I’ve been planning to write about gender and autism for a while now. Months ago, I wrote a personal reflection piece. It got two emphatic thumbs down in beta, so I let it languish in my drafts folder. Then, after some feedback from commenters here, I decided I would write a more informative companion post as context for the personal reflections, but that never happened. Then I cannibalized the personal reflections piece for something I was invited to submit to an anthology, which took me weeks to write because apparently everything takes me weeks to write lately.
Which left me still wanting to write about gender and autism here. As a first attempt, I’ve surveyed some of the ideas that people have put forth about gender and autism over the years, starting with Asperger himself.
Note: I’ve linked to a bunch of articles in this post, many of which I don’t agree with. However,I want to share the background information that I used so you can make your own decisions. Also, most references here are to binary gender and gender norms because that is the way most of the research is framed.
The Original Gender Link
In his paper describing his case studies, Hans Asperger hypothesized that autism must be a sex-limited or sex-linked condition because he had only observed it in boys. However, he also noted that some mothers of boys at his clinic who had autistic traits, which he found puzzling given the lack of girls who fit his model. His explanation for why there might be autistic women but not autistic girls was to suggest that autistic traits develop in females only after puberty.
He went on to state that he’d studied over 200 additional autistic children and had concluded from his observations that the autistic personality is an extreme variant of male intelligence. It’s important to note here that Asperger’s model was developed based on case studies of 4 boys who had been referred to him for behavior problems in school. All of them were considered to be uneducable in the traditional school system, creating a very specific profile on which Asperger based his observations.
It’s interesting to contrast Asperger’s idea of male versus female intelligence with Simon Baron-Cohen’s male and female brain models. Asperger believed that females were better learners with a tendency toward concrete practical thinking and tidy methodical work. He thought that males, on the other hand, were naturally gifted with logical ability, abstraction, precise thinking and formulating, and were predisposed to excel at independent scientific investigation.
He does go on to say that female thought processes draw more strongly on feelings and instincts while males are better at abstraction, but this observation is more of an afterthought and follows his general summation of what believes to be the primary gender differences. Asperger based his extreme male intelligence on his belief that autistic people have little to no ability for concrete thinking due to the highly abstract nature of their thought process, which he thought was a male trait.
Baron-Cohen took the extreme male variant idea and transformed it into something quite different from Asperger’s original concept.
The Extreme Male Brain
Simon Baron-Cohen’s extreme male brain theory has gotten a lot of attention, both from the media and the scientific community. Just about every scientific study on autism and gender done in the past 5+ years will at least mention it. In the popular media, it’s often boiled down to a simplistic “engineers and mathematicians are more likely to have autism” story, which makes for catchy headlines. The actual theory is a little more complicated and less clear cut than that.
The basic concept of the extreme male brain theory is that human thinking styles can be classified as either predominantly empathizing or predominantly systemizing. Baron-Cohen believes that empathizing is a female trait and systemizing is a male trait, because typical females tend to score higher on measures of empathy and typical males tend to score higher on measures of systemizing (categorizing/cataloging information and logic-based thinking).
Based on those assumptions, he then developed the concept of the Extreme Type-S personality, whose systemizing scores are above average and whose empathizing scores are below average. According to his research, 65% of autistic people are Extreme Type-S, indicating that autism is a form of extreme male thinking. Other researchers have used this theory to suggest that being female has a protective effect against autism.
There are a lot of holes in the EMB theory. It bases maleness and femaleness on a single pair of traits, which aren’t even mutually exclusive. It subscribes to outdated gender stereotypes of men as less nurturing and women as less logical/intellectual. It uses questionnaires designed by the researcher to prove the researcher’s point. It fails to even acknowledge the existence of nonbinary gender identity (which is especially significant in autistic populations, as mentioned later in this post). It completely ignores the possibility that females are simply underdiagnosed, which undermines the protective effect line of thinking. It uses characteristics of autism as a proxy for gender traits, thereby “proving” a link between gender and autism.
I could easily write an entire post on all of the problems with the Extreme Male Brain theory, but I’ll leave it at that. There are valid issues around the intersection of autism and gender, but this isn’t one of them.
Biological Differences in Autistic Adults
Gender dimorphism–observable differences between the males and females of a species–is a known biological phenomenon. It shouldn’t be surprising that there are some observable gender differences in autistic people as well.
For example, a recent study found that women on the spectrum have more white matter in their brains than their typical female peers. The autistic men in the study had a similar volume of white matter as their nonautistic peers. The study used this finding as “proof” of the “neurological masculinization” of autistic women’s brains. Conclusions like this make it obvious how much influence Baron-Cohen’s EMB theory has in current autism/gender research. The more interesting finding (to me), buried deep in most of the news coverage, is that there may be fundamental structural differences between the brains of males and females on the spectrum.
Another biological difference that’s been the subject of significant study is testosterone levels in autistic individuals. A few years ago, there was a popular theory that high levels of fetal testosterone and the cognitive profile of autism were somehow linked. A couple of years later, another group of researchers extended the theory to a gene called RORA, which is inhibited by testosterone and stimulated by estrogen. RORA levels have been found to be lower in autistic people. Since RORA is tasked with “turning on” a number of other genes, it’s possible that there is a link between testosterone levels, RORA levels and certain genes not being expressed. There are a lot of leaps that have to be made for the testosterone-genetics-autism link to pan out under this theory and much of is based on the study of either mice or cells in petri dishes as opposed to actual autistic humans.
In general, the evidence on elevated levels of testosterone in adults on the spectrum is mixed. Some studies have found that autistic adults of both genders had elevated levels of testosterone, but more recent research found that only autistic women have elevated testosterone levels. The study with mixed results, however, found that autistic individuals of both genders were more likely to have more androgynous body characteristics. Of course, the rating of how masculine or feminine a person’s facial features or voice are is subjective and based on binary gender norms.
Perhaps a more interesting line of inquiry is how autistic people themselves feel about their gender.
Gender Coherence and Autism
The link between gender dysphoria and autism is increasingly being studied. Research done this year in the UK found that among adults with gender dysphoria, the rate of ASD (5.5%) was more than twice that of the general population. Another study involving a larger group of adolescents with gender dysphoria found an even greater prevalence of ASD (7.8%).
There’s an interesting paper that attempts to explain these results by hypothesizing that autistic adults in general are more physically androgynous than their nonautistic peers and characterizes autism as a gender defiant disorder. I think the responses to our gender and body image survey added anecdotal evidence to this idea. Many of us mentioned some degree of gender dysphoria or an atypical relationship with gender norms.
This raises the question of what role being autistic might play in the formation of our personal experience of gender. For example, autistic children are less sensitive to social cues than typical children and may not make friends with or become part of groups of same-gender peers. If we’re not tuned in to what the social norms for children of our gender are, we’re less likely to adopt them early in life.
There may also be an aspect of autistic-related body dysmorphia in general that factors into gender dysphoria for some autistic individuals. Many autistic people have difficulty feeling connected to their physical selves or being physically comfortable with their body.
Finally, there is the issue of sensory sensitivities. Dressing or presenting androgynously may be a result of gender dysphoria or it may be related to avoiding sensory triggers associated with certain types, textures or styles of clothing.
Clinical Impact of Gender Differences
One of the reasons girls are diagnosed less often than boys is because many autistic females present differently than autistic males, on whom the diagnostic models are based. The most recent version of the DSM acknowledges this and it’s increasingly becoming the focus of scientific research.
While it’s interesting in an academic context to look at potential biological differences or the possibility that autistic people are more likely to have a more androgynous presentation, gender differences that may lead to more accurate diagnosis are where the rubber meets the road right now. It would be nice to see more research dollars being spent on developing a female model or a broader overall model of autism rather than trying to prove a link between autism and a “masculine” brain or other concepts that do little to improve the lives of people on the spectrum.