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wastubricine
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08 Jan 2021, 4:33 am

starkid wrote:
Honestly, this female autism thing has become nonsensical.
Fireblossom wrote:
wastubricine wrote:
Could a more accurate female oriented test/detection/diagnostic method be developed, what do you think?


Definitely possible, but it should also be kept in mind that some autistic women fit the same stereotypes as autistic men, and the possibility that some men's autism shows itself in a more "feminine" way mustn't be ignored, either.

No one should be evaluated for autism on the basis of stereotypes, so who fits which autism stereotypes is not relevant to diagnosis.

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I suppose there could be two criteria, one that's like an average autistic man and another that's like an average autistic woman, and then those two could be used as options when diagnosing people. If someone ticks enough boxes from either criteria, they'd be on the spectrum, regardless of their gender.
There's no such thing as an "average autistic" person at all because there are too many different possible combinations of traits that qualify for diagnosis.

Everyone has to fit the same diagnostic criteria to be diagnosed for autism, so there's nothing to be split into man and woman versions of diagnostic criteria. You'd just have two versions of the same criteria, possibly differing only by irrelevant gender stereotypes. There's no such thing as man autism and woman autism. If there's a group of people whose presentation differs so much from what's specified by autism criteria, either

A. they don't have autism, or
B. autism diagnostic criteria should be changed, and the new criteria should apply to everyone


Is it just me or there's some serious "Political Correctness fallacy" going on, pulling in some "No True Scotsman" as well?



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08 Jan 2021, 4:49 am

Or maybe just "black and white thinking"?



wastubricine
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08 Jan 2021, 5:51 am

True, that too.



starkid
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08 Jan 2021, 5:58 am

WP won't let me post this altogether, so I have to split it up into two posts:


MrsPeel wrote:
starkid wrote:
I've never heard of anyone blaming chromosomes for differences between men's and women's rates of diagnoses.


It's been hypothesised that females are somewhat protected from developing autism because we have XX chromosomes whereas males have XY. Possibly damage on the Y chromosome would be more likely to affect males.

You seem to be talking about females possibly having a lower incidence of autism than males. I was talking about autistic females being diagnosed less often than autistic males because I thought that was the OP's point.


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08 Jan 2021, 6:05 am

Some Aspies claim that their diagnosis is simply a formality and has no bearing on their lives. Others are quite aware of their status, regardless of a diagnosis or lack thereof.

I wonder if there is any difference in the ratio between how badly males vs. females are "affected" by (or at least cognizant of) being an Aspie.



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08 Jan 2021, 6:22 am

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I do believe that autism tends to present differently between men and women.

I've no interest in mere beliefs about scientific matters. What evidence do you have, if any, and does this difference in presentation apply to the whole spectrum? Does it apply to core autism traits like repetitive/restricted behaviors, the stuff that actually makes up the diagnostic criteria, or is it just trivial differences? If male autism differs from female autism, how do you know that both are autism?

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On the current data, nobody has a conclusion on whether it is truly more prevalent in males or whether girls have just been going undiagnosed and thus skewing the figures.

You could say that about any hypothesis about autism, but it doesn't make the hypothesis a genuine issue. It's also true that nobody has a conclusion about whether a significant number of undiagnosed autistic females actually exists.
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I see no reason not to have separate diagnostic criteria for males and females if it truly presents differently

Well, I see a reason not to have it: if two conditions differ so greatly that they require different sets of diagnostic criteria, they aren't the same condition. This idea of splitting autism in two is unscientific. There is zero evidence to support the concept of two sex-specific autisms.

And how would such criteria be applied? If male criteria is applied only to males and female criteria applied only to females, people who don't fit criteria for their sex won't get diagnosed. If anybody can get diagnosed according to either criteria, then there's no reason to have criteria separated by sex. What would happen for intersexed clients? How would anyone even develop such criteria? Having sex-specific sets of criteria is impractical and senseless.

Quote:
- or at least broadening the criteria to include both.

Autism diagnostic criteria already includes both sexes. That's why people of both sexes get diagnosed with autism. If the criteria excluded one sex, nobody of that sex would get diagnosed with autism.

And that's what makes this conversation ridiculous—you're implying that diagnostic criteria exclude females, but females are getting diagnosed with autism all the time, which blatantly and conclusively proves you wrong.


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08 Jan 2021, 7:31 am

Where I'm coming from is that autism is diagnosed by behavioural criteria, rather than the neurological differences underpinning those behaviours.

See my analogy to heart failure - two people can be suffering heart failure yet be having different symptoms and displaying different external behaviours. There may be some uncertainty over whether it is truly heart failure until blood tests and ECGs are undertaken.
For autism there is no blood test or other physical test, diagnosis is by behavioural observations only - which vary greatly, which means that there will always be a degree of uncertainty over whether or not the diagnosis is truly appropriate.

It's also notable that the early diagnostic criteria were developed based on studies of boys, and there have been studies since then indicating differences in the behaviour of autistic girls - for instance studies of playground behaviour indicate typically more attempts to join in with group play. I will try and find that for you.

So, in summary, I have a less rigid view than yourself over whether someone can be said to have or not to have autism. Until we develop physical diagnostics, it's not that black and white.



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08 Jan 2021, 7:39 am

starkid wrote:
MrsPeel wrote:
starkid wrote:
I've never heard of anyone blaming chromosomes for differences between men's and women's rates of diagnoses.


It's been hypothesised that females are somewhat protected from developing autism because we have XX chromosomes whereas males have XY. Possibly damage on the Y chromosome would be more likely to affect males.

You seem to be talking about females possibly having a lower incidence of autism than males. I was talking about autistic females being diagnosed less often than autistic males because I thought that was the OP's point.


?? I believe the OP was asking the question whether the ratio of male to female diagnosis was related to diagnostic inadequacies in picking up females or whether it might be a genuine difference in prevalence between the sexes (for instance due to chromosomes)? This is the original post:

Quote:
Has anyone actually bothered to check the ratio of level three autistics where it is not really in doubt? I hear a lot of people say women don't get diagnosed because of how the dsm is aimed at men and that women mask more frequently. I was just wondering if people have actually checked and it is not actually chromosome related. :shrug:


And what I was trying to say was that, from my readings, I believe the jury is still out on which is correct.



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08 Jan 2021, 7:44 am

starkid wrote:
Quote:
And that's what makes this conversation ridiculous—you're implying that diagnostic criteria exclude females, but females are getting diagnosed with autism all the time, which blatantly and conclusively proves you wrong.


This thread is about the male to female ratio in diagnosis.
That is usually quoted as somewhere between 5:1 and 2:1 males to females.
It is not ridiculous to discuss the reasons for the discrepancy between male and female diagnosis rates (and the variability thereof).
Nobody's saying that girls never get diagnosed.



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08 Jan 2021, 7:54 am

There are some females who present, within their autism, precisely like males. I’ve met quite a few females who are obviously autistic.

There are some females who, through social conditioning, and the relative “mildness” of their symptoms, present more subtly. They might be “missed” during their school years.

Based on the composition of WP, females seem to be under-represented as far as the formal diagnosis figures are concerned. There’s certainly not a 2:1 or a 4:1 ratio on WP in “favor” of males.

There is no gender-based autism, in my opinion.



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08 Jan 2021, 8:20 am

I think the difference is due to a couple of gender-related issues. One is that Ma Nature considers men expendable, so it is a worthwhile tradeoffs to get several semi-functional types, like the one that called me a liar yesterday, for every true innovator. One smart toolmaker would give his whole tribe an advantage. The other is that women need dictatorial powers in the home to deal with immature children and to hide 10% infidelety, so they are less subject to criticism. My mother was obviously weird, but nobody would say so to her face, or her doctor.



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08 Jan 2021, 8:50 am

Yeah, I tend to agree that mother nature knows what it's doing.

Whatever female version of autism I got allowed me to mask and go undiagnosed just long enough to have kids.
Whereas my son has the unmistakable male presentation of the socially inept genius kind.
I suspect he's the potential innovator, and my genetic role was just to bring him into the world.

I read somewhere that traditional hunter gatherer societies need a population of about 50 people to be viable.
So autism prevalence would work out about right to give each band one autistic shaman (or maybe a witch).



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08 Jan 2021, 8:56 am

The diagnostic criterion don't seem terribly narrow to me, but the stereotypes people associate with autism can be and they're based on how autism affects boys. To be referred for an autism diagnosis someone has to suspect autism and this someone usually isn't an autism expert. Furthermore some supposed experts may not be up to date with the current knowledge. Children are also more likely to get evaluated if they externalize their symptoms than if they internalize them because people tend to notice it more if a child is trouble than if a child is suffering silently. Symptoms or maladaptive coping skills of some of the more emotionally expressive autistic people can be mistaken for symptoms of other disorders, some of which people stereotypically associate with women. And if someone masks well it may be harder for a diagnostician to recognize their symptoms, especially if that person is an adult and has had enough time to learn. Some autistic people are more likely to slip through the cracks than others and many of them may be female.

It's hard to tell how many autistic children currently go undiagnosed, but it seems to be more common for autistic women to have been diagnosed as adults (and very common for everyone above a certain age to have been diagnosed as adults or not at all if they have and always had level 1 autism).



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08 Jan 2021, 9:26 am

I’ve known female “socially awkward geniuses,” too, unabashedly so. Classic Aspergians.

I am socially awkward, sans the genius element. I was Kanner-type till age 5.



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08 Jan 2021, 2:10 pm

I believe there is a "female" presentation amongst some people with autism, with the autism offset somewhat (as far as immediate impressions are concerned) by a certain shyness, a certain introversion, and a certain grounding in social conventions and expectations--which males might have as well, but in smaller percentages.

I also believe there are many females with autism who present just like males with autism.



strings
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08 Jan 2021, 2:21 pm

kraftiekortie wrote:
There are some females who, through social conditioning, and the relative “mildness” of their symptoms, present more subtly. They might be “missed” during their school years.


One thing that has puzzled me about this kind of statement, and I know that such statements are often made, is that it seems to be unclear what the interpretation should be.

One interpretation would be that autism can present itself in a milder form in females, and therefore the cut-off criteria for classifying a person's condition as autism should be correspondingly lowered in the case of females, to take this into account.

A different interpretation would be that it is simply the case that fewer females than males will meet the criteria for an autism diagnosis.

If I am understanding your statement correctly, you are saying that a given set of relatively mild symptoms might cross the threshold for justifying an autism diagnosis for a female, but that those same symptoms might fail to meet the threshold for justifying an autism diagnosis for a male?

It almost seems that by introducing different threshold levels for females as opposed to males, the goal is to try to bring about a parity in the numbers of diagnoses for females and males.

The alternative approach would be to say that the diagnostic criteria should be absolutely identical for females and for males. And this would, presumably, have the consequence that more males than females will meet those criteria.

If I've understood some of the earlier posts correctly, some people seem to be arguing more for the first interpretation, and some for the second interpretation. It would be interesting to read up on studies about this.