Final Week 3 Flashcards
Male Dominant ASD History
Kanner: 8/11 male
Asperger: 4/4 little professors were male
Lai: this historic description has led to an underrepresentation of females in research, leading to a male-biased understanding of ASD
Gender Ratio in ASD
DSM-5: ASD is diagnosed 4x more in males, women are more likely to show accompanying intellectual disability (girls without ID/LD may go unrecognized)
Hiller:
•”Absence of intellectual impairment, ASD is diagnosed less and later in females”
•Ratio:4-1 and 9-1 with the absence of intellectual impatient
Centre of Disease Control:
•Ratio for low IQ individuals with ASD: 2-1
Measurement Bias
•ADOS and ADI did not factor in gender differences when norming instruments
Women are:
•More likely to be diagnosed with ADHD, eating disorders, language delay, and anxiety
•When diagnosed with ASD, require: more severe ASD symptoms, more severe behavioural/cognitive impairment, and are often underreported by teachers
Differences from Neurotypical Women
Jamison & Schüttler:
•Lower self-esteem, and more internalizing (depression/anxiety)/externalizing (tantrums/crying) behaviours
Katelaars: found women with ASD showed
•Emotional recognition delay
•Were able to accurately identify levels of emotional arousal but were significantly poorer at labelling the emotion
ASD and Eating Disorders
Prevalence Rates (DSM-5):
•Anorexia: 0.4%
•Bulimia: 1-1.5%
•Binge-Eating Disorder: 1.6% (F), 0.8% (M)
•Gender Ratio for first 2: 10-1
Karjalainen:
•Found prevalence rates of 7.9% with gender ratio being 2.5-1
Female ASD Differences
- Greater interest in socialization
- Fewer stereotypical and repetitive behaviours
- Restricted interests more in line with gender norms
- Higher levels of comorbid internalizing psychopathology and less externalizing
- Age of diagnosis: later for females
- Age when parents report concern: no difference
Female Autism Phenotype
Bargeila: implies a female-specific presentation of symptoms
Frazier: large sample (vast majority male)
Females were seen to have significantly more:
•Social communication impairment
•Greater externalizing problems
•Higher levels of irritability and lethargy (lack of energy)
•Lower levels of restricted interests
•Lower cognitive ability
•Weaker adaptive skills
Sex Differences in ASD (Rubenstien)
Clear differences: •Women had lower ID •Epilepsy more common in females •Restricted and repetitive behaviours more common in males •Attention to detail more common in males Unclear: •More mood/anxiety noted in females •ADHD: no sex differences
Gender and Language
Howe: relatively large study dominated by men
•No speech: no sex differences in IQ or adaptive skills
•Limited speech: significantly lower IQ and adaptive skills in females
•Good speech: similar/better IQ and adaptive skills in females
Theories for Gender Ratio
Female bi-modal distribution, male-centered, social (female) camouflage effect, female protective effect
Female Bi-Modal Distribution
May be that the lower group is more “classically” ASD (similar to males) and the higher group is “atypical” and presents differently to males
Male-Centred
Definitions and measurements of ASD are male-centric
•Mandy et al: most clinic-based studies (5-1 ratio) exclude many women with ASD
Social Camouflage Effect
Fitting into society by:
•Hiding socially unacceptable
•Performing more neurotypical social behaviour
Lai: examples of social camouflage include
•Learned eye contact and social cues
•Pre-prepared jokes/learning to follow social scripts
•Mimicking others/imitating expressions
Female Camouflage Effect
ASD women with higher IQs and language skills often have:
•Better observational learning (mirroring)
•Better eye contact
•Better emotional recognition
•Stronger internal scripting (social rules) in relationships
•Better at hiding their symptoms
Measuring the Camouflage Effect
Lai:
•External behaviour presentation in social context (measured by ADOS)
•Internal status (dispositional traits measured by the Autism Spectrum Quotient and social cognitive capability measured by the Reading the Mind in the Eyes Test)
Female Protective Effect
Glockley: looks at the gender discrepancy in diagnostic rates
•If it isn’t heritable (not sex-linked transmutation) ratio should be more even
•Bimodal distribution found in female ASD samples only
Costs with Later/Missed Diagnosis
- Late introduction of services/misses early intervention
- Disproportionate amount of ASD specialists work with children
- Often mis-labelled
Future Implications
- Need to adjust measurement tools (Ex: less typical male restricted interests)
- Adaptive and cognitive profiles likely differ (needs to be built into assessment and treatment follow up)
- Need normative data for ASD females
Sexual Stereotypes and ASD
Based on outdated information:
•No empathy, not emotional, don’t like people
•Often reported by parents or clinician
•Samples often drawn from lower intellectual abilities/lumped in with other developmental disabilities
ASD and Sexual Interest
Assumption: ASD has lower sex drive
Fernandes: interviewed 150 ASD adults:
•93% of cognitively able sample expressed sexual interest
•68% of lower cognitive group expressed sexual interest
Sexuality in High-Functioning Autism: Systematic Review and Meta-Analysis (Pecora)
Interest in sexuality and dyadic relationships occur at comparable levels to neurotypical population
•Due to socio-communication deficits, social and emotional insight isn’t apparent
*Results in: problems of expression and initiation of sexuality
Types of Inappropriate Behaviours
Beddows and Brooks: •Public masturbation •Arousal to non-traditional objects •Exhibitionism (whipping dick out) •Offences (sexual abuse, non consensual hugging)
Evaluating Inappropriate Behaviours
Possible Reasons:
•Puberty, sensory issues, boundaries, curiosity, exposure to porn, poor sex education, previous sexual abuse
Potential Areas to Educate:
•ToM, social rules, formal sex education, parent education, differentiating intimacy
ASD and Sexual Orientation
Lower Cognitive Group: •Opposite sex: 60% •Same sex: 29% •Both: 0% •Unknown: 11% Higher Cognitive Group: •Opposite sex: 89% •Same sex: 5% •Both: 5% •Unknown: 0%
Gender Variance/Gender Dysphoria
DSM-5: people who experience a confusion between expressed gender and assigned gender Prevalence rates in general population: •.005-.014 (m),.002-.003 (f) Schalkwyk: •First ASD case of GD reported in 2005 Prevalence rates in ASD population: •Strang: 7.59x more likely to report •May: prevalence 4%
Theories on GD and ASD Prevalence
Biological Factors:
•Genetics, intrauterine hormone exposure, environmental toxin exposure
Social Factors:
•Differential treatment of genders, relationships with parents/peers, identification with non-normative groups
GD, ASD, and ToM
- Gender identity development begins at 3
- Paterski: ASD may have disturbed sense of self that impacts gender identity
- Less need for congruity with social definitions of gender
Similarities to Neurotypicals in Sexual Interests
•Same need for closeness and sexual relationships
Sexuality in Adolescent Boys with ASD (Dewinter):
•High functioning boys reveal no differences in lifetime sexual experience
Differences to Neurotypicals
Kellaher:
•Sexual interest, experience, and knowledge
•Use of porn
•Masturbation
•More inappropriate sexual behaviours
*Koegel: poor boundaries, understanding privacy, and public displays
ToM and Sexuality
- Awareness of partners needs
- Identifying the right timing/reading partner
- Hellemans: 33% of ASD males did not care whether the person enjoyed their touching
Victimization
Koegel: ASD are the perfect victims
•Limited communication skills/poor self advocating
•Hard to separate regular and reactive behaviour
•Anxiety/depression may be seen as part of regular ASD reactions
•Sexual experience may be interpreted differently
•Poor ToM may make it hard for individual to read intention
•Placed in care of multiple providers
Victimization Rates
Mandell: sexual abuse rates (reported by parents) is 12%
•General population: male (6-10%), female (16-23%)
•ID: 14%
Dating Challenges in ASD
Requires: •Proximity •Proper contexts (work, school) •ToM •Understanding social rules of dating •Ability to infer meaning of behaviour ASD and Marriage: not studied
Sexual Offending and ASD
Large number of case studies find:
•Failure to appreciate harm of the victim
•Interpersonal naivete (telling others about act)
•Sexual preoccupation
Population:
•Sutton: sample of 37 young males in jail for sex offending found 60% met ASD criteria
Stalking
Lindsay: ASD had higher percentage of stalking (8.5 vs 2.8)
•Obsessional in nature
•Poor ability to regulate behaviours
•Difficulty understanding impact on victim
