." Except none of those psychiatric conditions meet the descriptors for Autism. It's why they aren't Autism. That's how syndromes (clusters of symptoms) work. Autism is not an umbrella term for psychiatric illnesses. You may well experience these psychiatric conditions if you're autistic but they aren't Autism. If one understands Autism as an umbrella term for a large group of psychiatric conditions you understand nothing about Autism. Autism is not psychological, for a start. Worryingly, Hannah is doctoring in Autism Research and lectures on "The Science of The Mind" yet doesn't appear to realize that Autism is not a psychological condition and her psychiatric conditions are not Autism. I find this unsettling.
This is how the idea of Female Autism works. Autism in women is being redefined to be all these psychiatric conditions rolled into one in a handy bitesized term, Autism. It has nothing to do with Autism because females are biologically different so they experience Autism in a completely different way. Then they mask their symptoms. Symptoms of which, we still have no idea what they are. Can Hannah clarify what these unique 'symptoms' are?
"It is fair to say that my ‘special interests’ are centred more on people than things."
Well, that goes against Autism descriptors. I forget, sorry, this is Female Autism. Where Autism is apparent in being just like non-autistic people.
"One of the ways I have learnt to cope with my impairments is to monitor others around me, and learn how to ‘fit in’ through imitation."
What impairments? Eye contact, social interaction, interest in others, all present and correct. So how is this Autism?
If one acts just like others with eye contact and social interaction what is there to imitate?
"As I have gotten older this has moved into the more complex realm of Psychology, and understanding why people behave the way they do. I figured people are no different really to learning how to use a computer; we all have inputs and outputs. I tackle my own thoughts, feelings and behaviours with the same sort of obsessive rigour as scientists trying to find a particular vaccine in the midst of a pandemic, which is how I ended up doing a PhD studying autism in females."
What? I can guarantee I have no USB ports and I still have no disc drive, HDMI or headphone jack. Computers, humans, is a silly analogy. We're nothing like computers. We have feelings, emotions, thoughts, behaviours, a part of our brains is like computers. Scientific rigour?
What are these female autistic behaviours?
"I wanted to know if I was alone, why it took me so long to get a diagnosis, and how I had managed to adapt so well socially despite my impairments. What I have learnt so far is that there are hundreds of females out there in the same position as me, all wonderfully unique and kind human beings with bucket loads of empathy; not what the media teaches us autistic individuals look like!...The condition lends itself to quite an egocentric perspective, so I am having to consciously think ‘can I really speak for everyone here?’ and learn about the different experiences other people with autism have had."
What impairments? Yes, speak for everyone. Tell us about these impairments that aren't the same as male autistics.
"Whilst the majority of feedback I have received from the work has been positive, it appears you cannot become too big on the internet before trolls start attacking you, which has been the hardest hurdle to face. Being told by people who do not know you and have only read an article that you are a fraud and cannot possibly have the condition hurts, especially when you came to the club quite late and have lived with those doubts all your life. If the research was not so personal to me then perhaps I would be able to take these knocks on the chin, but that is the nature of the beast."
Well I don't mean to sound like an evil troll and I wouldn't say a word if you could just describe your behaviours that define your Autism so that I have an understanding of what you're talking about. Dear Hannah, I've read your blogs and you suggest you have no difficulties with eye contact, you're sociable, in fact the only thing you describe at length is meltdowns and they aren't an Autism descriptor, I don't even know what they are because the way you describe them is that you get very tired and upset. I'm not personally attacking Hannah, I'm not trolling, I genuinely want to know what her impairments are that she masks.
One can go to her blog aspertypical and really she's making her own bed by having posts on the anxiety of travelling, her "toddler style tantrum" meltdowns, how mindfulness is stressful. Is this Female Autism?
And when she does write on Female Autism we get her own study Understanding the Research: Undiagnosed Autism Spectrum Disorder in Women where we get some students taking the AQ (Autism Quotient) screener and the EQ (empathy Quotient) which isn't used as a screener and she found:
"Lots of females who scored above the criteria but who didn’t have a diagnosis! More specifically about 8.7% of the females we tested, compared to 6.5% of the males. [sic]"
I get 45 out of 50 on the AQ. So. It means nothing. Self reporting isn't science, of course. The EQ would skew any data anyway, assuming that the women and men involved followed "typical" gender patterns (women are more empathic than men...socially gendered, not biologically).
She writes a post An informal rant about individual differences in autism and why the extreme male brain theory should be axed in which she irrationally argues:
"I think the fundamental problem of why we cannot understand the difference between males and females with autism is because we look at the condition as a overriding layer of a person’s self, and do not consider that whilst this does colour a lot of our thinking and behaviours, there is still the influence of personality, external inputs such as society, gender, past experiences, birth order, star signs, past lives (too far!?)."
We should diagnose people autistic by looking at their individual personalities and wider sociology? That really makes no sense. You can't diagnose people based on their own personal characteristics. That really is meaningless as star signs. Imagine defining depression individually by personality rather than descriptors. Happy depressives?
Aha, indeed, she clarifies this:
"The point is we are all individual and unique already, and the autism mixes in with that. For example, when you see two people experiencing depression they may appear nothing alike."
Wow. If you can't work out the difference between depression descriptors and a person's individual personality then we really really are in trouble if you're teaching The Science of the Mind. I mean, depression is always characterized by low mood, low motivation, sleep disturbance, etc. It varies by severity in degrees but you can't be a happy outgoing depressive, right? But you can be an outgoing Autistic with none of those pesky male-centric descriptors apparently:
" This is why we become stuck with the very strict criteria of what autism is and what it looks like. We have a set off core symptoms that should be found in anyone with autism (social communication problems and restricted and repetitive behaviours), our mistake is to believe that these should look the same in everyone. "
What? How can a symptom or descriptor look different in different people? Severity can be different but the actual symptom will be the same.
"It would be a much easier diagnosis if they did, but can we say that just because someone makes good eye contact they cannot be autistic? "
Yes.
"No, because there are many factors that make people more or less prone to make eye contact. The impairment is with social communication as a whole, and this may be something a person struggles with internally more than externally."
Difficulties with eye contact is a core descriptor. If you do make typical eye contact there's no reasons why you wouldn't experience socialization in the same typical way. We read other's via eye gaze and eye contact, the reason why Autistics have difficulty understanding others' motivations or thoughts and why social communication is difficult for Auties all stems from difficulties in eye gaze/contact. That is, the difficulties with social communication, interaction and imagination are all directly linked to poor eye contact.
"What happens if you get an extremely extraverted [sic] autistic person? Will this look the same as an extremely introverted autistic person? What if you have an autistic person who has 5 brothers, compared to one who is an only child? Are they able to socialise better with their peers and be less rigid and self-orientated? The point is that impairments can be expressed in hundreds of different ways depending on an individual."
Clearly, distressingly, Hannah doesn't understand what Autism is. Extroverted Auties? What? How can one be extroverted whilst having 'deficiencies' in social imagination, communication and interaction? Autism is characterized by 'social impairments' it doesn't matter if you have 600 siblings. It won't magically make your impairments vanish. This is bizarre. It goes on much in this vain, completely misunderstanding what Autism is, a neurological syndrome not a personality type.
Of course, we still don't actually find out from her blogs what this female Autism manifests as, merely what it isn't. Male Autism. Or autism, as it's generally known.
The whole discussion reminds me, weirdly, of the video game GTAIII and the radio station Chatterbox...no really...Jeff calling in about the Rockford Rally...compare and contrast with the descriptions of Female Autism...
But what is it about, Jeff?
Here's a lecture by Hannah Belcher on Female Autism telling us all the things that Female Autism isn't...
Social and emotional impairments
Language and Communication Impairments
Problems with Flexibility of the thoughts.
Collectively known as the Triad of Deficits or Impairments. In the DSM these are Difficulties in Social Interaction, Communication and Imagination, the core to Autism diagnosis. So how then are women going undiagnosed if they exhibit these same core symptoms (that oddly, Hannah claims she doesn't).
Well because boys present these problems in hyperactivity, "more repetitive stereotypical behaviours" and "more challenging behaviour." Whereas females exhibit "anxiety and depression" and "better socializing ability, friendships, social mimicking and motivation."
So Autism isn't different for women, claims Hannah in this talk. It presents differently. That I would agree with. But this is not what these female Autistics, or indeed the NAS, are arguing. They argue that their Autism is fundamentally different, because it's not the same as male Autism. So which is it? Different Autism or different presentation?
Though then assuming that it presents differently because either Autism in women is different or that women can mimic is problematic as, as ever, how do you know this? If it's from women who have been diagnosed then these same women should experience the triad of impairments. So why, over and over, do those women not discuss those impairments, in fact claim they don't have them, because those are male impairments? Why do they continue to mask them if they don't have them? How do they mask them so well that they "appear normal"? Especially when some women don't mask, for some inexplicable reason.
I completely agree that females present differently to males. This isn't biological, per se, of course, it isn't biologically in me as a male to act more violently, say. In reading on diagnosis the overwhelming suggestion is that young males are referred because of anti-social behaviour at school.
It makes sense when reading Autism descriptors, repetitive interests and behaviours don't fit well with school curriculum. The boy gets frustrated. The boy reacts in anti-social ways. Teachers notify parents, parents see doctors, etc. This should, in theory, be the same for girls, in my argument, though...
Having argued that gender should not affect Autistics as gender is a social construct and as such, Auties should not conform to gender roles because socialized norms are inducted through social interaction, communication and imagination, mostly through our parents and peers, why then Mr Desmoulins would boys be picked up as Autistic and girls not? The obvious answer to the NAS and the above mentioned female Auties is masking. But masking makes no sense for the questions I raise above. A much simpler answer is that it is indeed gendered. However, not in the case of the autistic child.
Society is gendered, school is like a form of hyper-gendered reality where we learn our gendered roles not just socially but in the way the curriculum is set out and most importantly, the way schools engender learning.
Sociologist Pierre Bourdieu argued that girls do better at school because they are taught to be "docile." To Bourdieu docility doesn't just mean conforming to gender roles but that the school system itself is passive (think sitting behind a desk rote-learning) and girls are taught from birth to be passive while boys are taught to be active. While this is mostly socialized it is also quite literally instilled, did your parents not treat you and your siblings differently dependent on your gender?
Even if you're autistic supposedly 'lacking' in typical social skills you will still react like anyone to direct actions and instructions. For instance, typically in the home, boys are more likely to be allowed to go wild, to have more space, to be freer in where and when they roam, many things are unladylike, cliche but still underlying many of our relations with our children/parents. Autistics may not pick up on 'invisible' social cues but typically Autistics have a strong sense of right and wrong, if autistic children are told something is wrong then this they take quite literally. It's wrong for girls to act in certain ways. Like boys, basically. So, whilst autistic individual do not pick up on invisible gender cues (preferring gendered toys, particular dress, etc.) they will, just like us Neurotypicals (NTs) respond to direct gendered instructions (don't make a noise, don't run around like that, etc.).
These gendered differences are most apparent in the school yard (see the Female Autism 'study' below) where gendered home roles are reinforced. Boys dominate space with large scale games, football or large scale "rough and tumble" games, etc. Girls typically congregate in smaller groups, their games are much smaller scale. The boys games are generally organized whereas girls games tend to have less rules and whilst boys play in large groups typically, girls tend to be on the periphary of school playgrounds, often interacting without playing games. It's why typically boys do not communicate emotionally whereas girls learn to through this interaction. Boys tend to be more active, action over thought or emotion. It's therefore quite easy to see why a syndrome characterized by aloneness and confusion of social norms would be far more apparent in boys in this social setting (see study below).
Furthermore, when anyone discusses presentation of symptoms by gender they forget that the autistic child is not the person involved in the observation of autistic 'symptoms.' The NAS single out teachers as not noticing the symptoms in girls and they then, in a post hoc fallacy, assume it must be something in the girls or what the girls do or don't do that makes them go unnoticed. No one thinks that a teacher, well versed in instilling gender divisions in children via the school system, having parents that instilled these gender roles, perhaps having their own children in whom they instil these gender roles, would have internal biases about gendered behaviour. Take into account biology too in the sense that boys are bigger and stronger,it therefore seems logical that the bad behaviour of boys, or unusual behaviour (say not taking part in large scale games like football but standing apart) would be more noticeable to teachers (or indeed parents). It's not that girls hide it, it's that teachers don't recognize it and their own bias.
Proving the point. From a study cited by the NAS, "The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder":
"This study examined the extent to which gender-related social behaviors help girls with autism spectrum disorder to seemingly mask their symptoms. Using concurrent mixed methods, we examined the social behaviors of 96 elementary school children during recess (autism spectrum disorder = 24 girls and 24 boys, typically developing = 24 girls and 24 boys). Children with autism spectrum disorder had average intelligence (IQ ⩾ 70), a confirmed diagnosis, and were educated in the general education classroom. Typically developing children were matched by sex, age, and city of residence to children with autism spectrum disorder."
This is what passes for science in Autism research, someone standing around observing kids playing in a schoolyard (there are other names for this kind of behaviour, of course). But what does this cutting edge research find? Well, it's Female Autism confirmation bias in action. Instead of looking at the way the children were socialized into playing, the 'study' instead ignores sociology completely and argues:
"The results indicate that the female social landscape supports the camouflage hypothesis; girls with autism spectrum disorder used compensatory behaviors, such as staying in close proximately to peers and weaving in and out of activities, which appeared to mask their social challenges. Comparatively, the male landscape made it easier to detect the social challenges of boys with autism spectrum disorder. Typically developing boys tended to play organized games; boys with autism spectrum disorder tended to play alone. The results highlight a male bias in our perception of autism spectrum disorder. If practitioners look for social isolation on the playground when identifying children with social challenges, then our findings suggest that girls with autism spectrum disorder will continue to be left unidentified."
So socialized boys games involve actively taking large spaces in organized groups. And shock horror, autistic boys do not take part in these because to be part of an organized group you would have to learn the socialized rules. They stand out like a sore thumb.
Girls stay in close proximity and weave in and out of activities, usually one assumes then with no organized rules, it's obvious that they would be less likely to be picked up. It has nothing to do with the girls hiding their Autism by masking strategies and everything to do with the way that society is gendered. This is a sociological phenomena where boys control space, girls are hemmed in, in the wider world we see the same actions happen with manspreading.
Boys at play in large organized groups
While girls stay in close proximity...uh...gambling
The dominance of space continues in wider society
Rather than realize that the social roles actively gives evidence that boys are more likely to stand out because of the ways children play and socialize the 'study' simply confirms its own bias, it's nothing to do with sociology, it has to be the way the girls act. "The results highlight a male bias in our perception of autism spectrum disorder. If practitioners look for social isolation on the playground when identifying children with social challenges, then our findings suggest that girls with autism spectrum disorder will continue to be left unidentified."
So the bias is in the observer not unique descriptors in the children. Isn't this obvious? This doesn't confirm camouflaging at all, it confirms that boys and girls act differently, play differently and that socialized roles around space dictate that boys are easier to spot.
BEING AND NOTHINGNESS
"Mills, who previously worked for the NAS, says he became aware of the extent of the problem after conducting a study of women in secure hospital units in the early 2000s. “We found an overrepresentation of undiagnosed autistic women,” he says. “That got us thinking, How many had been missed?”
Woah, stop there. You found lots of undiagnosed autistic women in psychiatric hospitals? You have to be quite disturbed to be placed in secure hospitals, how woulds you untangle schizophrenia from Autism? I'd love to know. After all, for most of Autism's history Autism was considered a form of schizophrenia.
"In 2010, Mills and colleagues put on the first conference specifically for women on the spectrum. “We could have filled it 10 times over,” he says, “it was unbelievable.”"
Odd that there are so many undiagnosed women yet it sounds like there's lots of diagnosed women.
"Clinicians and experts are only just beginning to realise how differently girls on the spectrum can present compared to boys and how that impacts getting a diagnosis. Mills won’t be drawn on the medical profession, but notes that GPs are often simply “not looking for autism in girls”."
This both conforms to the NAS position that girls present differently and my own argument, that adults aren't looking at boys and girls without preconceived ideas of gender roles. It's not that GPs aren't "looking for autism in girls" but they are not looking for the "girls" in girls. And that would not be unique, of course, to male GPs. We're all indoctrinated into our ideological gendered assumptions. It's important to note that Mills here is talking about presentation of autistic characteristics, not having different characteristics. If lack of diagnosis of women is based on presentation then why assume that it's something the girls are doing to hide their Autism rather than look at why girls go unnoticed. If they are.
Mills: "Key traits of autism in girls are still not clear – if they exist at all. While boys, for example, have been noted to develop fixations with unique hobbies, or be socially withdrawn, girls on the spectrum often defy these seemingly established manifestations.
“Boys might line things up, girls might collect things,” Mills says. "In older girls we tend to have seen girls gravitating towards older girls, fixing on older girls, or pop stars, or particular pop groups, this kind of thing." While these “fixations” can be be “all-consuming and socially isolating”, he says, they can also be "difficult to untangle from normal development." My bold and italics
Baffling isn't it?
"Researchers have also found that a significant number of diagnosed girls develop an ability to mimic the behaviour around them, but often at a huge personal cost.
As Povey puts it: “Imagine a young girl who is really lost in this world, doesn’t understand how other people act, doesn’t get all the other sort of hidden social intricacies going on around her.
"What seems to happen is they therefore look at the girls who seem to be doing it best and almost copy that, without understanding what’s happening underneath and peoples’ motivations.
“So often they are almost the most perfect girls, but there is all this panic going on underneath the surface.""
Now, this is problematic if you have a syndrome characterized by social deficits. Imagine you're autistic. Or perhaps you are. Now you don't follow socialized rules (these we NTs learn unconsciously), you supposedly can't place yourself in others' minds, you're not driven to communicate your thoughts, feelings or behaviours, so why would you think, hmm let's observe those idiots doing idiot things, I'll copy their idiot behaviours and pass myself off as an idiot like one of them? Your new chums (who have had years to perfect their communication skills, mind, yet you are presumably doing it mechanically in the moment) )mysteriously don't recognize you doing this, even though there must've been a point before you did start to mimic and you were doing bizarre behaviours that weren't idiotic, and even you don't recognize yourself mimicking. After all, the women mentioned above didn't know they were autistic until adulthood so how could they have known that they were so different that they had to consciously mimic others? How can you consciously do something you're unaware of? It makes no sense. If masking were the fact that autistic girls, aware of their difference, try to copy their NT peers consciously, in order to fit in then yes, that would make sense. But then it would also make sense that they would be hopeless at it. Such copying, or socialization is all carried out unconsciously by NTs, to have to learn these skills manually over a very limited time period would surely be impossible, mannerisms, body language, communication, and so on. Most autistic women claim they begin to do this masking around puberty when it becomes very noticeable that they are different. So they've presumably had many years of not masking among their peers. They have to learn these skills that take years unconsciously for NTs and no one notices they were autistic. Ever.
This makes no sense.
You spend years being bemused by others' actions or according to the women above, you don't at all, in fact no one notices, you behave normally, too normally and that's why you don't get noticed. Then one day, after having been bullied, perhaps sexually assaulted or coerced, watched just about every media portrayal of girls that don't seem to be like you, feel intense pressure to conform to these ideals and you get depressed, maybe try to control your environment by controlling your body, you get anxious, social life as a young woman is terribly constricting and difficult, you get socially anxious, you get diagnoses of BPD, anorexia, anxiety, depression, you get drugs, you get counselling, but you still feel terrible because these social factors outside of your control still make life difficult. Then one day you hear of a disability, online maybe, on a blog by a woman just like you, seemingly 'normal' yet she too tells of having all these social struggles until...you hear of this wonder thing that isn't actually a disability but a kind of gift, you get to join groups with other young women, you can write your own blog about your struggles with this gift you didn't know you had, you don't seem to have this disability gift others tell you, but you don't seem like you have this gift that makes you unique, connected, disabled with all the extras that come with it (I get a bus pass!) because you've always pretended not to have it, in fact you didn't know you had it until you saw that other young women experienced the same problems as you then they found they had this gift, but because you don't seem like you have this gift at all you get all the great things the gift offers without any nasty side effects, like neurological behaviours you can't control. You get a diagnosis. You can now march forward as an autistic woman and you don't have to conform to all those expectations, any time you don't like something, it's understandable because you're autistic, any time you appear just like others to others, it's because you're masking. Pity, admiration, wow, you seem so...uh, can I say normal? Everything now makes sense.
IT ALL MAKES SENSE
Hannah's one of the six women on the piece, you do find the same people popping up again and again, Carly Jones is in everything female autistic whilst still appearing like some kind of hypernormal being from the planet Woman, and of course there's a living to be made from this for all of these women, if you're a cynic. I'm a cynic.
Hannah once again talks about her Autism without magically talking about Autism:
"Women and girls often have a natural drive to fit in socially, and so the symptoms they present with aren’t stereotypically ‘autistic’." So what are they then? We get the idea of what they're not.
"For example, they might find making eye contact difficult. I know I did. I’ve learned to count it out. I will look away for a few seconds and then back."
Oh dear. I'm afraid I did just literally slap me head. Difficulties with eye contact in Autism is not just eye contact. Depressives, anxious people use less eye contract typically but they can still process body language. Hannah suggests she doesn't have social imagination difficulties above.
"I’ve watched people carefully and studied psychology to degree level to get me to the point where I can now act quite naturally."
Sigh. So apparently regurgitating the theories of BF Skinner makes you somehow get past autistic descriptors. This is just so weird.
The rest of her piece is about her psychological conditions, anxiety and depression.
Whereas Jasmine, a fellow female autistic in the BBC piece, for some inexplicable reason tells us:
"I genuinely thought I was an alien.
It sounds silly but that was the only thing my childhood brain could comprehend.
When I was a baby people thought I was deaf. But I wasn’t deaf, I just wasn’t paying attention.
Then as a toddler, it was like I was always thinking logically and the other kids were just being reckless.
Why would I want to get splinters up my bum from a wooden slide in the playground?"
Dear god, a female autistic describing Autism descriptors! Hallelujah, bells ringing, blah blah.
Why have you not masked Jasmine to the point where no one would have noticed any of this? Why why why? Why did you continue to think others' behaviour was crazy and not just act like them magically to fit in?
Jasmine continues:
"When teachers put me on the spot and asked me questions, my brain totally shut down. It needed extra time to process what they were saying...I did have dyspraxia [a condition affecting physical co-ordination].
Doing my stand-up, I don’t feel as awkward as I do talking to people socially. It feels really natural to be up there performing.
I don’t have to talk to anyone specifically. I am talking at people. I think that’s the difference.
I’m not constantly thinking, ‘When can I chime in? When is my time to talk? Would it be rude if I said this?’
I take my dogs on stage. They give me extra comedy material.
I also feel calmer being able to stroke them while performing.”
Now isn't it weird that Jasmine should describe all these classic Autism characteristics yet she's a woman. Why doesn't she talk about her brilliant masking skills? In fact, why does she highlight that she was bullied at school because of her difference? Why doesn't she just list things that she's not? Male things. Though, I'm gonna throw one out there with no evidence, I bet she doesn't feel like she's a woman. Female maybe but I bet there's been a bit of gender confusion. Well, it would naturally (really naturally) follow that one would be confused about your gender if you don't follow gendered socialization. More on this later.
Then there's Amanda who tells us:
"To be honest, I don’t really have any friends. People that I call friends are those I’ve met through work or on a Facebook group. But I don’t have any actual friends who I would go out anywhere with.
I don’t like people coming round my house. It’s like my little sanctuary. It probably sounds a bit weird."
Why Amanda? Why aren't you artificially sociable (you can go home later and have a meltdown)? Why can't you mask being wonderfully normally sociable?
"My husband’s quite sociable and gets on with everybody - so he’ll go to parties without me. He lets me know they’re happening, but leaves the decision up to me. Ninety-nine per cent of the time I won’t go.
He used to get upset when I refused to go - but now he knows I’m not rejecting him. I just know I can’t put myself in a situation where I’d be very uncomfortable."
Amanda, you can't be Female Autistic, you're far far too autistic for a female. You should just be anxious and spend your time in Primark masking your unnameable autistic symptoms (meltdowns).
This piece is really letting the - Female Autism strange unique descriptors that no one can say what they are - side down. But what about Claire, 35 years old psychologist? Can she bring us back to Female Autism reality by not describing anything autistic in herself and when getting diagnosed everything made sense, all the things that made sense before now suddenly make a different sense?
"“‘There’s no way I can be autistic and a clinical psychologist,’ I thought." she thought.
‘It’s incompatible because autistic people don’t have empathy.
So if I’m autistic it means I can’t be empathic.’
That’s the level of naivety I had at that time."
But Claire, you don't need empathy to be a psychologist, everyone knows that (except psychologists but that's because the condition means they simply can't empathise with anyone who isn't a psychologist).
How does Claire's empathic Autism that she didn't recognize at all until aged 35 present?
"I had a bit of a light bulb moment one day in a lecture theatre during my psychology training. We were being taught about different conditions - including autism.
I thought, ‘Oh my gosh that sounds really like me. That is really freaky.’"
Ah yes, the old "that sounds like me moment." It's the core trait based internet female oh my god that sounds like me internet not male Autism Autism trope. Where a few vague traits sounds like me. It's how Barnum statements work, psychic cold readings, star signs, blah blah:
Do you have a tendency to be critical of yourself? You have a great deal of unused capacity which you have not turned to your advantage. While you have some personality weaknesses, you are generally able to compensate for them. Your sexual adjustment has presented problems for you. Disciplined and self-controlled outside, you tend to be worrisome and insecure inside. At times you have serious doubts as to whether you have made the right decision or done the right thing. You prefer stability to change but become dissatisfied when hemmed in by restrictions and limitations. You pride yourself as an independent thinker and do not accept others’ statements without satisfactory proof. You have found it unwise to be too frank in revealing yourself to others. At times you are extroverted, affable, sociable, while at other times you are introverted, wary, reserved. Some of your aspirations tend to be pretty unrealistic. Security is one of your major goals in life."
Barnum statements rely on the basis that:
you believe the analysis applies only to you
you believe in the authority of the evaluator
the analysis lists mainly positive traits
And of course it's horseshit because it's everyone (see more below).
"But some of it didn’t fit," says Claire. Let me guess, the social interaction, communication and imagination deficits bits?
"I think there’s a great desire in girls to be social, and autism diagnoses are often based on male traits."
Uhuh.
"So girls and women say, ‘No. I don’t have many issues with wanting to be social."
Right.
"By saying that, they’d lose points on the diagnostic measures."
Yep, that's how diagnosis works.
"There were missed clues when I was younger."
If only there were some kind of autistic Poirot to seek out these girl children who don't present Autism as Autism.
"I went to high school in the US, and so some of the quirky traits that make me ‘me’, were not seen as being odd or bizarre."
Huh? Americans are all autistic?
"They were seen as belonging to the Scottish girl - culturally attributed rather than individually attributed."
Ah, the Scottish are all autistic? Is she, I mean just to clarify, suggesting that being Scottish can be mistaken by Americans for being autistic?
"I also love fantasy fiction. I used read and read and read. I got lost in The Lord of the Rings. I would dress up as an elf. I went to Comic Con meetings."
Autism. Doesn't that mean that everyone who loved Lord of the Rings is autistic? About 2/3rds of the planet. Not me, I fucking hate that childish drivel.
"That was my way of escaping.”
From what? Being Scottish? Is this perhaps a key definer of this Female Autism? To be fair, I thought the key descriptors of this magical Female Autism based on the myriad blogs, articles, 'research' pieces and ahem, studies I've read were being:
- white
- middle class
- anxious
- no that's it....oh other than being female, of course.
There's three other women who describe being a woman and all the social crap that comes with being a woman in a patriarchal society. Female Autism.
Oh there is Maura who clarifies exactly what female Auties are masking when they aren't masking the triad of impairments descriptors because these are male-centric...
"I'm now 50. Six years ago I was diagnosed with Asperger syndrome, a form of autism. Like many women, this came after the diagnosis of my son, Darragh.
If it wasn't for this, I'd have gone through the rest of my life unaware of why I felt different.
As a child I'd felt as though everyone but me had been given a manual on how to behave around other people.
I was more comfortable around pets. Because I performed well academically and masked my anxiety, I flew under the radar."
See how these ideas become common currency without any annoying stuff like evidence or facts..."flying under the radar." This comes from Francesca Happe via Judith Gould via uh...nothing (see it repeated below). Just put it on repeat.
So Maura masked her anxiety. But anxiety is not a descriptor for Autism. Hmmm.
"When my autism was identified, it felt like taking off a corset I didn’t know I’d been wearing."
Huh? As mixed metaphors go...Suddenly all the debilitating restrictions I'd been feeling without knowing suddenly made sense.
"I understand now that I have a brain that processes sensory and social information differently from most other people.
I can take better care of myself by managing my social energy and avoiding sensory overload. I have found a sense of identity."
It's just astrology gibberish isn't it that's repeated ad nauseum. I didn't know I was autistic but then when I was referred and diagnosed suddenly it all made sense, all the things I'd never noticed before I suddenly noticed even though I can't say what they are.
"Women do not need to fear a diagnosis - it may help explain so much."
Look, if any women undiagnosed are out there weirdly reading this and not angry with me for questioning the Female Autism masking no actual symptoms thing with a reasoned argument then I can diagnose you for just one shiny 50p piece. No, I'll do it for free. You are a woman and it sucks because of us, men. Sorry about that, I didn't make it, blame god or Theresa May (she isn't to blame but fuck it, she's horrible). If you fit the Autism descriptors then you're autistic.
Maura concludes cryptically:
"I am living the life I want to live.
I have an interesting and rewarding career in Northern Ireland's civil service alongside supportive colleagues who accept me as I am.
I've continued writing about autism and disability and had several articles published. I've co-authored a book along with some of my autistic sisters from around the globe, some of whom have become close friends.
Most importantly, my diagnosis has enriched my personal relationships and made me a more confident mother."
Was she not living the life she wanted to live before the diagnosis of something she didn't know she was? Did no one accept her at work before her diagnosis. "You weirdy, Maura, with your...um...undiagnosed Autism that even you don't know about which is weird because you don't know about it yet we've all treated you like a weirdy with that whole hand stimming animal noise thing you feel compelled to do, the strange processing where you stare blankly then answer ten minutes later, the whole talking incessantly about your special interest..." said a work colleague once.
"Autistic sisters" oh dear.
How does diagnosis of Autism make you a more confident mother? How does it enrich personal relationships? Who knows?
TRAUMA
Back to Buzzfeed again and Emily Swiatek highlights a key issue in this new Female Autism:
"In Swiatek's experience, it became difficult for professionals to untangle traumatic life events from her biological condition. “You sort of become defined by that,” she says."
Indeed, as we'll see with the NAS piece on gender, a recurring theme is Trauma. No trigger warnings as I'm not going in depth about trauma but I will be briefly discussing how sexual abuse and rape interact with Autism diagnosis in women. In fact the two seem to be inextricably linked in a kind of chicken/egg symbiotic relationship. Meaning, if you're a female Autie the chances appear to be extremely high that you will experience some form of sexual abuse, almost certainly because of key descriptors of Autism, being less able to read signs of danger, others' motivations, etc. which is not suggesting in any way that victim/survivors are in any way responsible (I feel a need to state the obvious). However, women in general are very likely to experience some form of sexual abuse/assault (take your pick of figures anywhere between around 20 to 40% of women). As PTSD symptoms are almost impossible to disentangle from Autism descriptors, are autistic women more likely to be abused or are abused women more likely to be diagnosed autistic? Or both? Or neither... as Swiatek suggests:
"“I think when you are an 'Aspie' growing up,” Swiatek says, “you are so used to getting things wrong, so you are always trying to be the good girl. When someone will reward you for that in any way, because you don’t have the in-built safety mechanism necessarily, it can mean you are much more vulnerable.”"
The problem with unravelling that is that all young women are vulnerable and, of course, in that fearless young way, tend to not realize their vulnerability. So young women are more likely to be sexually assaulted, because of the way our society is still structured and women are more prone to generalized anxiety, depression, suicide, eating disorders. All have similar trait manifestations as Autism but are clearly psychological. Indeed, one might say that it's worse for women now in a hyper sexualized media saturated world. However, Autism is clearly neurological not psychological. There are very clear descriptors and very clear behavioural manifestations (repetitive behaviours like stimming, difficulties with eye gaze, clumsiness (dyspraxia), processing difficulties, difficulties understanding your emotions or feelings (alexithymia)) which differentiate it from these psychological disorders. Though, of course, these aren't magically present in the Female Autism being described here so...
"Swiatek says: "It’s really annoying, because where are the kind of awesome, confident women?""
Ah yes, awesome confidence. Is that a symptom?
"We don’t tend to see them."
Except in all these articles, blogs, TV shows, everywhere...
"Swiatek feels there is an absence of support and resources for those women who are aware of their condition. “I found it is pretty hard to know where to go, and I think we are not necessarily addressing it as a country," she says. “A lot of the [support] groups tend to be very focused on male presentations of Asperger's or women with that more classic autism that fits more of the male presentations: There’s not much for [an] intelligent, quite confident, sociable person.”"
This is just nuts isn't it? What support is she talking about? Resources? Again, this is why it's great getting an Autism diagnosis (not being autistic), you get loads of free stuff and everyone says "you're so awesomely confident." If you want to join a support group I can point you to loads of female groups. No, simply pop "Autism Female Group" in google. To meet lots of other women diagnosed autistic who don't have that "more classic autism," that one with symptoms.
Furthermore, Swiatek says she was unaware she was autistic. So none of this statement makes sense, not knowing where to go for help, resources, etc..
TRAITS
But what about traits? I mean, why bother with DSM or ICD-10 descriptors when you have, like, you know, traits, of like Autism?
In an interview for autisticuk: Swiatek says of the in depth study for Channel 4's Are You Autistic? (this will become an Autism factual science research fact):
"It’s really cool that the study showed this too -47,000 out of 87,000 potentially autistic responses were women."
I repeat from previous blog, we don't know how many women responded in the survey, if 90% of respondents were women then the 47,000 shows a very low rate. Bloody stupid science and reason getting in the way of confirmation biases.
But, say I'm a woman who doesn't fit the DSM descriptors at all but read someone's blog online talking about their autistic traits (anxiety, anorexia, depression, liking ponies a lot) what should I do? Does it necessarily involve breathing?
Swiatek: "I think my first piece of advice for people who are thinking about obtaining a diagnosis would be to stop, breathe [gaaaaa] and take a moment. It can feel really confusing and overwhelming when you first start looking into autism..."
No, only Female Autism.
".. .After that, I’d suggest doing some research and start listing the traits of diagnosis that you relate to."
There are no traits in the diagnostic descriptors. There are descriptors. Say, difficulties with social communication. Traits might be not understanding the purpose of small talk, not mirroring other's behaviour, confusion about conversation cues, etc.
But what if weirdly no one has ever noticed this unusual neurological syndrome presented by behaviours like physical or verbal stimming, not understanding social cues, processing difficulties etc.?
"You might want to ask friends, family or partners for their observations, although be aware that sometimes it can be hard for the people around us to say these things. Unfortunately, there are still a lot of stereotypes but that’s why asking people close to you to watch the show is a great opportunity to start to change those ideas."
Do you think I'm autistic mum?
No.
Why not?
You don't have any of the core descriptors in the DSM 5 of 2013 or the WHO ICD-10 fro 2010
But what if they're just not up to date with a new kind of Autism only presenting in females where you don't have any of those symptoms but get really anxious.
Do you get anxious?
Sometimes.
Oh my love, you might be autistic. I'm a terrible mother, how have I never seen this before?
That's the end of that brilliant play I just wrote. I'm taking it on Broadway one day I hope. I see Meryl Streep as the mother and Claire Danes playing Temple Grandin as the daughter.
Right, I've spoken to my mum, made a list of traits, what next?
"Once you have your list, you can start pursuing a diagnosis. In the UK, we can go straight to our GPS (I think that means GPs not global positioning system though you're just as likely to get a diagnosis from your car tracking) and ask for a referral for a diagnosis."
Yeah, good luck with that.
"Sadly, as was mentioned on the show, waiting lists can be long..."
That's because there's so many women waiting with their own trait list they got from a blog on the internet.
"...and there’s not always the expert knowledge in diagnostic teams – this is why so many of us haven’t been diagnosed already."
Ah, the expert knowledge to spot Female Autism, the Autism with none of the calories of Autism.
Actually, have you not wondered how you can diagnose Autism in women who don't exhibit any autistic symptoms? The only reference to this ever ever anywhere is in a Tony Attwood piece repeated by Judith Gould and then ad nauseum elsewhere:
"Unenlightened diagnosticians perceive someone who appears able and who has reciprocal conversation and who uses appropriate affect and gestures as not fulfilling the criteria set out in the international classification systems. Therefore a diagnosis is missed. It is only by asking the right questions, taking a developmental history, and observing the person in different settings, that it becomes clear that the individual has adopted a social role which is based on intellect rather than social intuition."
Crazy huh? Right questions? Surely we have diagnostic tools for that? Developmental history? Where from? From parents? From those being diagnosed? Hmmm reliable. Observing in different settings? You have to stalk them?
But what if you're rich and want to bypass the NHS and basically buy your Autism diagnosis?
"You may wish to peruse a private diagnosis if you have the means to do so and want a quicker process – I personally got diagnosed at the Lorna Wing centre and had an incredibly positive experience."
The Lorna Wing Centre at the NAS offer diagnosis here, the lead consultant is Judith Gould, who has propagated the Female Autism trope, I think this is what is called a self fulfilling prophecy. Madness.
The Swiatek piece concludes: "One of the most important things to know is that within the autistic community, we are very welcoming of people who self define as autistic because of the systemic issues people face in accessing diagnosis. The “official” diagnosis helps a lot of us have that peace of kind and self understanding that can be so essential for our wellbeing, but ultimately, it isn’t the diagnosis itself that makes us autistic. If you’re autistic, you’re autistic – it’s the way your brain is wired and that won’t change."
Except you aren't autistic. Well, not that "classic" male autistic, but the new Judith Gould masking something or other behaviours Autism. The problem with this is that as more and more females are diagnosed this way Autism becomes this syndrome where you don't have any of the behaviours linked to Autism but mask (anxiety?) and that is just complete madness. What will happen to all those women who actually exhibit Autism? We'll need to do away with the spectrum and go back to the old longitudinal categorization. Autism with severe Learning Disabilities, Profound Autism, Asperger's, Female Autism.
THEORIES TO EXPLAIN THE GENDER SPLIT
The National Autistic Society, who co-produced the show, Are You Autistic?, have a helpful guide to why women go undiagnosed Theories to explain the gender split.
First up is "the female Autism phenotype." One hears this often mentioned in the debate about diagnosis of females. A phenotype is essentially observable behaviours based on the interactions of environment and genes. So the argument runs that there is "a female-specific manifestation of autistic strengths and difficulties, which fits imperfectly with current, male-based conceptualisations of ASD." Not just that women mask or that women present differently but that Autism actually appears differently in women on both a behavioural and genetic level. No one can explain why this would be specific to Autism (no other syndrome is differentiated by sex). More importantly, there's no evidence that Autism is genetic. Literally zero evidence. That's not to say it isn't genetic but to argue that there's a female genetic component to a syndrome that we don't even know is genetic is pretty weird. And then, even weirder, it's only apparent in some women. For some inexplicable reason, those women who exhibit Autism don't have the female autism phenotype.
Considering Autism descriptors are all about brain functions it would appear logical to believe Autism is neurological but that doesn't follow that it's genetic. There are many studies suggesting links to pre-natal, birth and post natal complications. Lack of oxygen for the baby during these complications appears to be a common denominator. One of Asperger's four case study children definitely had that birth complication.
The NAS piece on gender difference cites one 'study': The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype.
The study is in the Journal of Autism Developmental Disorders. And as a study it's laughable. The first problem is in the opening abstract:
"We used Framework Analysis to investigate the female autism phenotype and its impact upon the under-recognition of autism spectrum conditions (ASC) in girls and women. Fourteen women with ASC (aged 22–30 years) diagnosed in late adolescence or adulthood gave in-depth accounts of: ‘pretending to be normal’; of how their gender led various professionals to miss their ASC; and of conflicts between ASC and a traditional feminine identity."
Framework analysis in this setting is asking women about their experiences in order to confirm a pre-conceived idea that there is a specific phenotype linked to a specifically female form of Autism. Ah science. Don't actually bother with genetics just get some self reporting data.
The 'study' is of fourteen late diagnosed women. Fourteen women is a ridiculously small sample size for any study.
The "pretending to be normal" trope comes from the title of a memoir by Lianne Holliday Willey, it's become a common currency term in the masking debate, well I say debate but no one except, uh, me? seems to debate it at all. LHW suggests in her memoir that she learnt to mimic others to get by socially even though she didn't seem to need to. Here's a taster from LHW's memoir:
“Simply put, within AS, there is a wide range of function. In truth, many AS people will never receive a diagnosis. They will continue to live with other labels or no label at all. At their best, they will be the eccentrics who wow us with their unusual habits and stream-of-consciousness creativity, the inventors who give us wonderfully unique gadgets that whiz and whirl and make our life surprisingly more manageable, the geniuses who discover new mathematical equations, the great musicians and writers and artists who enliven our lives. At their most neutral, they will be the loners who never now quite how to greet us, the aloof who aren't sure they want to greet us, the collectors who know everyone at the flea market by name and date of birth, the non-conformists who cover their cars in bumper stickers, a few of the professors everyone has in college. At their most noticeable, they will be the lost souls who invade our personal space, the regulars at every diner who carry on complete conversations with the group ten tables away, the people who sound suspiciously like robots, the characters who insist they wear the same socks and eat the same breakfast day in and day out, the people who never quite find their way but never quite lose it either.”
So it's weird that Holliday-Willey is none of these things isn't it?
The biggest problem with the study is the anti-science basis that it starts from. That there are lots of women going undiagnosed because the ratio of male-female diagnosis is so wide. This is a faulty hypothesis for any study. An assumption that because women are less likely to be diagnosed with Autism must mean that women aren't getting diagnosed enough is not a healthy scientific base for any study. No one assumes that loads of males are going undiagnosed for eating disorders despite a 10 to 1 ratio (see below). I won't go in depth into the study because it will just be page after page of a quote then pointing out how nonsensical the whole approach is. Suffice to just see the aims of the study:
"Given the above, in order to advance the study of ASC gender differences we conducted a study with three key features. First, we aimed to investigate directly not only the nature of the female autism phenotype, but also how it impacts upon risk of a girl and/or woman’s ASC going unrecognised."
How can you investigate a phenotype, interactions of genes and environment on behaviour without looking at genetics? How do you analyze a phenotype if the behaviours aren't present because of masking? Surely if we have no idea what this phenotype is how could we know how it impacts on not getting diagnosed? This is madness. A genetic component that we've invented and we recognize by asking those we diagnose ourselves based on it to self report symptoms of the component we've invented and why they didn't get diagnosed...it's like a bad trip, man.
"Second, we recruited women with ASC whose autistic difficulties had gone unrecognised in infancy, childhood and early adolescence. We reasoned that such late-diagnosed individuals would be more likely to exemplify elements of the female autism phenotype that are under-represented in samples of those identified in a timely fashion, and can provide insights into how such characteristics led to them being missed by clinical services.
This approach is supported by the recent finding that the gender ratio in adult ASC clinics is lower (two males to one female) than in child and adolescent services (five males to one female), suggesting that later-diagnosed samples are most likely to include a representative sample of females with ASC (Rutherford et al. 2016)."
Where to start. Right, this logic runs thus:
Some females are diagnosed in infancy, childhood and adolescence. They are diagnosed because they are less likely to "exemplify elements of the female autism phenotype" or in other words, they exhibit the characteristics of Autism. For some inexplicable reason there is a genetic component in some women who don't exhibit autistic characteristics, this is "the female autism phenotype" which isn't present in the pre-adult women diagnosed. And round and round. The women who mysteriously do have this unique genetic component have different autistic characteristics to both males and early diagnosed women. We're going to research how these characteristics that female autism phenotypical women have which don't conform to the DSM/ICD-10 descriptors go completely unnoticed. Uh, because they aren't the characteristics of Autism?
The most interesting point is that women go unrecognized until adulthood. This is confusing on several levels. We'll see later that observable autistic traits become more manifested in women as they get older (i.e. at 7 years old they are less noticeable, by the age of 16 women are more noticeable than men, see Mandy et al below). Now this makes no sense on several levels. Firstly, if girls learn to mask around puberty (the common story from quotes below is around the time of the move from primary to secondary education, aged around 11) then their autistic symptoms should become less noticeable with age not more noticeable. Secondly, the FAP is characterized by traits not descriptors and the traits are interchangeable with psychological conditions, anxiety, depression, eating disorders, all of which manifest in females in the teenage years. It's natural thus that girls would be diagnosed anxious, depressed, etc. Thirdly, if autistic traits do increase in women with age how come all the women in the blogs or shows like Are You Autistic? don't exhibit autistic traits?
And in yet another brilliant piece of confirmation bias, we've seen an increase in late diagnosed women, based on these strange new characteristics that aren't in the DSM and look, there's many more than the younger women who are diagnosed using the actual descriptors for Autism, proving thus that there are loads of undiagnosed women with this magical phenotype.
It's just head banging bonkers.
"Third, we took an inductive (i.e., data-driven) approach, conducting a qualitative investigation."
Ah science. This means self reporting in informal interviews (some on the internet!). This is complete nonscience.
"Our aim was not to test hypotheses about the female autism phenotype by formally comparing males and females. Rather, we sought to generate new ideas and deepen understanding of key concepts, such as ‘camouflaging’ (Barker and Pistrang 2015). This work is designed to yield novel, well-defined hypotheses about the female autism phenotype to guide future quantitative investigations; and to promote the development of measures that capture female as well as male manifestations of ASC."
What utter drivel. Bizarrely, the reference to Barker and Pistrang is from their book "Research Methods in Clinical Psychology: An Introduction for Students and Practitioners." Which as far as I can see is exactly what it says it is in the title, about research methods, so I can't see why the 'study' is suggesting Barker and Pistrang write about camouflaging in that book. It's about research and analysis of data. Very odd.
New ideas about camouflaging? I have one, it doesn't exist. Or is it just camouflaged?
Yeah, I feel like this
It's weird that if you write about this magical new Female Autism and I wrote blogs on it back at the start in 2011 you hear the same magical thinking again again. It's always future leaning, in some time in the magical future we'll be able to carry out "quantitive investigations." Of course, if we continue to diagnose adult women based on this phenotype hypothesis then the evidence will be self generating. Give it time and women with our dynamic new formula magical Female Autism Phenotype will easily outnumber women diagnosed using Autism criteria, we can then make both qualititive and quantitive data based on this thing we've invented.
The measures to capture adult females who don't have any of the characteristics of Autism has been there since Judith Gould's 2011 piece Misdiagnosis or Missed Diagnosis for the National Autistic Society.
I bet you're wondering why women are referred there, huh? For having difficulties with social communication, imagination and interaction or other autistic descriptors perhaps?
It's just a bizarre self fulfilling prophecy.
But what are the unique behaviours associated with this female autism phenotype? Surely in a study of said women it won't just be telling us what it's not and how the women really struggle to cope with their condition, right? Or maybe there'll just be even more bemusing conclusions like:
"The current study has sought to generate hypotheses about the presentation and challenges faced by women who meet diagnostic criteria for ASC, but who were not picked up in childhood. It should be noted that there is another group of females who have severe autistic-like difficulties (i.e., difficulties with social reciprocity, social communication, flexibility and sensory processing), but who do not actually meet diagnostic criteria for ASC (Dworzynski et al. 2012) . It is unclear whether such individuals should be included in studies of the female autism phenotype. One argument is that, because they do not qualify for a diagnosis, they cannot be considered representative of females with ASC. The contrary position is that they really do have ASC, but fail to meet criteria because current diagnostic criteria are insensitive to their more female-typical presentation."
Ha ha ha ha ha ha ha...this is how bonkers it is. We shouldn't include women who fit Autism descriptors in our study. The Dworzynski study found that "in the absence of additional intellectual or behavioral problems, girls are less likely than boys to meet diagnostic criteria for ASD at equivalently high levels of autistic-like traits. This might reflect gender bias in diagnosis or genuinely better adaptation/compensation in girls."
That is, even though presentation of criteria is the same boys are more likely to be diagnosed (aged 10-12 years). The assumption is gender bias or girls compensate better. Now, briefly here you have an argument about presentation of symptoms along with underlying assumptions by professionals of how those symptoms should manifest. Like everyone else I agree that females are more likely to go undiagnosed but crucially their behaviours are the same. This study found exactly that. There are 10 to 12 year old girls with the sets of behaviours that are actual Autism descriptors, difficulties with social reciprocity, social communication, flexibility and sensory processing. And the study on the Female Autism Phenotype is suggesting we shouldn't include them in the study of the female autism phenotype because they don't manifest the behaviours typical of the female autism phenotype but rather, they manifest behaviours typical of Autism. Is that not madness? we have to disqualify them from the study because they're, like, really autistic.
So, again, what are these behavioural manifestations of the female autism phenotype?
Really bloody good question.
"One element of the female autism phenotype that is elucidated by our analyses is the phenomenon of ‘camouflaging’, or ‘pretending to be normal’ (Holliday-Willey 2014)."
You know you're in trouble when you're quoting from a memoir. It might as well be "Marjory said on Twitter..."
" Efforts to camouflage were widespread but not universal in this sample. Participants spoke of making a deliberate effort to learn and use ‘neurotypical’ social skills, sometimes describing this as ‘putting on a mask’ (Baldwin and Costley 2015; Cridland et al. 2014). Our analyses suggest that the development of such neurotypical personas may rely on concerted and prolonged autodidacticism based on, for example, careful observation of peers, reading novels and psychology books, imitating fictional characters, and trial and error learning in social situations."
Hang on, even in your tiny sample of fourteen some still didn't mask? How many? Oh yeah, this is a qualititive study so there absolutely no data. Hmmm. For all we know it could have been 13 of them. But if they don't exhibit Autism like the girls excluded from the study but are masking. WHAT ARE THEY MASKING?
"We also identified unconscious elements to camouflaging that warrant further investigation, whereby women reported their social behaviour being copied from others around them without even realising they were mimicking in this way."
So how did they realize they were? That's surely a paradox. Unless they realize later in life that they unconsciously copied others and that dear friends is called socialization.
"The current analyses do not in any sense provide a definitive picture of camouflaging. Rather, we intend that the account of camouflaging given in the present paper, and other research reports of the phenomenon (e.g., Baldwin and Costley 2015; Cridland et al. 2014), be used to derive a precise and coherent conceptualisation of this construct."
Good luck with that.
"We believe that this camouflaging measure, at least initially, should rely on self-report, as by its very nature, camouflaging behaviour is often not obvious to observers."
Oh christ...
"Our data suggest that some of the challenges of being a female with ASC do not come directly from the individual’s autistic difficulties; but rather reflect how these difficulties play out within a culture that has specific expectations for females."
AAAAAAAAAAAAAAAAAAAAAAAAAAH
That's not Autism is though? That's being a woman in a patriarchal society....gaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
Ok, I'm calm.
"Some women in the sample reported a conflict between their desire to accept their autistic selves, and perceived pressures to fulfil traditional gender roles. "
But what the are these autistic self behaviours? Please tell me, I'm in pain here.
"For example, participants described feeling pressure to play certain traditional feminine roles (the wife, the mother, the girlfriend), and finding this incompatible with how they wanted to live as a person with ASC."
Huh? How does this ASC manifest then? Aren't all the women typically paraded out in these studies typically female because they don't appear autistic and can mask to appear completely 'normal'?
"Several women in our sample reported that their autistic social communication difficulties made it difficult for them to join and enjoy female peer groups, which they perceived as being more subtle and less forgiving of faux pas than male social groups."
What faux pas? What are these social communication difficulties if they aren't the descriptors in the male-centric DSM?
The 'study' just rambles on like this with nothing specific just generalized comments about these women not feeling something or other and this must be the Female autism Phenotype at work....
"Based on our investigation of the experiences of females whose ASC went unidentified in childhood and early/mid adolescence, we hypothesise that this phenomenon reflects both: (1) specific features of the female autism phenotype; and (2) characteristics of the systems that are designed to identify and help people with ASC. Reflecting this, we propose a model of the bias against recognising female ASC, for testing in future quantitative, deductive (i.e. theory-driven) studies. In terms of individual characteristics, we suggest that females who are especially invested in and skilled at camouflaging are at greater risk of their ASC going undetected (see also Baldwin and Costley 2015)."
Women who don't appear to manifest autistic behaviours are not likely to be diagnosed shocker!
Please, please put me out of my misery and tell me then how this phenotype manifests other than camouflaging...what are they camouflaging if it isn't autistic behaviours? You can't say the FAP manifests as camouflaging. Camouflaging what?
"Further, we hypothesise that the female tendency to have internalising (e.g., anxiety, depression) but not externalising (e.g., hyperactivity/impulsivity, conduct problems) difficulties is also a risk factor for non-detection of ASC... In addition we propose that greater social motivation (Sedgewick et al. 2015) and better non-verbal communication (Rynkiewicz et al. 2016), both characteristics of the female autism phenotype, should be investigated as factors that can lead professionals to rule out ASC as a possible diagnosis when a females with autistic difficulties presents for assessment."
So, they don't present like boys and they're socially motivated and have better body language skills than...? Who? Autistic males? Autistic females who manifest autistic behaviours? Your guess is as good as mine. Still, we're clearly never going to find out what this phenotype manifests as. Remember, a phenotype is a set of behaviours.
Instead it endlessly regurgitates camouflaging, professionals not recognizing it, need new descriptors to diagnose, blah blah without ever laying out what these descriptors could be.
"All but one reported clinically severe anxiety, and levels of distress were elevated, emphasising the importance of identifying women with ASC in order to provide support, including for co-occurring emotional difficulties. Most participants (8 of 14) explicitly stated that their lives would have been easier had they received their diagnosis earlier in life."
Anxiety, yeah but that isn't Autism. You get anxious because of your Autism. I point you back to GTAIII above. Trying to get an answer about what these behaviours relevant to the female autism phenotype is like trying to get Jeff to tell you what his rally is about.
"Pre-diagnosis, they recalled being misunderstood, with their autistic difficulties often labelled in very negative terms by peers and adults, for example as laziness or wilful defiance."
What autistic difficulties, Jeff?
"Most participants had experienced the eventual receipt of their diagnosis as helpful. Some stated that it had fostered a sense of belonging in a group of like-minded people, and that this had promoted a more positive sense of self. The Internet and social media appear to be especially important for enabling the existence of such communities. Thus, our findings suggest that another cost of missed diagnosis is that it denies people with ASC the opportunity to benefit from identifying with the autism community."
I have a plan. Why don't we just diagnose all women as autistic and then they can choose to join autistic support groups?
"We believe that our inductive, in-depth approach has generated some new insights into the female autism phenotype and its impact upon risk of missed diagnosis."
You keep on believing this girl, donchoo let nobody tell you different.
Having not told us what this female autism phenotype is, offering no evidence of its existence, we come to the conclusion. Here at last all is laid out for us. We finally 'get' where they're coming from and what this means and might mean to womankind the world over:
"In their account summarizing the priorities of autism research based on interviews with people with ASC, (Pellicano et al. 2014) stressed the need to understand why women with ASC ‘slip through the net’ and to identify ways to counter this gender-based inequity in current clinical practice. Our findings suggest that the attainment of these goals will require several courses of action. First, research to define the female autism phenotype must include the development of measures of camouflaging, so that this phenomenon can be studied quantitatively, increasing understanding of its prevalence and effects on diagnosis and wellbeing. Second, levels of knowledge about ASC and training needs of a range of healthcare and educational professionals, including those who do not specialize in ASC, should be investigated. This would lay the ground for the development of training programs about the female autism phenotype, to improve recognition and referral to appropriate services."
Oh fucking fuck fuck. So The FAP is camouflaging. Camouflaging what? Who knows? I'm guessing anxiety. How can you quantify behaviours you can't see? How could you possibly train professionals to recognize something you can't even describe in your own study beyond "they camouflage"? It's (being un-pc) just bloody mental.
In hans Asperger's study on "Autistic Psychopathy" he outlines in one paragraph how autistic children learn to function socially without the supposed abilities in communication, interaction and imagination:
"Here we come to an important insight: in autism there is a particular difficulty in mechanical learning, indeed there is an inability to learn from adults in conventional ways. Instead, the autistic individual needs to create everything out of his [sic] own thought and experience. More often than not this results in defective performance, even in the more able autistic individuals."
That makes sense.
CLINICAL EVIDENCE
In the end with the FAP it makes little difference if you attend to hyper-normal internet videos describing how all those criteria we know are just male criteria, it's different in women like me because we mask...something...or other or the studies on this camouflaging of...something...or other...it's all nonsense.
Obviously if women who "look normal" are autistic then, well aren't all women? Except the ones who exhibit autistic criteria (still no idea why they would).
Judith Gould head honcho clinical psychologist at the NAS in a typical brief discussion manages to encompass all the paradoxes of this position in ten bitesized minutes....
For those of a literal minded needing precise schedules here's the discussion in bullet point:
- In the late 70s myself and Lorna Wing produced an idea of an Autism Spectrum
- We were concerned about the categorical approach of putting people neatly into boxes and descriptions
- Life isn't like that
- People can't be fitted neatly
- So diagnosis of anything is completely meaningless (she doesn't say that, I'm extrapolating)
- To try and have a firm diagnosis based on behaviour which is variable, transient, depends on your age, you can have someone with Kanner's Autism at three and the same person at 13 could be described as having Asperger syndrome
- To then have diagnostic labels, which is what I would call them, is not useful
- It's far better to describe somebody in, what we use, our terminology is, Social Communication, Interaction and Imagination
- Having those three areas of difficulty is strongly associated with a repetitive pattern of behaviour
- Everything merges into each other, we've got a famous saying "nature never draws a line without smudging it."
- So for research and treatment it helps to have a common understanding of what Autism is
- But then if we get into detail and then exclude people because they don't fit into that category then we're doing people a grave disservice
- People coming to her have had psychiatric diagnosis but still they struggle
- But they don't fit "into the systems" so they're told, no you're not autistic
- So you get another diagnoses which is unhelpful
- Our training teaches people "to think behind the questions you're asking to diagnose"
- The stereotyped view of what Autism is is very much male dominated
- Because in the early years the proportion of males to females was higher
- I think that many many girls are undiagnosed
- The difficulties with diagnosing the girls with Autism that they present in a different way
- They watch others, learn to copy the rules of sociability but don't understand what they mean
- They can appear to be sociable when in fact they are struggling
But arguing that the typical "categorical" approach is not useful then listing the way you look at diagnosis using that very categorical approach, systematic behaviours based on social communication, imagination, interaction deficits makes no sense.
These are the key categorical descriptors in the DSM. If you're diagnosing using them then you're diagnosing Autism. But she wants to shift away from them (while still using them?) to avoid stereotyped diagnosis, you have look behind the questions...
?TAHW
...whatever that means...and I believe there's lots of undiagnosed girls because they present these categories differently. They mask whilst not knowing what they are masking. But sometimes they do.
?TAHW
...whatever that means...and I believe there's lots of undiagnosed girls because they present these categories differently. They mask whilst not knowing what they are masking. But sometimes they do.
Gould helpfully gives an example of this female presentation. A woman runner has a rigid dislike of dogfighting, sees men dogfighting and challenges their behaviour.
Crazy rigid behaviour huh? Really hating dogfighting. What a weirdo, how has no one picked up on this woman before?
"It's the strong values, the rigidity and the passivity that can result in inappropriate behaviour."
She then talks about how professionals, teachers, GPs don't recognize the autistic behaviours in girls because "they may present with mental health issues" and so end up getting diagnoses of mental health issues. Weirdly.
"If you look at eating disorders, she argues, there may be a ritual or factual reason rather than an emotional reason. OCD can overlap with the women. So everything needs to be teased out."
Everything? Surely eating behaviours have always been part of diagnosis? The cliche for Auties is eating the same foods, not liking different foods, not liking spicy food, not liking to mix foods, struggling to remember to eat, etc. How are these particularly female? More in a moment.
"The presentation is often of self harm, depression, anxiety and you really have to get behind that and look at maybe the cause."
How? If the symptoms are of depression and anxiety not Autism then how do you "tease out" the autistic behaviours?
So having said you diagnose based on the "Triad of Impairments" expressed in rigid behaviours Gould then makes a magical exception for women:
"I really feel we have to move away from this categorical description of Autism...based on behavioural patterns and so descriptions of behaviour can be interpreted in different ways however they are written can be interpreted by different individuals."
Indeed. Autism is diagnosed by behaviours by a psychologist. It is the psychologist's interpretation. But if you then do away with categories what the hell is a psychologist diagnosing? It would be teaching without exam specifications (the booklet describing criteria for teaching and exam marking). It would be chaos.
"I think people get missed if we are dogmatic in the way we are interpreting these patterns of behaviour. You can have Autism with anything. Up until now we've had exclusion categories so for instance if you have ADHD you can't have Autism. We know you can have Autism with a whole range of other things."
But if you diagnose Autism because the client/patient exhibits ADHD then you're doomed to shifting what Autism is? Which is exactly what Gould is doing. Women present with depression, anxiety and anorexia but ignoring categorical diagnoses Gould magically can look behind the questions and see they are actually autistic. If you're not using the DSM categories then what are you using? Your own intuition?
"We're still in narrow categories rather than seeing the whole person along a dimensional format.
You can use the ASD label but that tells you nothing about Johnny or Sarah. You've got to describe the person. What their skills and deficits are. We're hoping it becomes more dimensional than categorical."
This is what Hannah (above) is suggesting. Diagnosing by personality rather than accepting that people will present differently but the categorical 'symptom' will be the same. It's nuts. Imagine diagnosing depression or schizophrenia this way? It makes no sense.
Fortunately, William Mandy gives a web seminar on the FAP, camouflaging and all the other things discussed here. It's worth a listen because oddly, Mandy, is aware of the contradictions inherent in the position yet still blithely marches on to the same tune....
MANDY & CAMOUFLAGING
The talk encompasses:
He begins by pointing out that "the awkward, the uncomfortable answer is that we don't actually know what Autism is."
So this is a pointless argument then isn't it? If you can't say what Autism is how can you say there's a specific female type of Autism, presenting genetically?
"We have no biomarker for Autism, we can't see it, we can't directly observe it....So what do we do when we can't actually observe the atypicality of Autism? Well we do what anyone does in this situation, we look at its manifestations."
So we "have an agreement of which observable symptoms are the manifestations of Autism and these are what are written down in the DSM V."
Having all agreed this I'm now going to do a talk on how magically lots of women don't manifest these symptoms and that's why they are missing diagnosis.
"And in the last twenty years there's been a consensus that Autism is dimensional not longitudinal, that we're all on a spectrum and there's a somewhat arbitrary line cut off of what ASD is."
This in itself is nuts, of course. Lorna Wing, who is responsible for "the spectrum" argued that it spans the whole breadth from severe learning disabled to "near normal." (Lorna Wing 1981)
"Autism is highly heritable," argues Mandy, having moments before told us that there's no biomarkers for Autism. Huh?
It's associated with additional neurodevelopmental, cognitive, behavioural problems.
Except magically in late diagnosed women. Where it's just emotional.
Women go undiagnosed...
"There's something about the characteristics of girls and women, of the FAP that means they are less likely to be diagnosed."
"So I'd like to talk about the FAP, the characteristics of females with Autism."
Hoorah.
"I'd like to offer two notes of caution...First, I've tried to base what I'm about to say on sort of scientific findings..."
Ah, good old sort of science.
"There's lots of knowledge and wisdom out there about the FAP that comes from autistic women, girls, parents, clinicians and that's really valuable but it needs to be tested scientifically before you can develop an evidence base in this area."
So, yeah, we're going on the testimony of women who we've diagnosed as having this unique FAP because we haven't got anything else and even I recognize this is just a self fulfilling prophecy.
"I've tried to focus on findings that have some empirical scientific thought."
Ooh I look forward to this.
"The other thing is, what I'm keen to stress is that while there are consistent difference in the ways that autistic males and females present, these are just trends, if you like, I don't want to make gross generalizations, every male with Autism is like this, every female is like that. You'll meet many females with what you might call a male typical phenotype and males with characteristics of the female phenotype so when I use FAP I'm seeking not to make generalizations about every girl and woman."
But why Dr William?
Well, the FAP is characterized by "Higher Social Motivation."
Now remember, Dr William has told us to act with caution but he has "tried to base what I'm about to say on sort of scientific findings."
So what are these sort of scientific research papers by Hiller et al 2014 and Head et al 2014 that show this higher social motivation in female autistics?
HILLER ET AL
Hiller et al's Sex differences in autism spectrum disorder based on DSM-5 criteria relies on teacher and parent reporting:
"While no sex differences were found in the broad social criteria presented in the DSM-IV-TR or DSM-5, numerous differences were evident in how boys and girls came to meet each criterion. For example, girls were more likely to show an ability to integrate non-verbal and verbal behaviours, maintain a reciprocal conversation, and be able to initiate, but not maintain friendships. Moreover, girls presented with both less and different restricted interests. Teachers also reported substantially fewer concerns for girls than boys, including for externalising behaviours and social skills. Results suggest girls with ASD may present with a surface-level 'look' different from the 'classic' presentation of ASD, and present as less impaired when in a school setting. Consequently, results provide insight in to why the disorder may be more difficult to detect in cognitively-able girls."
In the study of 69 boys and 69 girls teachers reported different behaviour patterns.
Well, that is sort of sciency. If we ignore any science. And sociology. And psychology. Actually no science was involved here. It's just gender socialization. That's it.
The Head et al study Gender differences in emotionality and sociability in children with autism spectrum disorders:
"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."
Ha ha ha ha ha ha, science. Children filling out friendship questionnaires then their parents filling them out and comparing them.
Remember, these are the most sciency ones.
The second FAP characteristic is more socially oriented and gender typical stereotyped interests, which again is taken from the same splutter cough ha ha no really scientific study by Hiller et al. Teachers reporting the children's interest.
"Besides the DSM information, Hiller et al. also collected information about the children’s experiences at school, as there is some evidence to indicate that girls’ social and emotional symptoms are masked in a school environment (Hiller et al., 2014). The children’s parents completed questionnaires about any concerns expressed to them when their child was in preschool, and their current classroom teachers completed questionnaires about the children’s social functioning, externalizing behaviours (e.g. being disruptive in class, ‘meltdowns’, etc.), friendships, restricted
interests, and atypical movements."
The findings are here but it's worth showing what they found:
"There were no significant differences overall when looking at the broad social criteria for both the DSM-IV-TR and DSM-5 – this was not surprising and was consistent with findings from other studies."
That is, that boys and girls had the same, to put it in Judith Gould's words, "categorical" difficulties. So this shows that boys and girls have 'the same Autism' if you like. But they present differently, which is exactly what I've been saying:
"But the authors’ findings related to specific behaviours were more revealing:
• girls were better able to share interests, engage in reciprocal conversations, and use nonverbal gestures – if a child did not have impaired ability to share interests, that child was almost four times more likely to be a girl. If a child had some ability to engage in conversation, then that child was almost three times more likely to be a girl. And over one third of the girls had no impairment in their ability to integrate nonverbal and verbal communicative behaviours.
• girls presented with better imaginative play – 75% of girls fell into the “no impairment” or “somewhat impaired” categories of imaginative play
• both boys and girls had difficulties with friendships, but their problems manifested differently – girls were often able to initiate friendships but had difficulty maintaining them, whereas boys had difficulty with both initiating and maintaining friendships. Girls’ difficulty maintaining friendships was usually related to their need to control the play. Hiller et al. explain that because boys present with more significant problems with friendships, this might make their impairment more salient and easier to detect.
• girls were more likely to show some ability to regulate their behaviour in different situations – this
includes monitoring their voice and avoiding inappropriate comments or externalizing behaviours
• girls’ social behaviours were more likely to be coded as “somewhat impaired” than boys – this
means that these behaviours were not as overt or impaired as would be expected for a typical ASD
presentation. Less experienced clinicians may not see these ambiguous behaviours as signs of ASD,
and this could contribute to under-identification. despite girls’ better use of nonverbal communication, boys and girls demonstrated equal social understanding impairment – social understanding involves the ability to interpret and understand nonverbal behaviours. So girls’ use of nonverbal social gestures does not reflect their underlying understanding (Hiller et al., 2014)"
So girls were better than boys at social interaction. How much is that down to gender roles? In a school situation it is theoretically easier for girls to initiate these social roles. I should point out that the mean age of the children (the average age) was 8 years old. So these are (theoretically at least) pre-pubescent children. It's also important to question the validity of a teacher's observations, both from an environmental point of view (how on earth do you observe individual children in a large scale group dynamic) and their own social attitudes. I'm going to make a giant leap here based on a real-world assumption, that these are children in infant and primary schools so the likelihood is that the teachers are female (15% of primary teachers are male). Could there be gender assumptions there?
AS to "Restricted, repetitive behaviour criteria."
• fewer girls presented with restricted interests and lining up or sorting behaviours – Hiller et al. feel
that this may contribute to making ASD more difficult to identify in girls
• boys and girls presented with different types of fixations – boys often had fixated interests with video games, iPads or television, while girls had fixated interests around random objects like animals, rocks, shells, or books. Hiller et al. explain that girls’ more random obsessions may make them more unlikely to appear as the type of fixations that are associated with ASD. Furthermore, girls’ preoccupation with objects may interfere less with daily life than boys’ fixation on gaming or screens, and therefore girls’ fixations may be reported less often by parents.
• younger boys’ restricted interests often revolved around wheeled toys, and older boys’ (>7 years)
interests revolved around screens (gaming, TV, etc.)
• both younger and older girls’ interests were seemingly random"
That just confirms social gender roles surely?
Hiller et al is the only cited 'study' on repetitive behaviours.
"The behaviours of girls are often quite typical and gender stereotyped compared to males," argues Mandy.
But how much of that is to do with access? To do with pre-conceived gender roles? If boys are playing video games is that because their parents don't want their daughters playing violent games? The games themselves being aimed at males?
In the end, this is still about presentation so how does that show that there is a genetic (phenotypal) difference with women? It simply means that women blend in better because social roles in school are very different by gender.
EATING DISORDERS
The third element of FAP, according to Mandy is "greater vulnerability to emotional difficulties (including eating disorders). He references his own study. The only Mandy study based on this from 2012 is Investigating autism spectrum disorder and autistic traits in early onset eating disorder.
In which "Twenty‐two participants with early onset eating disorder (EOED) were assessed using standardized ASD measures and compared to IQ matched TD [typically developing] (n = 24) and ASD (n = 20) controls."
They found: "An ASD diagnosis was no more common in EOED than in TD controls. However, repetitive and stereotyped behavior was more often observed in the EOED group and, compared to TD controls, there was a trend (p = .07) toward greater autistic social impairment in EOED.
Whilst participants with EOED did not show increased ASD prevalence, they did have elevated autistic traits of clinical significance, particularly repetitive and stereotyped behavior."
That is, among the small sample of EOED there wasn't evidence of a link to ASD but they had some traits, including repetitive and stereotyped behaviour.
I'm going throw this one out there but.........could these repetitive stereotyped behaviours have anything to do with food?
Sigh.
There are links between EOED and ASD according to a recent qualititive survey by Tchanturia & Westwood Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review
But that lengthy piece merely finds "Despite differing assessment tools and recruitment from heterogeneous patient groups, studies consistently report elevated ASD symptoms in AN [Anorexia] populations. It remains unclear whether these symptoms represent an underlying neurodevelopmental disorder, are exacerbated by ED pathology or whether they are mere similarities in cognitive and socioemotional functioning, also shared with other psychiatric diagnoses."
That anorexics have some symptoms similar to ASD, you know, repetitive behaviours, problems with social interaction.
Mandy argues that "the pattern of risk is somewhat distinct between males and females...all of these elements of the female autism phenotype actually probably reflect just gender differences in the general population. Which is interesting isn't it? Which is something researchers should be mindful of."
Slow hand clap. Well done. You got there. But then having recognized this, Mandy blithely goes on with how FAP manifests itself in groups of females who don't appear autistic by using sciency studies ignoring his own advice.
10-1 female male ratio? Oh you know why? Because these descriptors are female-centric. Why can't I, a male who is a bit fat and likes all sorts of food be included on the anorexic spectrum? Why aren't we investigating why men go undiagnosed?
I'm not laughing at eating disorders. As Mandy points out "morbidity" should read "mortality." It's a terrible psychological condition that does indeed effect far more women than men and I think we can hazard a guess why, ahem media, society, general sociology of gender.
Like ASD eating disorders become far more apparent in females in adolescence and early adulthood, the time when your sex and sexuality become very apparent. That isn't a coincidence, obviously.
I'm always skeptical of Gillberg's work since he destroyed all his files when some other clinicians questioned his research methods (it's a pretty famous case in Sweden data destruction and research misconduct in Sweden). The quote used by Mandy that "Around 25% of women with AN meet criteria for Autism" I presume is actually from Gillberg, Anckarsater, et al The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study.
This 'study' of 51 anorexics with a mean age of 16 were compared to a typical group of the same size and the study found that the anorexic cohort scored higher on the ASD screener, the AQ Test. One of the 51 anorexics met the criteria for Autism, four for Asperger's and nine for PDD NOS, which used to be the fuzzy catch all for people who weren't really autistic but, you know, had a few traits.
Only one of the control group met the PDD NOS criteria.
So lots of anorexics self reported using the AQ screener vaguely autistic traits (yeah, very sciency) AQ factors like:
- I find social situations difficult
- I tend to have very strong interests, which I get upset about if I can’t pursue.
- I am fascinated by numbers.
- I find it hard to make new friends.
- It upsets me if my daily routine is disturbed.
- I don't enjoy doing things spontaneously.
- I like to carefully plan any activities I participate in.
- I don't enjoy social occasions.
Weirdly, if you use this screener for people with scizophrenia,depression, anxiety, bi polar, BPD, oh you name any psychological condition you get a correlation. Strange huh?
As far as i know no one has correlated these psychological conditions with ASD traits.
Of course, anorexia is not neurological is it? Is it? Why would it then be unique to women?
Mandy offers a word of caution however, citing The Minnesota Starvation Experiment of 1945.
Where 36 guys starved themselves to find out the psychological effects of starvation. Obviously this was a response to what the Allies had found at Auschwitz, Buchenwald, etc.
The results found that self harm became common, obviously there was a fixation on food and issues of control, they became depressed, anxious, lost interest in sex, showed signs of social withdrawal and isolation, they had difficulty focusing and concentrating, became neurotic, they became more ego-centric, fixated on themselves, they hoarded objects, the fixated on subjects, and so on.
Any of those sound familiar?
Of course, similar responses have been found in so called wild or feral children, essentially children who live in the wild like Victor, the subject of Francois Truffaut's L'enfant Sauvage or Wild Child
Unusual gait, repetitive behaviours, difficulty learning by rote, etc.
From my own perspective, wild children are extreme examples of people missing out on typical socialization. But for autistic individuals socialization is not missed but made problematic.
"What we found from this study is that starvation can make you look a bit autistic," says Mandy of The Minnesota Starvation Experiment. What is interesting is, that as far as I can ascertain, those in the study didn't get 'better.' The responses were long term.
"The guys in this study didn't start off with any social difficulties but after they dropped about a quarter of their body weight they became much less socially motivated, less interested in the social world and they became more inflexible they became focused their interests."
Obviously starving yourself doesn't make you autistic. Losing body weight makes you tired, it makes you highly aware of your body, obviously, and results almost certainly in social withdrawal, it leads to fixations about your self, your body and food. But then so does depression typically, insomnia and so on. So to then make a link between anorexia and ASD is crazy. Yes, I can see that ASD females might be more likely than NT females to be anorexic, assuming that anorexia is about controlling one's body when one can't control one's environment. But to then assume that there is a high incidence of ASD among anorexics is classic cart before horse. Clearly, those who control their bodies this way will have trait similarities to ASD but that doesn't follow that they are ASD. This is simple post hoc fallacy territory. Since anorexics have some similar traits to ASD it then follows that anorexics are likely to be ASD. That's the most basic intellectual fallacy. So why is Mandy continuing with this work to date?
So why are 75 to 80% of anorexics not autistic according to this silly idea?
"A key element of the female autism phenotype is that in females, it would seem much lesser in males, Autism is a substantial risk factor for the development over adolescence of severe restricted eating difficulties."
What? No no no no no no no...you've put a whopping great cart before the horse, Mandy...clearly it should be, severe restricted eating difficulties are a risk factor for female autistics. This is complete madness.
Now we get to the big one. The key symptom of FAP.
CAMOUFLAGING
The greater capacity to camouflage autistic difficulties.
The Lai et al study is A Behavioral Comparison of Male and Female Adults with High Functioning Autism Spectrum Conditions.
Because this was 2011 diagnosis was still under DSM IV. So Autism, Asperger's, PDD NOS were still discrete definitions.
"One question is whether these women were true cases of ASC. Simply judging from their ADOS scores, only 6 of the 29 (20.7%) females were classified as “autism spectrum”, in comparison to 19 out of the 33 (57.6%) males...these females reported an even higher level of autistic traits than males and their scores were well within the range that most people with ASC typically report."
Hmmm.
"While this study has documented that adult women with ASC present fewer current socio-communication symptoms, it is an open question as to the underlying reasons for such an effect...
However, the contrast between evident childhood symptoms and reduced current autistic interpersonal features fits with anecdotal reports from women on the autistic spectrum [53], [54], [55], [66] as well as our participants' and their caregivers' subjective experiences described in the research interviews. This suggests that able women with ASC may be more motivated and may put more effort into developing compensatory skills that help them to appear “socially typical”. Hence, females with ASC may show different developmental trajectories compared to their male counterparts."
So, after looking at the group of males and females it still comes down to the females self reporting their super ability to camouflage. And crazily, one of these references is from a self help book by Rudy Simone (a woman who claimed she'd cured her Autism by giving up wheat) another is from a book by Jean Kearns Miller who is "only diagnosed as having autistic traits, but that may be enough considering I “pass” as neurotypical so well. I do think women tend to notice our atypicalities more and, therefore, become good mimics."
Blink.
"Indeed, experienced clinicians have observed that one reason females (girls or women) with ASC may be less easily identified is because of their ability to “camouflage” their autism [15], [16]."
Oddly, these clinicians are uh Tony Attwood. He has some sort of multiple personality clearly. And they're just anecdotes in his books from 2007.
So this is where the masking ball gets rolling...
"This type of camouflaging may involve conscious, observational learning of how to act in a social setting and by adopting social roles and following social scripts. Hence, a female teenager or adult with ASC may be able to develop reciprocal conversation, social use of affect, gestures and eye gaze, that would place them under the radar for the more commonly understood and recognizable (male) phenotype of ASC. Some of the women with ASC reported they consciously “cloned” themselves on a popular girl in their class whilst at school, imitating their conversational style, intonation, movements, dress-style, interests, and other mannerisms, in minute detail."
Some of the women told us...
"Women who adopt these camouflaging strategies nevertheless report that underneath their superficially sociable behavior they are often experiencing high levels of stress and anxiety as they have to work hard to keep up the mask, and that it is exhausting by the end of the day."
Which is weird as the study includes a handy graph of co-morbid psychological conditions...which shows little variance between males and females " Univariate ANOVAs showed no group differences on anxiety, depression or obsessive-compulsive symptoms."
Jesus, this is Mandy's evidence?
"There are more similarities than differences between males and females on the autism spectrum...
...along with some subtle but significant differences. These may delay or prevent diagnosis, or lead
to problems in females being mislabelled."
I hope you're as confused as me.
Mandy highlights his own grad student's 'study' “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions by Laura Hull et al.
"Thematic analysis was used to identify key elements of camouflaging, which informed development of a three-stage model of the camouflaging process. First, motivations for camouflaging included fitting in and increasing connections with others. Second, camouflaging itself comprised a combination of masking and compensation techniques. Third, short- and long-term consequences of camouflaging included exhaustion, challenging stereotypes, and threats to self-perception."
So using "Thematic Analysis" in a "Three Stage Model" what did this pseudo-science sounding bullshit entail?
"A newly designed questionnaire of camouflaging was developed by the researchers...The questionnaire included 23 closed and 20 open questions, and examined participants’ motivations for camouflaging, the characteristics of their camouflaging experiences, the consequences of camouflaging (positive and negative), and their attitudes towards camouflaging."
With question gems like:
1. Have you ever had the experience of 'camouflaging' your autism?
There's a link in the ha ha ahem study for a word document with said in depth questions.
"Participants were emailed an online link to ‘a study looking at experiences of coping behaviours in social situations’ or followed a link posted on social media."
I'm back from repeatedly banging my head on the wall...
"Early in the questionnaire after demographic data had been ascertained, participants were asked the following question: “Have you ever had the experience of ‘camouflaging’ your autism? A reminder: in this survey we use the term ‘camouflaging’ to refer to ‘coping skills, strategies, and techniques that function to “mask” features of ASC during social situations’.” Those who responded ‘no’ were directed to the end of the questionnaire, where they could leave their thoughts on camouflaging if they wished."
"Most neurotypicals are camouflaging nearly all the time they are in public. (Male, 79)"
Yep, male, 79, that's what this is.
You can read the study for all the self reporting quotes. They're all much of the
"I don’t want to draw attention to myself by appearing to be different. (Female, 30)" level.
Socialization!
So, yep, that's the study.
"This study identified key themes underlying the motivations, techniques, and consequences associated with social camouflaging amongst adults with ASC. The vast majority of participants (male, female, and of other genders) reported camouflaging to some degree, although there was significant variation in individual experiences of camouflaging. The results were combined into a model of the camouflaging process, which we hope will contribute to the generation of testable hypotheses and identification of avenues for future research."
"There was extensive variation in the consequences of camouflaging reported, but one of the most striking findings was that the vast majority of participants reported some unpleasant and unwanted consequences of camouflaging. These included the exhaustion experienced during and after camouflaging, which has been identified in previous research,"
Ah, meltdowns.
"Camouflaging appears to challenge many participants’ views towards themselves, and produce negative emotions and attitudes, such as being a ‘fake'."
Uhuh.
"It may be that the rigidity of thinking and scrupulous honesty that are present in many individuals with ASC leads them to view any change in self-presentation as false (Chevallier et al. 2012). Regular camouflaging would consequently increase the individual’s perception of themselves as a ‘liar’ or inauthentic person, and could lead to long-term negative impacts on self-esteem. This could account for the finding that some participants viewed camouflaging as lying, in contrast to those who viewed it as a performance."
I thought a pre-requisite for Autism was not lying?
"This study demonstrates that camouflaging of ASC-related characteristics in social situations may be a common behaviour amongst adults with ASC. Camouflaging is motivated by the desire to fit in with others and to make connections. The behaviours themselves can be grouped into masking and compensation strategies. In the short term, camouflaging results in extreme exhaustion and anxiety; although the aims of camouflaging are often achieved, in the long-term there are also severe negative consequences affecting individuals’ mental health, self-perception, and access to support. Our findings demonstrate that camouflaging is an important aspect in the lives of many individuals with ASC. Future research is needed to quantitatively measure camouflaging and compare techniques in individuals with ASC of all genders, to identify demographic and ASC characteristics associated with individual variation in camouflaging and its outcomes, to uncover underlying psychological and interpersonal/contextual processes, and to devise strategies that minimise negative impacts of camouflaging and facilitate the realization of maximal individual potential."
"This is utter bollocks (male 45)"
"But what are they camouflaging though?" (another male coincidentally 45)
Looking at, say, the recent Channel 4 show, Are You Autistic? why is it that out of ten women involved in the show only two exhibit autistic characteristics, Georgia and Sam, and Georgia is clearly having trouble keeping her hands from stimming? Yet, none of the other women mention stimming, let alone appearing awkward because they can't stim. One says they'll go home to a dark room because, you know, like, sensory overload or something. None say "I'm off to clap and shake my hands awkwardly."
Autistic women do have to suppress stimming and that would certainly be exhausting and anxiety inducing. But, be honest, none of the FAP women probably know what a stim is let alone do it.
So mimicry is instinctive? What, like genetic? Huh? If mimicry is instinctive then what exactly is their Autism then? As surely socialization is simply instintive mimicry?
If you can compensate by looking and sounding just like the popular girls how exactly would anyone spot them? I ask again, why do they continue to compensate even after diagnosis?
Mandy gives a lengthy description of one woman who used these strategies, learning to put on her best normal to pass as completely normal to the point where she appears completely normal. How do we know this? She told us about it.
So he tells us of one woman who stims but realized this caused unwanted attention so she decided no longer to stim in public. "Then she's wait until she got home, in the privacy of her own her before she could do some stimming. Which she found to be a very pleasant experience. So that would be an example of masking."
Except it isn't is it? That's what most autistics learn to do. So by that rationale most autistics are masking. But they still stand out because of the "triad of impairments." If masking was simply avoiding obvious physical behaviours like stimming in public then I would agree that masking exists. However, this isn't what Mandy, Gould and the women above are describing. They are suggesting you can fake eye contact, social interaction skills, communication and processing skills.
If it were hiding stimming then why do none of the "FAP" women above mention their stimming? Well, obviously because they don't stim. Because the magic FAP means soothing repetitive behaviours aren't a characteristic, that's that male Autsm thing. Except for the woman that Mandy talks about.
He has a further example of compensation.
"She talked about how she transitioned to secondary school she became increasingly conscious that she didn't know how to behave in social situations and didn't instinctively want to behave like the other girls in the class and she decided that she was going to pick a particular girl in her class who she thought was particularly popular and admirable and copy that girl."
Apart from this describing socialization can anyone spot a logical fallacy in that argument? She didn't instinctively want to behave like the other girls so she copied that one that acted most like the other girls.
Huh?
Hull et al drew up a nice brainstorm of the women's compensation techniques and the consequences to them of looking completely normal. To make it sound sciency it's called a "Thematic map of the three stages (motivations, camouflaging, and consequences) of the camouflaging process."
Mandy even points out that this 'study' "was of 100 women online giving verbal data..."
How does anyone take this seriously?
The most bizarre statement "a more positive reason for camouflaging. It enables me to be with other people in a way that is relatively comfortable for me."
Huh? I thought it caused great anxiety? Meltdowns? Terrible debilitating exhaustion? If it's that easy why isn't everyone doing it? Oh yes, I forgot, these women have a unique genetic component, the FAP.
"People talked about the stress, the anxiety the exhaustion of it."
Which is it?
"Some people say one they first meet people they camouflage but as they get to know them they camouflage less and less until they can be themselves."
Huh? Doesn't Mandy think...I do that! Everyone does.
I know I'm repeating myself but just to reiterate that Mandy told us at the beginning of the talk: "I've tried to focus on findings that have some empirical scientific thought."
So he ignores the science bit and endorses Self reporting, which isn't even empirical in the sense that the women don't have their characteristics observed so how can one argue this is reliable data.
We know head further down the rabbit hole into Wonderland as Mandy argues that there "so far I've talked about, if you like, the cross sectional aspects of the female phenotype but it is possible that there are some differences between males and females autistic symptoms that could only be visible to us if we look longitudinally. We think about characteristics over time."
I thought longitude was out and dimensional was the way to look at things? I thought all those old stereotypes spouted by the likes of Kanner or Asperger were just male-centric, we've moved on grandad.
Apparently not, when it suits one's argument.
"Asperger wonders why he doesn't see females in his clinic and he muses along these lines..." see quote. Of course the whole text preceding the quote is:
"In view of these facts, the problem of the emotionality of autistic children is made extremely complicated for us. In any case, the children cannot be understood simply in terms of the concept 'poverty of emotion', used in a quantitative sense. Rather, what characterises these children is a qualitative difference, a disharmony in emotion and disposition. They are full of surprising contradictions which makes social adaptation extremely hard to achieve.
It is fascinating to note that the autistic children we have seen are almost exclusively boys. Sometimes girls had contact disturbances which were reminiscent of autism, and there were also girls. However, we never found the fully formed picture as shown in cases 1 to 3. How can this
be explained? There is certainly a strong hint at a sex-linked or at least sex-limited mode of inheritance.
The autistic personality is an extreme variant of male intelligence. In general, girls are the better learners. They are more gifted for the concrete and the practical, and for tidy, methodical work. Boys, on the other hand, tend to have a gift for logical ability, abstraction, precise thinking and formulating, and for independent scientific investigation. This is the reason, too, why in general boys at older age levels do better than girls in the Binet test. The narrowly logical and abstract items which start at the ten-year level are simply more congenial to boys! In the autistic individual the male pattern is exaggerated to the extreme. In general, abstraction is congenial to male thought processes, while female thought processes draw more strongly on feelings and instincts. In the autistic person abstraction is so highly developed that the relationship to the concrete, to objects and to people has
largely been lost, and as a result the instinctual aspects of adaptation are heavily reduced."
Clearly Asperger felt Autism was more likely to be present in boys.
So Mandy et al have done a dimensional study of autistic traits (social elements) and measured them longitudinally at 7 years, 10, 13 and 16.
Note how the traits in females become much more pronounced "apparent" rise in autistic traits to the point where "females have caught up with males in autistic trait scores."
Mandy's even come up with a sciency name for this:
"The adolescent emergence hypothesis - ATs in females become more overt later in development, such that their ATs escalate during adolescence (e.g., Asperger, 1943)."
And to push their claim they just ignore diagnosis:
"Current diagnostic criteria, which are largely based on male cases, are relatively insensitive to the female autism phenotype. Therefore, we included participants across the full range of AT severity, not just those with an autism diagnosis, to avoid a systematic bias against participants with female-typical autistic difficulties."
Yep, let's include females without diagnosis to prove our point that females go undiagnosed.
What we then do is get parents to fill out report forms on their child's behaviours using the SCDC:
"The SCDC21 is a questionnaire, completed by parents, that measures social reciprocity and
verbal/nonverbal characteristics resembling those found in ASD.
There are 12 items, rated according to whether the corresponding behavior has been seen during the past 6 months; if so, whether the associated statements are not true, quite or sometimes true, or
very or often true. Scores of 0-1-2 apply, so the maximum possible score is 24."
William Mandy was one of those who designed this test.
The paper on the study is here: Investigating Gender-Specific Trajectories of Autistic Traits Across Childhood and Adolescence in a Large Birth Cohort
"Participants (N=9744) were girls (n=4784) and boys (n=4960) from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort study. ATs were assessed aged 7, 10, 13 and 16 years using the Social Communication Disorders Checklist (SCDC), a widely used and psychometrically sound parent-report AT measure."
The results are interesting:
"We observed different AT trajectories for males and females (Figure 1). A latent growth curve model showed that, controlling for IQ, non-autistic psychopathology and socio-economic status: (a) aged 7, males had higher ATs than females (p<.001); (b) males and females both showed a decline in ATs between 7 and 10 years; (c) females, but not males (p<.001), showed a substantial escalation in ATs between 10 and 16 years.
This same pattern of findings occurred when we investigated gender ratios of those with very high ATs. For example, aged 7 years, males had much higher odds than females of scoring ≥ 99th AT centile (OR = 6.15, 95% CI [5.44, 6.85]), but by 16 years females and males had similar odds of having ATs ≥ 99th centile (OR=1.18, 95% CI [0.56, 1.80])."
In short, autistic traits became far more observable in females as they went beyond puberty.
"We present the first empirical evidence for the adolescent emergence hypothesis: a sub-group of girls showed substantial escalation of ATs between 10 and 16 years. This may partly explain why females tend to be diagnosed with autism later than males."
I'm sold. I'll ignore it that it's based on parental reporting. Let's just assume this is correct. Women begin to exhibit autistic symptoms more the older they get. In fact, surpassing males whose symptoms remain stable over time.
Here's the data in a colourful bar chart. Watch that orange bar (not pink?) for girls go from around half the incidence of autistic traits comparable to males aged 7 to aged 16, females overtaking males in observable autistic traits.
I'll repeat that. OBSERVABLE AUTISTIC TRAITS.
How on earth does this data then fit in the with the camouflage hypothesis? The whole point of the camouflage hypothesis is that females around the time of puberty look about them, see they don't fit in and so mimic the behaviours of other girls to fit in and "pass for normal." So how come this data suggests exactly the opposite. That females begin around puberty to exhibit autistic traits. Huh?
In fact, it makes sense that in degenerative neurological disorders like Alzheimers or Parkinsons symptoms get worse and managing of symptoms get harder. But rationally you would assume that non-degenerative neuro disorders get easier to manage as one learns more about the condition and techniques to control or manage it. In short, in theory, Autism should become less noticeable with age. But as with everything in this discussion we leap into an Alice in Wonderland or Lemuel Gulliver world where everything is not is it seems, everything is upside down.
"These are early days, the findings need to be replicated, they're an Autism trait measure, because they are so challenging to many of the fundamental things we think about Autism."
"This is some indicator that...subtle autistic difficulties in females may become evident later in development than they do for males."
Again, this makes no sense as it's surely the subtle autistic difficulties (rather than the big Triad of impairments) that women mask so well as to pass for normal. And surely this is just sociology?....
"And that would fit with the widespread observation that females receive their Autism diagnosis later than males. And there is some evidence that the complexity of the social world, for both genders, increases across late childhood and adolescence, there is some evidence that that increase is steeper for females than males."
No shit?
"So what we might be seeing here is a situation whereby the social demands made on girls goes up more sharply for girls between the age of 10 and 16 years and then produces escalating demands on girls' social skills and thereby increasing numbers of girls struggling to meet the demands made on them by their social environment."
I repeat, this is the exact period that women claim to learn masking skills which make them pass for normal and hence they go undiagnosed. It's completely mad, you can't have both.
Finally then "is there a direct relevance of the female phenotype having a direct effect on diagnosis?
Because there was no research in this area we did a qualititive study, so instead of deriving hypotheses and testing them using statistics we took a data driven approach where we did in depth interviews autistic women who had been diagnosed late."
This is the "in depth" study I look at above; The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype
The one with fourteen women interviewed, some on the internet, blah blah.
They did the study to "map this terrain, to deeper our understanding of this phenomenon and to generate ideas and hypotheses that can subsequently be tested in a uh um uh uh quantitive hypothesis driven way."
"I just want to pull out ways in which the Female Autism Phenotype can prevent women from being identified in a timely fashion," says Mandy. Yes, what are these ways that FAP prevent diagnosis?
"“You’re not autistic." This theme included reported experiences of autistic difficulties being ignored and misunderstood, perceived reasons for this, and beliefs about the implications of having received a late diagnosis. Almost all the young women reported having experienced one or more mental health difficulty, with anxiety, depression and eating disorder being the most commonly reported. Most participants commented that health professionals treating them had not noticed their symptoms might be related to ASC:
“Four to five years of depression and anxiety treatment…years of talking therapy…and not once did anyone suggest I had anything other than depression”.
So, um, dear god I'm actually stimming myself here as I try to get my head around this paradox.
I'll call women who exhibit the female autism phenotype FAPs. So FAPs exhibit symptoms of depression, anxiety, eating disorders and that's what they get diagnosed, they've learned to mimic (mask/camouflage) so health professionals, teachers, even parents don't recognize these symptoms (despite parents apparently recognizing them in the SCDC) and that's frustrating that they recognize the depression etc. that I don't mask but the ASD I do mask goes undetected.
“You go to your doctor…and you get diagnosed with multiple personality disorder which is completely opposite to what you are.”
What's the opposite of multiple personality?
“When I mentioned the possibility to my psychiatric nurse she actually laughed at me…I asked my mum, who was a GP at the time…if she thought I was autistic. She said, ‘Of course not’. At the time, a good 10 years ago now, there just wasn’t much information about how girls presented, and from what she knew, I was nothing of the sort.”
You see, mothers back then didn't recognize these unique FAP symptoms that are masked but appear like depression.
So you acted normal and you didn't get diagnosed because you passed for normal and this is somehow the doctors fault for not recognizing your unique symptoms that you mask. Even though oddly typical autistic characteristics are also commonly misunderstood:
"A number of young women said that they had been told they were ‘rude’ or ‘lazy’ after they had made social faux pas, due to their misunderstanding of social rules:
“I was often accused of being rude when I had absolutely no intention of being so…he [a teacher] started saying I wasn’t trying and that I was a waste of his time.”"
But I thought you masked to the point of passing for normal. Isn't this the unique FAP skill?
"Co-existing mental health difficulties seemed to be another barrier to diagnosis."
If the women masked their ASD which appears to manifest as depression and anxiety and were diagnosed with depression and anxiety...oh I'm confused...
""Upon complaining to their teachers, they recalled that they were blamed and been told to try and ‘act more normal’."
Huh? I thought you did act normal and that's why you don't get diagnosed? I thought the key symptom of FAP was camouflaging to the point of appearing normal?
"“When I was being bullied, I was told not to antagonise these girls and actually I was only antagonising them by being myself.”"
I thought you mimicked those girls to pass as normal?
Is no one else utterly bemused? So, in summary, FAP manifests in different characteristics to the typical male Autism in some way and girls around puberty learn to mimic the girls they observe doing well socially but then that stops the girls getting diagnosed because they pass for normal and they get depressed and anxious and get diagnosed for depression and anxiety and get criticized for appearing rude and not acting normal and the data evidence shows that girls exhibit more autistic traits from puberty onwards at the exact same time that they learn to mask their behaviours.
That's the female autism phenotype.
The other explanations by the NAS for "the gender split" mostly posit the exact opposite to the FAP:
Except it isn't is it? That's what most autistics learn to do. So by that rationale most autistics are masking. But they still stand out because of the "triad of impairments." If masking was simply avoiding obvious physical behaviours like stimming in public then I would agree that masking exists. However, this isn't what Mandy, Gould and the women above are describing. They are suggesting you can fake eye contact, social interaction skills, communication and processing skills.
If it were hiding stimming then why do none of the "FAP" women above mention their stimming? Well, obviously because they don't stim. Because the magic FAP means soothing repetitive behaviours aren't a characteristic, that's that male Autsm thing. Except for the woman that Mandy talks about.
He has a further example of compensation.
"She talked about how she transitioned to secondary school she became increasingly conscious that she didn't know how to behave in social situations and didn't instinctively want to behave like the other girls in the class and she decided that she was going to pick a particular girl in her class who she thought was particularly popular and admirable and copy that girl."
Apart from this describing socialization can anyone spot a logical fallacy in that argument? She didn't instinctively want to behave like the other girls so she copied that one that acted most like the other girls.
Huh?
Hull et al drew up a nice brainstorm of the women's compensation techniques and the consequences to them of looking completely normal. To make it sound sciency it's called a "Thematic map of the three stages (motivations, camouflaging, and consequences) of the camouflaging process."
Mandy even points out that this 'study' "was of 100 women online giving verbal data..."
How does anyone take this seriously?
The most bizarre statement "a more positive reason for camouflaging. It enables me to be with other people in a way that is relatively comfortable for me."
Huh? I thought it caused great anxiety? Meltdowns? Terrible debilitating exhaustion? If it's that easy why isn't everyone doing it? Oh yes, I forgot, these women have a unique genetic component, the FAP.
"People talked about the stress, the anxiety the exhaustion of it."
Which is it?
"Some people say one they first meet people they camouflage but as they get to know them they camouflage less and less until they can be themselves."
Huh? Doesn't Mandy think...I do that! Everyone does.
I know I'm repeating myself but just to reiterate that Mandy told us at the beginning of the talk: "I've tried to focus on findings that have some empirical scientific thought."
So he ignores the science bit and endorses Self reporting, which isn't even empirical in the sense that the women don't have their characteristics observed so how can one argue this is reliable data.
ASPERGER
We know head further down the rabbit hole into Wonderland as Mandy argues that there "so far I've talked about, if you like, the cross sectional aspects of the female phenotype but it is possible that there are some differences between males and females autistic symptoms that could only be visible to us if we look longitudinally. We think about characteristics over time."
I thought longitude was out and dimensional was the way to look at things? I thought all those old stereotypes spouted by the likes of Kanner or Asperger were just male-centric, we've moved on grandad.
Apparently not, when it suits one's argument.
"In view of these facts, the problem of the emotionality of autistic children is made extremely complicated for us. In any case, the children cannot be understood simply in terms of the concept 'poverty of emotion', used in a quantitative sense. Rather, what characterises these children is a qualitative difference, a disharmony in emotion and disposition. They are full of surprising contradictions which makes social adaptation extremely hard to achieve.
It is fascinating to note that the autistic children we have seen are almost exclusively boys. Sometimes girls had contact disturbances which were reminiscent of autism, and there were also girls. However, we never found the fully formed picture as shown in cases 1 to 3. How can this
be explained? There is certainly a strong hint at a sex-linked or at least sex-limited mode of inheritance.
The autistic personality is an extreme variant of male intelligence. In general, girls are the better learners. They are more gifted for the concrete and the practical, and for tidy, methodical work. Boys, on the other hand, tend to have a gift for logical ability, abstraction, precise thinking and formulating, and for independent scientific investigation. This is the reason, too, why in general boys at older age levels do better than girls in the Binet test. The narrowly logical and abstract items which start at the ten-year level are simply more congenial to boys! In the autistic individual the male pattern is exaggerated to the extreme. In general, abstraction is congenial to male thought processes, while female thought processes draw more strongly on feelings and instincts. In the autistic person abstraction is so highly developed that the relationship to the concrete, to objects and to people has
largely been lost, and as a result the instinctual aspects of adaptation are heavily reduced."
Clearly Asperger felt Autism was more likely to be present in boys.
So Mandy et al have done a dimensional study of autistic traits (social elements) and measured them longitudinally at 7 years, 10, 13 and 16.
Note how the traits in females become much more pronounced "apparent" rise in autistic traits to the point where "females have caught up with males in autistic trait scores."
Mandy's even come up with a sciency name for this:
"The adolescent emergence hypothesis - ATs in females become more overt later in development, such that their ATs escalate during adolescence (e.g., Asperger, 1943)."
And to push their claim they just ignore diagnosis:
"Current diagnostic criteria, which are largely based on male cases, are relatively insensitive to the female autism phenotype. Therefore, we included participants across the full range of AT severity, not just those with an autism diagnosis, to avoid a systematic bias against participants with female-typical autistic difficulties."
Yep, let's include females without diagnosis to prove our point that females go undiagnosed.
What we then do is get parents to fill out report forms on their child's behaviours using the SCDC:
"The SCDC21 is a questionnaire, completed by parents, that measures social reciprocity and
verbal/nonverbal characteristics resembling those found in ASD.
There are 12 items, rated according to whether the corresponding behavior has been seen during the past 6 months; if so, whether the associated statements are not true, quite or sometimes true, or
very or often true. Scores of 0-1-2 apply, so the maximum possible score is 24."
William Mandy was one of those who designed this test.
The paper on the study is here: Investigating Gender-Specific Trajectories of Autistic Traits Across Childhood and Adolescence in a Large Birth Cohort
"Participants (N=9744) were girls (n=4784) and boys (n=4960) from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort study. ATs were assessed aged 7, 10, 13 and 16 years using the Social Communication Disorders Checklist (SCDC), a widely used and psychometrically sound parent-report AT measure."
The results are interesting:
"We observed different AT trajectories for males and females (Figure 1). A latent growth curve model showed that, controlling for IQ, non-autistic psychopathology and socio-economic status: (a) aged 7, males had higher ATs than females (p<.001); (b) males and females both showed a decline in ATs between 7 and 10 years; (c) females, but not males (p<.001), showed a substantial escalation in ATs between 10 and 16 years.
This same pattern of findings occurred when we investigated gender ratios of those with very high ATs. For example, aged 7 years, males had much higher odds than females of scoring ≥ 99th AT centile (OR = 6.15, 95% CI [5.44, 6.85]), but by 16 years females and males had similar odds of having ATs ≥ 99th centile (OR=1.18, 95% CI [0.56, 1.80])."
In short, autistic traits became far more observable in females as they went beyond puberty.
"We present the first empirical evidence for the adolescent emergence hypothesis: a sub-group of girls showed substantial escalation of ATs between 10 and 16 years. This may partly explain why females tend to be diagnosed with autism later than males."
I'm sold. I'll ignore it that it's based on parental reporting. Let's just assume this is correct. Women begin to exhibit autistic symptoms more the older they get. In fact, surpassing males whose symptoms remain stable over time.
Here's the data in a colourful bar chart. Watch that orange bar (not pink?) for girls go from around half the incidence of autistic traits comparable to males aged 7 to aged 16, females overtaking males in observable autistic traits.
I'll repeat that. OBSERVABLE AUTISTIC TRAITS.
How on earth does this data then fit in the with the camouflage hypothesis? The whole point of the camouflage hypothesis is that females around the time of puberty look about them, see they don't fit in and so mimic the behaviours of other girls to fit in and "pass for normal." So how come this data suggests exactly the opposite. That females begin around puberty to exhibit autistic traits. Huh?
In fact, it makes sense that in degenerative neurological disorders like Alzheimers or Parkinsons symptoms get worse and managing of symptoms get harder. But rationally you would assume that non-degenerative neuro disorders get easier to manage as one learns more about the condition and techniques to control or manage it. In short, in theory, Autism should become less noticeable with age. But as with everything in this discussion we leap into an Alice in Wonderland or Lemuel Gulliver world where everything is not is it seems, everything is upside down.
"These are early days, the findings need to be replicated, they're an Autism trait measure, because they are so challenging to many of the fundamental things we think about Autism."
"This is some indicator that...subtle autistic difficulties in females may become evident later in development than they do for males."
Again, this makes no sense as it's surely the subtle autistic difficulties (rather than the big Triad of impairments) that women mask so well as to pass for normal. And surely this is just sociology?....
"And that would fit with the widespread observation that females receive their Autism diagnosis later than males. And there is some evidence that the complexity of the social world, for both genders, increases across late childhood and adolescence, there is some evidence that that increase is steeper for females than males."
No shit?
"So what we might be seeing here is a situation whereby the social demands made on girls goes up more sharply for girls between the age of 10 and 16 years and then produces escalating demands on girls' social skills and thereby increasing numbers of girls struggling to meet the demands made on them by their social environment."
I repeat, this is the exact period that women claim to learn masking skills which make them pass for normal and hence they go undiagnosed. It's completely mad, you can't have both.
Finally then "is there a direct relevance of the female phenotype having a direct effect on diagnosis?
Because there was no research in this area we did a qualititive study, so instead of deriving hypotheses and testing them using statistics we took a data driven approach where we did in depth interviews autistic women who had been diagnosed late."
This is the "in depth" study I look at above; The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype
The one with fourteen women interviewed, some on the internet, blah blah.
They did the study to "map this terrain, to deeper our understanding of this phenomenon and to generate ideas and hypotheses that can subsequently be tested in a uh um uh uh quantitive hypothesis driven way."
"I just want to pull out ways in which the Female Autism Phenotype can prevent women from being identified in a timely fashion," says Mandy. Yes, what are these ways that FAP prevent diagnosis?
"“You’re not autistic." This theme included reported experiences of autistic difficulties being ignored and misunderstood, perceived reasons for this, and beliefs about the implications of having received a late diagnosis. Almost all the young women reported having experienced one or more mental health difficulty, with anxiety, depression and eating disorder being the most commonly reported. Most participants commented that health professionals treating them had not noticed their symptoms might be related to ASC:
“Four to five years of depression and anxiety treatment…years of talking therapy…and not once did anyone suggest I had anything other than depression”.
So, um, dear god I'm actually stimming myself here as I try to get my head around this paradox.
I'll call women who exhibit the female autism phenotype FAPs. So FAPs exhibit symptoms of depression, anxiety, eating disorders and that's what they get diagnosed, they've learned to mimic (mask/camouflage) so health professionals, teachers, even parents don't recognize these symptoms (despite parents apparently recognizing them in the SCDC) and that's frustrating that they recognize the depression etc. that I don't mask but the ASD I do mask goes undetected.
“You go to your doctor…and you get diagnosed with multiple personality disorder which is completely opposite to what you are.”
What's the opposite of multiple personality?
“When I mentioned the possibility to my psychiatric nurse she actually laughed at me…I asked my mum, who was a GP at the time…if she thought I was autistic. She said, ‘Of course not’. At the time, a good 10 years ago now, there just wasn’t much information about how girls presented, and from what she knew, I was nothing of the sort.”
You see, mothers back then didn't recognize these unique FAP symptoms that are masked but appear like depression.
"A number of young women said that they had been told they were ‘rude’ or ‘lazy’ after they had made social faux pas, due to their misunderstanding of social rules:
“I was often accused of being rude when I had absolutely no intention of being so…he [a teacher] started saying I wasn’t trying and that I was a waste of his time.”"
But I thought you masked to the point of passing for normal. Isn't this the unique FAP skill?
If the women masked their ASD which appears to manifest as depression and anxiety and were diagnosed with depression and anxiety...oh I'm confused...
""Upon complaining to their teachers, they recalled that they were blamed and been told to try and ‘act more normal’."
Huh? I thought you did act normal and that's why you don't get diagnosed? I thought the key symptom of FAP was camouflaging to the point of appearing normal?
"“When I was being bullied, I was told not to antagonise these girls and actually I was only antagonising them by being myself.”"
I thought you mimicked those girls to pass as normal?
Is no one else utterly bemused? So, in summary, FAP manifests in different characteristics to the typical male Autism in some way and girls around puberty learn to mimic the girls they observe doing well socially but then that stops the girls getting diagnosed because they pass for normal and they get depressed and anxious and get diagnosed for depression and anxiety and get criticized for appearing rude and not acting normal and the data evidence shows that girls exhibit more autistic traits from puberty onwards at the exact same time that they learn to mask their behaviours.
That's the female autism phenotype.
OTHER EXPLANATIONS
- That "autism is an exaggeration of normal gender differences." This is not explained.
- The ‘extreme male brain’ theory of autism possibly caused by the effects of foetal testosterone on brain development. That Autism is characterized by male charactiristics. Though why that would stop women getting diagnosed is not explained. Surely autistic women would then simply not appear like typical gendered females (but we don't like that because it misses out all those camouflaging women who appear all feminine and like make-up, etc.)
- That genetic differences mean that girls are less likely to inherit autism than boys. This uses the 2000 study by Skuse et al which claimed that "Autism is a highly heritable disorder." even though we have no idea whether Autism is genetic. And it simply argues that "for phenotype expression of many autistic characteristics is influenced by an imprinted X-linked gene." Autism is expressed through the male chromosome. But we don't like that one because (see previous explanation)
- that, overall, men and boys tend to be more susceptible to organic damage than women and girls (Rimland, 1964), whether through hereditary disease, acquired infection or other conditions. Since it is now almost universally accepted that there is an organic cause for autism, it is possible that boys are more likely to be autistic. What is this heresy?
- that women and girls are better at masking or camouflaging their difficulties. This just links to the study above by Dean et al The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder which shows boys and girls socially play differently so that it's harder to spot autistic girls. Nothing to do with masking, simply sociological gendered conditions: "The male landscape made it easier to detect the social challenges of boys with autism spectrum disorder. Typically developing boys tended to play organized games; boys with autism spectrum disorder tended to play alone."
- autism traits in girls are under-reported by teachers This links to "Girls under the radar" [see just repeat] "In 1944, Hans Asperger (trs. Frith 1991) wrote that the ‘contact disturbances’ experienced by the girls in his group were ‘reminiscent of autism’ without showing the ‘fully formed’ autism seen in the boys. Similarly, today an ASC explanation for autism-like difficulties in girls is often discounted because their behaviour conflicts with the stereotype of ASC core characteristics and associated features." So we need a new not fully formed Autism just in females. Though sometimes in males. And not all females. Just the ones not exhibiting autistic characteristics. But shock horror, the study does acknowledge socialization! Huzzah! "All young people, whether or not they have ASC, experience gender-related differences in upbringing (for example, role models, expectations, socialisation) within and outside the family. From a young age, they are given genderassociated cues and experiences (Cheslack-Postava and Jordan-Young 2012). With their daughters, mothers show increased sensitivity, more frequent interactive styles, and more social behaviours (such as eye contact, vocal response to questions) than with their sons. This gender differentiation may have an impact on gender-associated differences in ASC. Siller and Sigman (2002) observed: "…among children with autism, levels of synchronization between caregiver interactions and child’s focus of attention during play were associated with gains in joint attention and language up to 16 years later."
- ‘There is a real issue of inequality in autism research; many studies explicitly exclude women and girls (because they expect low numbers), so we continue to base our knowledge of autism on findings from men and boys.’ Francesca Happé, again asserts that this new wonder female autism is under researched. Just pop in "female autism" in google. This is nonsense.
- ‘She does not have repetitive behaviours’ Women with ASC present in wide-ranging and subtle ways and have been observed to have fewer repetitive, ritualistic behaviours (for example, abnormal posture and gait, hand flapping, tremor, dystonic posturing of hands, fingers, etc) than boys and men with ASC. Shock horror there's no references for this one.
- Lack of diagnosis. Many girls are never referred for diagnosis, as their ASC traits – ameliorated by masking and unrecognised due to male stereotyped expectations – go unacknowledged (Dworzynski et al. 2012). Why then does the SCDC evidence show exactly the opposite then?
- The helpful handbook by the NAS Flying Under the Radar has a long checklist of the symptoms of the FAP and what can be done to help in schools. They include things like "Quiet, shy, awkward, compliant, passive," " Explosive outbursts or meltdowns," "Fine motor or sensory difficulties," " Shut down or cry over small things due to sensory/emotional overload," but oddly go undiagnosed because they "Camouflage emotions or mask symptoms at school."
CLAIRVOYANCE
There's a strange wish to confirm that women are going undiagnosed among those diagnosing Autism. It's akin to leading questions in clairvoyance. Usually these involve what the 19th Century critic of clairvoyance,George Lewes, suggested were "leading questions, by intonations, by the hundred suggestions of voice and manner."
Psychics typically use cold reading techniques to turn vague statements into facts, also known as fishing.
Take for instance the recent Channel 4 show, Are You Autistic?. Francesca Happe, one of the psychologists who first led this female Autism revolution plays out two of her strange stories (situations where actors' intentions aren't theoretically clear to autistic people).
One is a bad song played by one actor, the other says yeah it was great. A white lie.
Happe then asks the female contestant on the show, Jo:
"So do you think he actually thought it was good?"
"Well possibly not, I didn't think it was good."
"But you can't be sure what he thinks."
Classic cold reading technique. "Well possibly not" becomes a key Autism descriptor of lacking Theory of Mind: ""but you can't be sure what he thinks." Did Jo say that? I wish to point out that I'm not saying Jo is or isn't autistic (though she doesn't exhibit or describe any autistic behaviours), merely pointing out how Francesca Happe's drive to diagnose women (over men, the other contestant, JP, clearly exhibits autistic traits) leads her to confirm her own bias by using techniques similar to cold reading, the skill used by clairvoyants.
In her diagnosis, Jo talks to Simon Baron-Cohen:
SBC: What would be the value of a diagnosis?
J: I think I need to know that I'm not just weird, or rude...
SBC: Which is what people have said?
J: Well I know that's how I can appear
SBC: But what you want to know is is there a reason why I behave differently?
J: I feel like I take on a role everyday, depending on where I am, if I'm doing the schoolrun I'm the mum with the schoolrun who engages in a bit of hi, how are you? type of thing. then when I go elsewhere I'm a different person but when I'm at home alone, that's nice because I don't have to put in an effort to be anyone I'm just content.
I found the transition from primary school to secondary school too huge. I did go to a normal kind of high school and I couldn't cope with it, it was too big and didn't really get on with anyone in my class. I remember being in the corridor when the bell went for another lesson and everyone just came out at once and went to go to their next room and I just felt god this is absolutely horrific, it was just really really overwhelming."
Now obviously this is only a snippet of her discussion with Baron-Cohen but this and her earlier description of going out to meet her friends at a cafe and other general descriptions of her life are typical of the new wave of Female Autistics who describe their social problems in vague ways that could conform to most of our lives. This is called the Forer Effect (or Barnum statements). Take stage magician, Derren Brown's truly expert version of the Forer effect, general statements you could apply to anyone and contrast and compare with the statements above by female autistics who magically mask their behaviours:
"You are a person prone to bouts of self-examination. This is in sharp contrast to a striking ability you have developed to appear very socially engaged, even the life and soul of the party; but in a way that only convinces others. You are all too aware of it being a façade.
This means that you will often be at a gathering and find yourself playing a part. While on the one hand you’ll be talkative and funny, you’ll be detaching yourself to the point where you will find yourself watching everything going on around you and feeling utterly unable to engage. You’ll play conversations back to yourself in your head and wonder what that person really meant when he said such-and-such — conversations that other people wouldn’t give a second thought to.
How have you learned to deal with this conflict? Through exercising control. You like to show a calm, self-assured fluid kind of stability (but because this is self-consciously created, it will create bouts of frustrated silliness and a delight in extremes, or at least a delight in being seen to be extreme). You most easily recognise this control in how you are with people around you. You have learned to protect yourself by keeping people at bay. Because in the past you have learned to be disappointed by people (and because there were issues with you adjusting to your sexuality), you instinctively keep people at arms’ length, until you decide they are allowed over that magic line into your group of close friends. However, once across that line, the problem is that an emotional dependency kicks in which leaves you feeling very hurt or rejected if it appears that they have betrayed that status.
Because you are prone to self-examination, you will be aware of these traits. However, you are unusually able to examine even that self-examination, which means that you have become concerned about what the real you is. You have become all too aware of façades, of sides of yourself which you present to the world, and you wonder if you have lost touch with the real and spontaneous you.
You are very creative, and have tried different avenues to utilize that ability. It may not be that you specifically, say, paint; it may be that your creativity shows itself in more subtle ways, but you will certainly find yourself having vivid and well-formed ideas which others will find hard to grasp. You set high standards for yourself, though, and in many ways are a bit of a perfectionist. The problem is, though, that it means you often don’t get stuff done, because you are frustrated by the idea of mediocrity and are wearied by the idea of starting something afresh. However, once your brain is engaged you’ll find yourself sailing. Very much this will likely lead to you having considered writing a novel or some such, but a fear that you won’t be able to achieve quite what you want stops you from getting on with it. But you have a real vision for things, which others fall short of. Particularly in your academic/college situation, you are currently fighting against restraints upon your desire to express yourself freely.
Your relationship with your parents (there is a suggestion that one is no longer around, or at least emotionally absent) is under some strain. You wish to remain fond of them but recent issues are causing frustration – from your side far more than theirs. In fact they seem unaware of your thoughts on the matter. Partly this is because there are ways in which you have been made to feel isolated from certain groups in the past – something of an outsider. Now what is happening is that you are taking that outsider role and defending it to the point of consciously avoiding being part of a group. This will serve you well in your creative and career pursuits. You have an enormous cynicism towards those who prefer to be part of a group or who exhibit any cliquey behaviour, and you always feel a pang of disappointment when you see your ‘close’ friends seeming to follow that route. Deep down it feels like rejection.
However, for all that introspection, you have developed a sensational, dry sense of humour that makes connections quickly and wittily and will leave you making jokes that go right over the heads of others. You delight in it so much that you’ll often rehearse jokes or amusing voices to yourself in order to ’spontaneously’ impress others with them. But this is a healthy desire to impress, and although you hate catching yourself at it, it’s nothing to be so worried about.
There’s also an odd feeling that you should have been born in a different century. You might be able to make more sense of that than I can.
There are some strong monetary shifts taking place at the moment. Both the recent past and what’s in store over the next few months represent quite a change.
You have a real capacity for deciding that such-and-such a thing (or so-and-so a person) will be the be all and end all of everything and be with you for ever. But you’d rather try and fail, and swing from one extreme to the other, than settle for the little that you see others content with.
Conclusion: It’s very interesting doing your reading, as you do present something of a conundrum, which won’t surprise you. You are certainly bright, but unusually open to life’s possibilities – something not normally found among achieving people. I’d say you’d do well to be less self-absorbed, as it tends to distance you a little, and to relinquish some of the control you exercise when you present that stylized version of yourself to others. You could let people in a little more, but I am aware that there is a darkness you feel you should hide (much of this is in the personal/relationship/sexual area, and is related to a neediness which you don’t like).
You really have an appealing personality – genuinely. Many thanks for doing this, and for offering something far more substantial than most."
My god, it's me. I'm autistic! It all makes sense. It's just socialized selves, what we all are to varying degrees. This is what the female autistics are describing, it's what the female autism phenotype is...it's just what we all do.
In 1844 Dr John Forbes, a critic of phrenology and homeopathy, attended a seance to observe the unique abilities of the psychic, Alexis Didier.
"The conduct ofAlexis throughout was altogether that of a man who was playing a deceptive part, and looking in all directions for help in his efforts to succeed in what was given him to do."
Forbes found "he and his friends made unconceded attempts to wheedle the party who gave the word, into conceding something as to help him in solving the problem."
Yet, Forbes failed to perceive "one single unequivocal example of his reputed powers."
Forbes argued spectators of Alexis and clairvoyance in general were either "totally unacquainted with the laws of evidence, or too enthusiastic of temperament to be guided by them."
Forbes criticized printed and oral accounts of clairvoyance because they were "utterly valueless, from being defective in exact and minute details." That belief in clairvoyance could be ascribed to "a proneness of faith, a faith which led observers to marvel at apparently successful demonstrations while ignoring numerous failures."
That sounds familiar?
Tony Attwood started the masking, my god there are huge swathes of women undiagnosed idea after diagnosing Lianne Holliday Willey and writing a foreword to her book, Pretending to Be Normal and later Safety Skills for Asperger Women. In the latter Attwood argues:
"Girls and women who have Asperger's syndrome are different, not in terms of the core characteristics but in terms of their reaction to being different. They use specific coping and adjustment strategies to camouflage or mask their confusion in social situations or achieve superficial social success by imitation or escaping into a world of fantasy or nature."
How does that gel with Hannah or Emily above who didn't even know they were autistic and don't have the same (male-centric) core characteristics? Poor old Tony, even he's been left behind as the paradigm has shifted so much. You don't now need these core characteristics, that's trad dad.
"In early childhood, probably long before a diagnostic assessment, a girl who has the characteristics of Asperger's syndrome will begin to know she is different to other girls. She may not identify with or want to play cooperatively with her female peers. Her thoughts can be that the play of other girls is stupid, boring and inexplicable. She may prefer to play alone so that she can play her way. Her interests can be different to other girls, not necessarily in terms of focus, but intensity and quality. For example, she may collect over 50 Barbie dolls and choose not to enact with her friends from the neighbourhood 'Barbie getting married' but arrange the dolls in particular configurations. There can be a determination to organise toys rather than share toys and also not play with toys in conventional ways. She may prefer non-gender specific toys such as Lego and not seek acquisitions related to the latest craze for girls her age to be 'cool' and popular. There can be an aversion to the concept of femininity in wearing the latest fashions or fancy or frilly clothing. The preference can be for practical, comfortable clothing with lots of pockets."
Revisiting Attwood I've realized that his initial ideas might be wrong (his blindspot is believing Liane Holliday Willey is autistic because she masks) but they still, at least, conform to the definitions of what Autism is. This is a long long way from women who don't have male-centric symptoms and mask their anxiety, can love boybands and make-up and act completely 'normal' so that no one notices and they don't even know themselves.
"Many girls and women who have Asperger's syndrome have described to clinicians and in autobiographies how they sometimes think they have a male rather than a female brain, having a greater understanding and appreciation of the interests, thinking and humour of boys. The girl who has Asperger's syndrome can be described as a 'Tom Boy' eager to join in the activities and conversations of boys rather than girls."
I remember this Autism, what we used to call Autism. It's still known as Autism but now most females don't exhibit any of these characteristics. Instead they appear just like other women. Odd huh?
Emily Swiatek and her autistic chums on Are You Autistic? The one on the right is so good at imitating that she weirdly imitates classic unconscious body language cues, playing with her hair when talking to the dishy boys in the speed dating scenario...That's impressive
"When boys who have Asperger's syndrome make a social error, their response may be to become agitated and their clumsy and immature social play skills are quite conspicuous and annoying to peers and adults. There is recognition that this child needs an assessment and intervention. Girls are more likely to apologise and appease when making a social error."
This is exactly what I mean when I talk of "docility" above. Even though autistic girls may not follow typical socialized patterns because of the "triad of impairments" they are still taught to be docile, to act like women.
Attwood: "Peers and adults may then forgive and forget, but without realising that a pattern is emerging. However, the girl with Asperger's syndrome is increasingly recognising her social confusion and frequent faux pas. She may react by trying not to be noticed in a group, for others to be aware of her social confusion, preferring to be on the periphery of social situations. However, girls with Asperger's syndrome can be avid observers of human behaviour and try to decipher what they are supposed to do or say. Another strategy to having problems with social reasoning is by being well behaved and compliant at school so as not to be noticed or recognised as a different. A girl with Asperger's syndrome may suffer social confusion in silence and isolation in the classroom or playground..."
Unfortunately then Attwood goes off into flights of fantasy based on the experiences of Liane Holliday Willey, who pretends to be normal and succeeds with great aplomb. As many others have suggested, Holliday Willey's descriptions of her masking are simply the experiences of a young woman feeling pressure to conform to being a young woman, socialization (see Derren Brown's Forer experiment above). "Liane used imitation to become socially successful." She "figured out how to play the neurotypical game." So successful at the NT game that for some reason she still imitates a hyper-typical white middle class American woman to this day. Weird huh?
So Attwood also strangely suggests: "From my own extensive clinical experience and reading autobiographies, women who have Asperger's syndrome can be extremely sensitive to the emotional atmosphere at a social gathering. There is an almost 'sixth sense' for feelings within others of antagonism, fear and despair in group situations."
Attwood does, however, add: "Being a 'Tom Boy' in childhood, not being interested in fashion and femininity, make up and perfumes, as well as appreciating the logic of the male brain can lead to concerns regarding sexuality and gender identity."
TRANSGENDER AND FEMALE AUTISM
It's logical that a syndrome characterized by impairments in social interaction would lead to either not conforming to gender stereotypes or feeling one was the wrong gender.
So it's weird then when masking is enacted by FAP Female Autistics gender doesn't become an issue anymore. Once again, this doesn't make any sense. If you're masking social skills you're not (god, I'm presuming here because it's such nonsense) actually miraculously "losing your Autism" but just pretending to not have the key social "impairments" of Autism. So why then would you, in adulthood, after diagnosis, not think, fuck this, I'm sick of pretending to be a model woman, I do not conform to socialized gender stereotypes, screw pretty make-up and pink things? Why would you continue to mask and conform to gender stereotypes?
Of course, underlying my whole rationale is that there are now huge swathes of women being diagnosed autistic that are not autistic. They don't exhibit key characteristics and claim they don't have key characteristics but are masking. They get anxious and have meltdowns. They're not picked up in childhood because teachers etc. don't recognize their symptoms because they are able to camouflage....the symptoms they don't have because there's a bias towards male symptoms...
Now, obviously, one could argue, well who gives a shit? If they're happy and they know it let them clap their hands (or not, they don't stim, that's mysteriously only male autistics and females who oddly don't mask for some unknown reason).
However...a big however...is that if Autism is now being defined in women as this new masking not having Autism descriptors Autism what about real autistic women? What the hell happens to them? Do they get diagnosed? After all, they aren't exhibiting Female Autism characteristics by the very nature of them exhibiting Autism characteristics. What about resources and support? All these Female Autistics who don't have any recognizable characteristics are also going to take that support, those resources, that are badly needed for real autistic women.
This new Female Autism will simply become the norm. Women who have had difficult life circumstances, bullying, depression, sexual abuse, social anxiety, anorexia, will be diagnosed autistic. This in turn becomes Autism. Though it has absolutely nothing to do with Autism. It's mad.
There are parallels with proposed laws around transgender here in the UK. Hadley Freeman in The Guardian points out the problems with a new changes to the Gender Recognition Act.
"Currently, anyone who wants to change gender needs to have lived in their chosen gender for two years and been diagnosed with gender dysphoria. If the changes go through, anyone will be able to declare they are a man or woman, regardless of whether they have made any actual changes to their lifestyle or body. This is known as “self-identification” and the reactions have borne out that Margaret Atwood line, “Men are afraid women will laugh at them while women are afraid men will kill them.” Men have largely ignored the issue, until it comes charging into their changing room, while a lot of women have argued that predatory men could now come into female-only spaces unchallenged."
Sex is biological, you're born male or female (there are rare complications such as intersex), you are socialized into gender (woman or man) and Transgender people typically don't feel they are the gender they've been socially assigned and the sex they were biologically born. You can't change your sex (despite the cliche sex change op nomenclature for gender realignment), the whole genetic xx/xy coding. Most of us liberals couldn't generally care a less how someone defines themselves, what they wear, or indeed their physical gender alignment. Except...it becomes problematic in real social settings. Hadley Freeman's (and many other women's) concerns around the changes to gender recognition are present in the present. A woman who was once identified as a man is still male. This becomes problematic in areas that are specifically defined as female; well woman centres, female only gyms or swimming pools, female toilets, etc. Of course, these areas are also known as areas for women (gendered) which confuses things more. It's not transphobic to be concerned by the implications of allowing males who identify as women into safe spaces allocated to females...or indeed women.
A similar issue rises with not only self identifying autistics but people who are diagnosed autistic under new, looser definitions of what Autism is. As more and more FAP women are identified by their mysterious non-symptomatic masking abilities what happens to women who are actually autistic? These FAP women come to dominate the space and control arguments around Autism whilst all the time obviously not being autistic. They set the agenda. Yet they are biologically not autistic.
Freeman argues:
"When a 19-year-old trans woman was elected a Labour woman’s officer last year, a Labour councillor explained that “lived experience as a woman” was not a pre-requisite to be a woman’s officer. Biology, too, has been deemed terribly passe. “Inclusive feminism,” Plaid Cymru’s Leanne Wood wrote when considering why self-identifying trans women should be allowed into women’s refuges, understands that “gender is a complex and deeply personal thing, and is about so much more than outdated ideas of biology.” On the day of this year’s Women’s March, trans model Munroe Bergdorf tweeted that to “center reproductive systems” at the demonstrations was “reductive and exclusionary”."
Oh how many times have I heard the argument that I have outdated notions on Autism because I believe that Autism is biological (neurological) and thus gender (socialized behaviours) is irrelevant. Uh, many times.
"There is understandable concern about being on the wrong side of history. But I’ll tell you what has never put anyone on the right side of history: shouting women down. Gender is a feeling and biology is a physical fact, and the reason women-only spaces exist is not to protect some special inner feminine essence, but because there are significant physical differences between male-born bodies and female-born ones, and the latter have long been at a disadvantage."
Female Autism is a feeling, Autism is a biological fact. But to argue this is to be on the wrong side of history.
Comments
Post a Comment