Are Females Inherently Protected from Developing ASD?

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The article linked below details a study of twins that suggest that females are inherently protected from developing ASD. Details are provided below beyond what is presented in the article, but they are very long and very detailed so one might want to restrict their viewpoint to the first linked article instead of wading through the comments of further analysis.

http://www.boston.com/news/science/blog ... /blog.html

It is interesting that a type of accelerated brain growth is studied as almost exclusive to males with regressive autism. Females that are much rarer in this subgroup were not reported with this anomaly nor others in other autism subgroups studied.

http://www.ucdmc.ucdavis.edu/publish/news/newsroom/5983

While a study is currently in progress at this point in time with the same research group linked below, specific to those with autism spectrum disorders, the linked research suggests that language development delays in the general population are associated with high levels of prenatal testosterone among males but high levels of prenatal testosterone among females provides a protective effect for language development.

http://onlinelibrary.wiley.com/doi/10.1 ... F47.d04t04

At least in these two studies it appears that females may have advantages associated with language development that males may not share at the same degree that females share.

These factors do not appear to be studied in the article referenced in the topic research, but they seem to be potential inherent factors beyond the ability to socially adapt to the social cultural environment specific to females. The inherent factors linked above cannot yet be discounted, overall, as factors that may also provide advantages in social adaptation, that males do not overall share, to the same degree.

Anorexia seems strongly associated with females with autism spectrum disorders, specifically Asperger’s syndrome. Androgyny has also recently been associated with high functioning autism. Non-verbal learning disorder symptoms are met in the majority of individuals diagnosed with Asperger’s syndrome. Hyperlexia, pragmatic language impairments, ADHD, Sensory Processing Disorder, and auditory processing disorder are associated as well. Some of these conditions alone parallel some or most of the observed behavioral impairments currently associated with ASD’s.

Other associated genetic and health conditions are fragile X syndrome occurring more often in males, 22q11 deletion syndrome, Noonan’s syndrome, regressive autism with abnormal brain growth specific to males as indicated in the linked study above, immune system problems, mitochondrial dysfunction, GI problems, and other conditions that may underlie some of the observed behavioral impairments defined as ASD, as contributing factors.

Per the Boston topic study the higher percentile ASD traits associated in males with female siblings on the spectrum, were more likely associated with language development delays, that at least the two studies linked above suggest females may be protected from to some degree potentially because of biological determinants.

The DSM5 criteria has now narrowed down what use to be potentially 2027 combinations of criterion elements to meet just the criteria for autistic disorder down to 11 combinations, for one Autistic Spectrum Disorder where the mandatory 3 elements in the social communication criterion are described broadly per impairments in developing and maintaining peer appropriate relationships, social-emotional reciprocity, and non-verbal impairments.

Sue Swedo, chair of the DSM5 working committee, in a video from the APA linked below, clarifies that RRBI’s may be met by history alone, per DSM5 criteria, but the three mandatory criterion elements in social communication are life long severe impairments, limiting and impairing functioning in everyday life.

Swedo describes ASD as a disorder of social reciprocity. Interestingly it appears that the ICD11 beta revision to date is removing the requirements of RRBI’s and renaming Asperger’s disorder as social reciprocity disorder, and describes Autism as a disorder of “reciprocal socio-communicative interaction, together with restricted interests and repetitive behaviours”.

http://www.psychiatry.org/practice/dsm/ ... cu6bw.dpuf

http://apps.who.int/classifications/icd ... cd%23F84.0

There are a large number of contributing factors specific to identified learning disorders, genetic conditions, and health conditions including an eating disorder, that appear to underlie and/or are contributing factors associated with ASD’s.

However, the criteria changes in both the DSM5 and ICD11, may no longer capture all of these contributing factors to what will be defined and observed as Autism Spectrum Disorder in the DSM5 and the named conditions in the ICD11.

The social-cultural adaptations that females are under more pressure to adapt to than males, are a key issue in why females may be missed in a diagnosis, however the androgyny and anorexia association may also contribute as factors to behavioral impairments associated with ASD, because of social-cultural pressures to adapt to gender roles that androgynous individuals may not be comfortable with.

http://www.ncbi.nlm.nih.gov/pubmed/12434643

In the case of males, it may be to repress social-emotional reciprocity and in the case of females, the pressure may be the opposite to increase social-emotional reciprocity, because of social-cultural expectations.

In either case, RRBI’s may or may not result as an adaptation to social abuse and/or isolation when perceived social adaptation requirements cannot be met. In this scenario, the result to date could be increased diagnoses of ASD for males over females in puberty.

These types of social stresses are identified as one of the most difficult of social stresses that often leads to social abuse and social isolation. I think the association of androgyny is a factor in this issue that has barely surfaced in research, and just one of many contributing factors that may or may not lead to an actual diagnosis of ASD differing in prevalence among males and females specific to the prevalence of those contributing factors among males and females.

The DSMIV criteria for PDDNOS and Asperger’s syndrome requirements for diagnosis were broad enough where an individual could still be diagnosed with social-cultural adaptations in social communication in two out of four of the optional social interaction criterion elements.

While it is possible for RRBI’s to be met by history alone per DSM5 criteria, as identified by Sue Swedo, all three of the Social Communication mandatory criterion elements must be currently observed for a DSM5 diagnosis for ASD. The result of this, by technical standards, means that it is likely that even fewer females, who have developed social-communication adaptations, will be diagnosed on the spectrum in the future.

Social cultural adaptations for females and differences in presentation of ASD are being researched and studied almost entirely in countries outside of the US, in research by Gould from the Lorna Wing Research organization in the UK, Simon Baron Cohen in the UK, and clinical observation by Tony Atwood in Australia.

These issues are highlighted by the National Autistic Society in the UK, but seem to be greater dismissed and/or overlooked in the US. The final details of the approach by the ICD11, specific to the issue of social-cultural adaptation remain to be seen. But, there are many more questions to be asked and pursued for answers, specific to why more males are diagnosed with ASD than females.

I don't buy it.

Females are more "protected" from being recognised as having an ASC more like.

They have yet to date, to identify the conclusive cause(s) of autism. It could be that males are affected by the accelerated brain growth, but females are affected by other factors.

There is also the issue of autism presenting slightly differently in females. That doesn't necessarily mean less severely.

Also, they are talking about language delays. These are only applicable to autism and not Asperger's.

The topic article recognized that females are diagnosed with ASD at a male to female ratio of 4 to 1, and didn't really provide any reasons other than male siblings affected more severely with female siblings diagnosed on the spectrum. The association specific to language development delays or regression in males, appears to be the only current recognized potential inherent factor that females may be protected from, per the two studies on that specific issue of language delay and regression, other than fragile X syndrome. That constitutes about 30 percent of the currently identified spectrum including individuals with fragile X syndrome, which might be more adequately studied if demographics of males and females were provided specific to language development delays and language regression, and if the male to female ratio was actually found to be higher than other subgroups on the spectrum.

The study in England that provided evidence that 1 percent of the adult population in a general population scan could be potentially diagnosed with an ASD, provided a male to female ratio of 9 to 1 which offers potentially even more evidence of social-cultural adaptation through adulthood for females considering the CDC statistics that are close to a 5 to 1 male to female ratio are based strictly on a demographic of 8 year old children, with a similar ratio, demographic, and statistic for official government statistics on children in England.

Given that information while it may be that females may be protected for language development delay and/or language regression to a greater degree than males, they may be much more protected from diagnosis by social-cultural adaptation masking the observed social-communication behavioral impairment requirements for diagnosis, that become more restrictive and mandatory per the 3 required social communication requirements in the DSM5 criteria for ASD.

The CDC statistics for females in Alabama is 1 in 909, close to a 9 to 1 male to female ratio in that state. While socio-economic factors per awareness and access to diagnosis are cited factors, there is also a strong patriarchal element in that state beyond most other areas in the country that conform to very restrictive gender roles that has not been considered because social cultural-adaptation in general in the US, is not a factor that the CDC has addressed at all.

But at age 8, one would not expect this factor of social-cultural adaptation to be nearly as strong as it could moving into young adulthood and beyond. And it has been noted that a substantial number of females are not diagnosed until puberty, who are completely missed in CDC statistics, which could be related to hormonal and/or social cultural factors.

Per the two paragraphs I provided in the first post of just some of the genetic conditions, health conditions and learning disorders that parallel and/or underlie as contributed factors for currently required observed behavioral impairments for diagnosis, a substantial number of those contributing factors may no longer be captured by the new more restrictive DSM5 criterion elements in social-communication for ASD So, instead of finding new causal/contributing factors there may actually be a loss of causal/contributing factors for the new more restrictive mandatory required observed behavioral impairments for an ASD diagnosis.

So, in effect what is newly defined as autism spectrum disorder may also be captured as an inherently different disorder, overall, from the previous more loosely required criterion elements, at minimum requirements for a diagnosis that would likely be more inclusive of all the genetic, learning, and health related disorders as contributing or underlying factors of the required observed behavioral impairments for diagnosis.

That's all pretty heavy reading, a little too much to take in, therefore hard to work out whether you are in opposition or agreement or neutral to what I said. All I can do is refer you to information about females:

http://www.autism.org.uk/about-autism/a ... ctrum.aspx

http://www.guardian.co.uk/society/2012/ ... s-children

What do you mean by 'protected'?

My guess is the higher rate of autism in boys is partly due to misdiagnosis of girls, and partly due to X-linked autism-related genes.

Maybe.

It is highly unlikely that low-functioning autism goes unrecognized in females. There, the sex ratio is 2.5-1. The HFA/Asperger's ratio is 5-1, so maybe it goes unrecognized there. Maybe half of HFA/Asperger's girls are not recognized.

However, under any understanding, males are more vulnerable to developing it to begin with (as is the case for many neurological disorders).

Gee, I guess we can't help being naturally superior

No, you're not superior...because you are one of the ones who did develop it.

Touché.

...although, I meant as a gender overall anyway.

That's like a felon being proud to be a citizen of her country.

Sure, your country may rock, but what part did you play in making it that way?



Not that I'm calling you a felon. Don't take it literally. Just messing with you because it's super fun!

Thanks for providing the links. Those are the sources I was referring to in my original post, per research being done in the UK on this issue, that is not being done in the US.

These issues are not being addressed in the US and should. That is part of my point, and also I I am also addressing what if any actual inherent factors protect females from being diagnosed with an ASD. So far specifically I only see a greater potential degree of potential for protection of language development, in the actual research that exists, as well as the well known fact that males are more likely to have fragile X syndrome, as a predominantly male genetic syndrome.

In the online world, overall, there is likely equal to greater participation among females than males in social networking, per limited statistics that exist here and on other sites, but this is also the case in general for females, as statistics prove this out on sites like facebook, and twitter, as opposed to sites like Reddit that are more information sharing based, and less social bonding based.

However. since these voices are as strong as they are, there can be the assumption that there are more females in online autism communities on the spectrum because in reality they likely are in many areas of facebook and autism oriented sites and blogs, but the males that may be less inclined to social network, in general, whether they are on the spectrum are not, may be participating in other avenues of internet activity, other than social networking.

There is also the potential because of this online exposure that more females are coming to realize that this is not a male specific condition. and are advocating for themselves. The environment in the UK for this type of awareness and acceptance is much different overall, because this is where the real experts on the condition of Asperger's syndrome originated and continue to provide insight that goes much further than just a diagnostic manual, per the diversity of the condition among males and females.

Hans Asperger, Lorna Wing, Uta Frith, Christopher Gillberg, Simon Baron Cohen, and Tony Atwood, are the core of what now exists of an online autism community beyond that of parents of children diagnosed with autism. The whole self-advocacy movement and online communities for people on the spectrum would have likely never been the size and force it is today, without the efforts of those individuals in the UK and the creation of the diagnosis of Asperger's syndrome.

Gillberg captured numbers in Europe of people diagnosed with Asperger's using his criteria substantially higher than those diagnosed with autism disorder. It is almost opposite from what is seen in statistics gathered in the US, as the CDC only captures 9% of their demographic of Asperger's syndrome, 44% of autistic Disorder, and 47% for PDDNOS. The CDC captures 2% of females diagosed with Asperger's syndrome relative to what they measure as the full spectrum. But as stated before females on the spectrum, many of whom report Asperger's as a diagnosis, consist of at least 50% of social networks in online communities overall, per limited statistics that exist.

The Gillberg criteria is set up not only to capture more individuals with Asperger's syndrome specific to what Hans Asperger described as "Autistic Pychopathy", but also potentially captures more females because the communication impairments listed in that criteria are not specific just to language development delays and more severe impairments of language alone in the communication area as pragmatic type language impairments are also listed.

Tony Atwood has to live with the DSMIV criteria in Australia but Gillberg, Cohen, Wing and Frith, are all his colleagues where there is an emphasis on the original definition of "Autistic Psychopathy" as described by Hans Asperger. And not surprisingly, Atwood identifies that in his clinical practice that the male to female ratio for Asperger's syndrome may be 2 to 1. He did not agree with the DSM5 guidelines removing Asperger's specific to this concern with females going undiagnosed or misdiagnosed as well as males. All these people in the UK are working together to identify the different presentations in females opposed to males on the spectrum.

Interestingly, there are underlying currents of opinions in some areas of the Autism Community that are vehemently against all of these professionals except for Hans Asperger, who these experts I identified in the UK, Australia, and Sweden, effectively are among the few experts in the world that actually represent the voice of Hans Asperger.

I monologue, and try to take an unemotional outlook on differences in opinion. I like to discuss the merits of what I see of ideas that are presented.

That is part of what I mean by protected, as well as the other factors I identified as potential protective factors including factors associated with language development. The topic article provided a generalized protective element but did not take any effort to speculate on what the specific factors might be, per the twin studies that were done. There was a general statement that it was associated with genetics, but I think that hormonal factors may also be associated. Specifically, prenatal testosterone exposure, per the research that currently exists, that I linked.

Tyri0n, do you have a source for the 2.5 to 1 male to female ratio among "low functioing autism". I cannot find that statistic. Females with what is considered the more severe types of autism, are suggested as more severely impacted than males overall, but I can't find an overall ratio of prevalence equal to what you are suggesting here.

Go rewatch that video of Christopher Gillberg talking about autism that you linked a few weeks ago. Find the point where he says that the 4:1 ratio (or the 9:1 or any of the others) are almost certainly wrong, and that it is closer to 1.5:1.

Also, there are studies about how hard it is for girls and women with autism to be diagnosed with autism, but instead get diagnosed with other things. Gillberg also discusses this.

It should also be said that many online communities tend to be host to a lot of hostile commentary about women and often directed at women who participate in those communities, and that perhaps reflects the distribution of women online as compared to men. Reddit has a lot of social stuff going on, well beyond information sharing. But it also features a lot of misogyny and a tendency for the predominantly white male membership to close ranks and defend that misogyny under pretexts of "freedom of speech."

And some of that information that gets traded around are pictures taken of underage girls. So, yeah. Reddit's a terrible example of what prompts women to engage on line because it is a terrible community that tends to allow a lot of terrible behavior online. The mostly white and male membership is self-selected by the sheer amount of sexism and racism... and pedophilia.

http://www.huffingtonpost.com/2013/02/1 ... 61932.html

http://jezebel.com/5842172/reddits-pedo ... f-jailbait