April 2016

A young woman rises from her bed, dreading the day ahead of her.. Not because of the hellish traffic on the way to work, or because of the annoying coworker who won’t stay out of her business,  or because of her frustratingly demanding boss, but because of one thing: social interaction. The thought of greeting the receptionist at the front desk makes her hands tremble. Standing by the water cooler and participating in light chit-chat makes her feel exhausted and inferior. She hasn’t received a raise in years, because she can never bring herself to step into her boss’s office and ask how their kids are doing, what their hobbies are. When discussing the weekend with the other members of her office, her eyes can never bring herself to meet her coworkers’, since then she couldn’t carefully monitor their expressions and make sure she hasn’t slipped up in some way. At night, she collapses into her bed, exhausted and depressed, only to be brought back to this hellish cycle when her alarm goes off the next morning. She’s always been this way, and she’s never understood why. She can’t understand facial expressions as well as others, she feels like she’s constantly wearing a mask, she finds herself easily exhausted in social situations, and the only enjoyable part of her day is when she can dive wholeheartedly into her work, likely something math or pattern-based.  This is just a glimpse into the world of autistic women. Despite the fact that their autism affects their life on a daily basis, they rarely receive a diagnosis that could help them understand themselves and receive the help they need. This is because doctors have always been extremely reluctant to diagnose women with autism. There exists a gender bias in the psychological world, specifically in the autistic community, in which doctors are far more likely to diagnose men, and ignore female signs and symptoms.

To begin, autism, or autism spectrum disorder, is defined as “a serious neurodevelopmental disorder that impairs a child’s ability to communicate and interact with others. It also includes restricted repetitive behaviors, interests and activities” (Mayo Clinic Staff 1). In more basic terms, it is a spectrum disorder that impairs an individual’s ability to interpret and understand social cues. Typical symptoms include a higher aptitude for logical thinking, sensory overload, lack of eye contact, “stimming” or physical stimulation, problems with language comprehension and production,  and constant movement (which can also be categorized under “stimming” (Shaw 11). In regards to stimming, there are many different kinds; visual stimming, which stimulates the visual cortex and involves waving hands in front of the face, staring back and forth between different objects, and blinking rapidly. There is physical stimming, which includes twirling hair, tapping body parts, and opening and closing latches or doors. Also, there is auditory stimming, which stimulates the auditory cortex, and can involve snapping fingers by the ears, playing the same note or few notes repeatedly on a musical instrument, or making noises themselves, similar to self-talk. Lastly, there is ‘touch’ stimming, in which autistic people rub or feel interesting surfaces or textures to stimulate their sensory cortex (Cowley 5).

There are many acknowledged and unacknowledged autistic historical figures and celebrities such as Michael Jackson, Temple Grandin, Albert Einstein, Isaac Newton, Bill Gates, and more. However, the issue with gender bias in the autistic community lies within that list: among all of those names, there was only one woman. Though much research was done, it was hard to find any information on female autistic figures. There is almost no research being done on this enormous gender gap in autism diagnosis, and the fact that there are far more men than women with autism has simply been accepted as fact. Anyone who disagrees is faced with two common arguments: biologically, far more men are affected by autism than women, and that women don’t show autistic symptoms.

To address the first argument, one must listen to an interview from Professor Tony Attwood, on Sharon daVanport radio show, Other People’s Words. Professor Attwood said, “I think what kind of happened is if [women] have been seeking help, there may have been a history of inappropriate diagnoses or almost-right diagnoses. There can be a history of the possibility of anorexia nervosa or borderline personality disorder, and so people have approached the person because of that sort of interpretation of what the person is doing.” He was describing the misdiagnosis of women with autism, and the interpretation of their symptoms as borderline personality disorder, anorexia nervosa, and other disorders. This shows that women are out in the world, trying to get diagnosed, but their symptoms and signs are being misinterpreted. A commonly cited statistic is that there are five men with autism for every one woman. However, this statistic has been disproved. The true numbers are more in line with two men with autism for every one woman. While men are still more likely to have autism, it is not to the drastic degree that everyone believes, and the statistic doctors lean on in order to not have to work hard to analyze possibly autistic women is simply false.

It cannot be denied that men’s brains and women’s brains work differently. Men, when their brains are active, can be seen having more intense brain activity in one particular spot, while women will have almost constant, less intense activity spread across almost the entire brain, depending on the stimulus. Thus, it could be easy to see that if the physical brain is different, then display of certain signs in the brain would be different for men and women.

A brain scan is actually a part of an autism diagnosis, and the signs doctors are looking for are unusual sites of activity in the male brain. Since the male brain typically fires off intense bursts of energy in one area, it is easy to spot an autistic brain, since it has large sites of intense activity occurring simultaneously throughout the entire brain. This is hard to differentiate in a female brain, because the typical female brain is always firing in a similar fashion to an austistic person’s brain. However, the difference can be spotted if one pays attention to the location of the neurons firing, and the intensity. An autistic brain will usually be firing more often in the sensory cortex and sensory lobes, while a female, neurotypical brain will usually fire in areas of language comprehension, creative thinking, and memory cortexes (Cowley 3). In addition to this, women with autism display symptoms differently. This leads to the next argument against the idea of a gender bias in the autism community.

The second argument is that women do not display ‘autism symptoms’. However, these symptoms are associated with autistic males. They include repetitive behavior, selective muteness, abrasive/avoidant personalities, and displays of physical discomfort when forced into social situations. These are all symptoms that are seen in boys with autism. Since the research on autism is usually done on men and boys, and rarely on women, doctors have no idea, usually, what female symptoms are. Usually, the ratio of boys to girls in autism studies ranges from 5:1 to 12:1 (Cowley 2). Women are simply not being studied. This lack of representation is what leads to misunderstandings about female symptoms of autism. If women are not being represented, there is a lack of information, as well as a lack of interest, about autistic women, leading to misdiagnoses and misconceptions about autism that harm everyone, not just women. This lack of information and interest also keeps the scientific world stuck in the cycle of not studying girls with autism, which leads to more misdiagnoses, which in turn snowballs throughout the years.

This can also be seen in other parts of the psychological world. Famous psychologists such as Stanley Milgram and Philip Zimbardo, who did amazing work in their fields, only did research on white, college-age, middle class men.  Therefore, all the information being taught to new psychologists is from the perspective of and/or catered towards the mythical norm.

This argument can also be addressed by discussing female symptoms. Females with autism usually participate in what is usually called ‘the Chameleon Effect’. Professor Tony Attwood said, “… what can happen is that the girls will have their way of hiding, camouflaging, imitating others, which means that they’re often not picked up” (DaVanport 15). It’s an exhausting process by which autistic women mimic neurotypical individuals to try to blend in. They’re usually quite adept at this, and it is quite difficult to ‘spot’ a woman with autism. However, the exhaustion from keeping up the ‘mask’ can lead to depression, anxiety, and other similar disorders. This is often how doctors will take the ‘easy way out’ in diagnosing women with autism, since their depression and anxiety, or even multiple personality disorder (since the women have many different masks for different social situations) is extremely evident, and seems to be an easy way to sum up and explain the women’s deviant behavior. In the past, women with severe autism would receive lobotomies, because doctors did not believe women experienced autism at all, and they believed women with autism were “psychotic and manipulative” and needed to be “readjusted”.  This is another way a lack of information about autism permanently and horrifically damaged the lives of women in the past.

Doctors usually use the aforementioned chameleon effect to justify their lack of female diagnoses. However, that is simply lazy medicine. One simply has to pay attention to see that the person in front of them is wearing a mask. They refuse to make prolonged eye contact, many of their phrases sound rehearsed or straight from a novel or TV drama, and you can see them becoming physically exhausted quite quickly. (DaVanport 14). When alone, they retreat inside a world of fantasy. Even their physical movements are rehearsed, and are identical every time they are executed, like a shrug or a dismissing wave of the hand. It doesn’t take much time to see that they are trying as hard as possible to appear neurotypical and keep the facade up. This, combined with the differences in brain activity between neurotypical females and autistic females, should be an extremely simple indicator of autism. Yet, we continue to see dismal rates of diagnosis of females with autism, despite the actual predicted statistic of men versus women with autism (2:1) (DaVanport 11).

This problem can be easily solved. All it takes is effort on the part of doctors and educators. If psychologists are taught to recognize female symptoms of autism, they can spot them with less effort, and women can receive the help they need. This starts in the classroom. At Webster Groves High School, autism is only mentioned as a supplemental vocabulary word to memorize. The textbook for AP Psychology, the class in which autism would be expected to be taught, frequently refers to individuals with autism as “he” or “boys”. But some schools in the post-secondary level are beginning to include courses specifically studying women with disabilities/psychological disorders, or even more specifically, classes about autism and gender. Agnes Scott College, a liberal arts women’s college in Georgia, has recently developed a course called “Gender and Psychology” that studies this very aspect of the psychological world.

Also, if more women are included in autism studies, more information can be obtained about female autism, and thus this information can be taught to new professors, and the cycle continues, creating a better and better world for women with autism.  It is extremely simple to put out ads seeking women with autism, or men and women, and making sure to study the same amount of women as men with autism (if they are studying men and women). The Autism Women’s Network even has meetings and conferences where women can meet doctors doing studies on autism, and learn about how the process of a psychological study is carried out, and they are then more likely to volunteer to be studied. The doctors can also profit, if they are (and are subsequently viewed as) less lazy by the general public. This all can lead to more support for the scientific community which, on another note, is in desperate need of support, given the current environmental and energy crises. Also, regardless of these crises, the scientific world is a huge aspect of developing and further advancing the human species. If there is no support for this community, which recent studies show there is not, with trust in physician integrity dropping steadily over the past three years (Shaw 14), society cannot make gains and advance, both in their application/development of technology, and back in the sphere of psychology, with the ability to recognize and treat psychological disorders.

This is not to say that autism is a ‘disease’ or a disorder that needs to be cured. Poor organizations like Autism Speaks display their lack of understanding of autism when they pour millions of dollars into researching autism diagnosis in the womb, with the purpose of “avoiding autistic births” (Cowley 10). This problematic idea that autism is a devastating condition is another thing that keeps women from seeking a diagnosis. In reality, autism is simply, to reference the views of Professor Tony Attwood, a “rewiring of the brain, similar to AM and FM radio” (DaVanport 1). The process of diagnosis does not end in receiving a “remedy” or “cure” for autism, but rather an explanation for troubling and difficult thoughts and behavior, as well as an indicator that the patient should receive therapy in order to learn ways to cope with or work with their autism and participate meaningfully in the social world. For many women, receiving a diagnosis is a huge relief, and “a chance for introspection and acknowledgement of [their] own identities. It’s like learning a new part of [themselves]” (DaVanport 16).

In conclusion, it is clear that there is an easily solvable gender bias in the diagnosis of autism. Women across the world await the reform of autism diagnosis, which would lead to an increase of their understanding of themselves, and an improvement in their daily lives. Doctors across the world are looking for the next breakthrough in medicine to bring them fame and fortune, as well as a positive public opinion of the scientific world that can help them advance humanity. An autism diagnosis reform would be mutually beneficial to both of these parties. The gender bias in autism diagnosis can be solved by teaching doctors to acknowledge and recognize female symptoms, even starting in their high school Psychology course, and thus allow autistic women to receive the help and counseling they need. Doctors like Tony Attwood have already started this journey, and continue to spread positive, The cooperation between doctors and the non-medical world can bring about a revolution, and with more helpful information about women autism being spread, these forgotten girls can be brought into the light of day.

References

Cowley, Geoffrey. “Girls, Boys and Autism: Is this mysterious and sometimes devastating condition just an extreme version of normal male intelligence? That’s one provocative new theory. Behind autism’s gender gap.” Newsweek 8 Sept. 2003: 42. Opposing Viewpoints in Context. Web. 24 Mar. 2016.

DaVanport, Sharon. “Interview W/ Tony Attwood.” Interview. Audio blog post.Transcribery. WordPress.com, 11 Nov. 2010. Web. 25 Apr. 2016.

“Girls and boys with autism differ in behavior, brain structure.” Mental Health Weekly Digest 21 Sept. 2015: 75. Opposing Viewpoints in Context. Web. 24 Mar. 2016.

Mayo Clinic Staff. “Autism Spectrum Disorder.” Mayo Clinic. N.p., 3 June 2014. Web. 25 Apr. 2016.

“Researchers at University of California Have Reported New Data on Autism and Developmental Disorders (Does Gender Moderate Core Deficits in ASD? An Investigation in Restricted and Repetitive Behaviors in Girls and Boys with ASD).” Mental Health Weekly Digest 16 Nov. 2015: 184.Opposing Viewpoints in Context. Web. 24 Mar. 2016.

“Research from University of Gothenburg Provides New Data on Autism.” Mental Health Weekly Digest 18 Apr. 2011: 60. Opposing Viewpoints in Context. Web. 24 Mar. 2016.

Shaw, Susan M., and Janet Lee. Women’s Voices, Feminist Visions: Classic and Contemporary Readings. New York: McGraw-Hill, 2012. Print.