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Why Does Autism Occur More In Males

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What Is The Difference Between Autism And Autism Spectrum Disorder

Simon Baron-Cohen, “Why is Autism More Common in Males

The term autism was changed to autism spectrum disorder in 2013 by the American Psychiatric Association. ASD is now an umbrella term that covers the following conditions:

  • Autistic disorder.
  • Pervasive developmental disorder not otherwise specified .
  • Asperger syndrome.

People with ASD have trouble with social interactions and with interpreting and using non-verbal and verbal communication in social contexts. Individuals with ASD may also have the following difficulties:

  • Inflexible interests.
  • Insistence on sameness in environment or routine.
  • Repetitive motor and sensory behaviors, like flapping arms or rocking.
  • Increased or decreased reactions to sensory stimuli.

How well someone with ASD can function in day-to-day life depends on the severity of their symptoms. Given that autism varies widely in severity and everyday impairment, the symptoms of some people arent always easily recognized.

Can Diet Have An Impact On Autism

Theres no specific diet designed for autistic people. Nevertheless, some autism advocates are exploring dietary changes as a way to help minimize behavioral issues and increase overall quality of life.

A foundation of the autism diet is the avoidance of artificial additives. These include preservatives, colors, and sweeteners.

An autism diet may instead focus on whole foods, such as:

Some autism advocates also endorse a gluten-free diet. The protein gluten is found in wheat, barley, and other grains.

Those advocates believe that gluten creates inflammation and adverse bodily reactions in certain autistic people. However, scientific research is inconclusive on the relationship between autism, gluten, and another protein known as casein.

Why Autism Strikes Mostly Boys

Why does autism strike four times as many boys as girls? The answer may lie in specific biological shielding mechanisms that operate in girls, but not boys, even when both sexes have the same genetic defects associated with the disorder.

That conclusion leapt from the data in a study led by University of Minnesota researcher Nicola Grissom, Ph.D., an assistant professor of psychology. Published in Molecular Psychiatry, the study opens a door to understanding and one day better treating the disorder.

“Researchers have known about the ‘female protective effect’ in autism spectrum disorders for quite a while, but the reasons why girls might be protected while boys are vulnerable have remained mysterious,” Grissom said.

This effect means a boy has a 1-in-42 chance of being diagnosed, but a girl has only a 1-in-189 chance, according to the Centers for Disease Control. Those who do develop the disorder have difficulty in responding to rewards that would otherwise serve as cues that help shape social behavior.

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Social Communication And Interaction Symptoms

Children and adults with autism often have difficulty connecting with others.

This can result in a range of symptoms, such as:

  • inability to look at or listen to people
  • no response to their name
  • resistance to touching

believe that women and girls are more likely to camouflage or hide their symptoms. This is particularly common among females at the high-functioning end of the autism spectrum.

Common forms of camouflaging include:

  • forcing yourself to make eye contact during conversations
  • preparing jokes or phrases ahead of time to use in conversation
  • mimicking the social behavior of others
  • imitating expressions and gestures

While both males and females with autism can camouflage their symptoms, it appears to be more common in women and girls. This could explain why theyre less likely to be diagnosed with autism.

Its important to note that studies looking at differences between autism in women and men have been very small or flawed. Experts still dont have any definitive information about these differences, including whether theyre real or just a result of camouflaging.

Still, one of the done on the subject suggests that, compared to men, women with autism have:

  • more social difficulties and trouble interacting
  • less of an ability to adapt
  • less of a tendency to become hyper-focused on a subject or activity
  • more emotional problems
  • more cognitive and language problems
  • more problem behaviors, such as acting out and becoming aggressive

Difficulties Abound For People With Both Asd And Gender Dysphoria

Who is affected by Autism?

The biggest impact of this connection is to saddle people who have both conditions with two of the most socially challenging and culturally misunderstood traits that you can have in the world today.

This is particularly difficult for parents raising children who have both autism and gender dysphoria. The autism support community is large and welcoming and there are many patterns to follow for parents who are learning to raise a child with ASD. But when your kid also thinks they are half boy and half girl, there are not many signposts out there for how to navigate the world.

The fact that gender issues have become a political hot-button isnt making things any easier. As of September of 2017, at least fifteen states had introduced some sort of legislation regulating bathroom access for individuals who identify as a gender other than what they were assigned at birth. Most bills seek to prohibit people who have spent their lives living as a certain gender from using the restroom that aligns with their gender identity.

Its hard enough for neurotypical individuals with gender dysphoria to understand that kind of discrimination explaining it to a child with ASD may be impossible and incredibly hurtful.

Most of those bills have not passed, but public discourse over gender identity is heated. Some parents have good reason to fear their children will be subjected to ridicule and bullying as the issue becomes increasingly politicized.

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Increased Mutation Burden In Female Asd Patients

We collected DNMs from 5748 ASD trios and 1911 control trios from the ASC, SSC, MSSNG, and other published studies. Our analysis revealed that the probands carried significantly more loss-of-function and deleterious missense mutations than the matched controls, with no difference in tolerant missense mutations .

Fig. 1: Mutation load of functional classes of DNMs in the coding region.

a Mutation load per person in ASD versus control group. b Mutation load per person in male ASD subjects versus male controls. c Mutation load per person in female ASD subjects versus female controls. d Mutation load per person in male ASD subjects versus female ASD subjects. Mutation types are displayed by class. p-values were calculated by Fishers exact test. The p.adjust function in R was employed to calculate the corrected p-values for multiple comparisons, *adjusted p< 0.05, **adjusted p< 0.01, ***adjusted p< 0.001, N.S. not significant. The error bars represent 95% confidence intervals for the mean rates.

Getting To The Causes Of Autism

Getting to the cause — or, more accurately, causes — of autism will be more difficult than unraveling the causes of cancer, says Gary Goldstein, MD, president and CEO of Kennedy Krieger Institute in Baltimore, a facility that helps children with autism and other developmental disorders.

“This is harder than cancer because in cancer you can biopsy it you can see it on an X-ray,” Goldstein says. “We don’t have a blood test . There is no biomarker, no image, no pathology.”

“There won’t be one single explanation,” says Marvin Natowicz, MD, PhD, a medical geneticist and vice chairman of the Genomic Medicine Institute at the Cleveland Clinic.

“There’s been a lot of progress in the last few years in terms of understanding the causes of autism,” Natowicz says. “We know a lot more than we did.” Still, he says, research has a long way to go. “One number you see often is that about 10% of those with autism have a definitive diagnosis, a causative condition.” The other 90% of cases are still a puzzle to the experts.

Often, a child with autism will have a co-existing problem, such as a seizure disorder, depression, anxiety, or gastrointestinal or other health problems. At least 60 different disorders — genetic, metabolic, and neurologic — have been associated with autism, according to a report published in The New EnglandJournal of Medicine.

On one point most agree: A combination of genetics and environmental factors may play a role. Scientists are looking at both areas.

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Differences In Gender And Sexuality Identification

Sexuality is often discussed within the autistic community, with many observations that identities other than cishetero seem to be more common than is observed in the neurotypical population. There have not been many formal studies on this to date, however members of the community speculate that autistic individuals generally have different ideals, perceptions and desires than neurotypicals or simply do not comprehend or agree with society’s expectation, making them more apt to diverge from the norm.

A study looking at the co-occurrence of ASD in patients with gender dysphoria found 7.8% of patients to be on the autism spectrum. Another study consisting of online surveys that included those who identified as nonbinary and those identifying as transgender without diagnoses of gender dysphoria found the number to be as high as 24% of gender diverse people having autism, versus around 5% of the surveyed cisgender people. A possible hypothesis for the correlation may be that autistic people are less capable to conform to societal norms, which may explain the high number of autistic individuals who identify outside the stereotypical gender binary. As of yet, there have been no studies specifically addressing the occurrence of autism in intersex individuals.

Sex Differences In Genetic Contributions To Asd Risk

Why is autism more common in males – Simon Baron-Cohen

Biological theories for the sex difference in ASD prevalence most frequently take the form of a multiple-threshold multifactorial liability model , in which females have a higher threshold for reaching affection status than males . Thus, genetic studies operating under this model hypothesize that females with ASD are likely to be carrying a higher heritable mutational âloadâ than affected males. This model predicts that relatives of female probands should be at increased risk for ASD as compared with relatives of male probands, which is supported by a recent twin study . In contrast, other studies have failed to support the genetic loading hypothesis, including a study of 882 families and another recent study of high risk siblings of autistic probands that found that only the sex of the sibling was a significant predictor of their future ASD status . However, a new study of more than 9000 dizygotic twin pairs from population-based cohorts provides the most conclusive demonstration of female-protective factors to date, showing that siblings of autistic females exhibit significantly greater autistic impairments than siblings of autistic males . This finding also supports a role for heritable variation in ASD liability under the threshold model.

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Not Mutually Exclusive Theories

The X and Y chromosome theories and the fT model offer potential explanations for the biased sex ratio in ASC and warrant further research. While often conceived as competing theories, they need not be mutually exclusive. This is because we cannot rule out the possibility that genes on the X and Y chromosomes may be regulated by fT or have products that affect the production or sensitivity of an individual to fT. X chromosome genes may also regulate Y chromosome genes and vice versa. In addition, it is possible that X or Y chromosome genes and fT exposure are independent risk factors for ASC.

The theories do, however, make contrasting predictions for individuals with certain intersex conditions, in particular those with Complete Androgen Insensitivity Syndrome , where there is a complete deficiency of working androgen receptors, in the presence of a typical male genetic complement . Given the rarity of this condition, studies using measures of autistic traits may be more feasible than studies of diagnosed cases of ASC in CAIS per se.

  • 33.De Vries G, Simerley R. B Anatomy, development and function of sexually dimorphic neural circuits in the mammalian brain. In: Pfaff D. W, Arnold A. P, Etgen A. M, Fahrbach S. E, Moss R. L, et al., editors. Hormones, brain and behaviour: development of hormone-dependent neuronal systems. San Diego: Academic Press. pp. 137191.
  • 36.Hines M Brain gender. Oxford & New York: Oxford University Press.
  • Sex Hormonal Contributors To Asd Risk

    One major theory that invokes a broad role for testosterone in ASD etiology is the Extreme Male Brain theory, which proposes that ASD arises from hypermasculinization of the brain . A theory born from cognitive-behavioral observations, this masculinization is conceptualized along two cognitive dimensions: 1) empathizing, the drive to perceive othersâ feelings and thoughts and respond appropriately, and 2) systemizing, the drive to interact with and understand rule-based systems. Early work convincingly demonstrated that typical females score significantly higher on measures of empathizing and value placed on meaningful relationships with others , whereas typical males score significantly higher on measures of systemizing . In these studies, high-functioning ASD cases scored lower than typical males on measures of empathy and friendship, and higher than typical males on measures of systemizing.

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    What Is The Outlook For People With Autism Spectrum Disorder

    In many cases, the symptoms of ASD become less pronounced as a child gets older. Parents of children with ASD may need to be flexible and ready to adjust treatment as needed for their child.

    People with ASD may go on to live typical lives, but there is often need for continued services and support as they age. The needs depend on the severity of the symptoms. For most, it’s a lifelong condition that may require ongoing supports.

    A note from Cleveland Clinic

    Through research, there has been much that has been learned about autism spectrum disorder over the past 20 years. There is ongoing active research on the causes of ASD, early detection and diagnosis, prevention and treatments.

    Last reviewed by a Cleveland Clinic medical professional on 12/29/2020.

    References

    Associated Medical & Mental Health Conditions

    A Dozen Ways You Might Be Misunderstanding the Autistic ...
    • Autism can affect the whole body.
    • Attention Deficient Hyperactivity Disorder affects an estimated 30 to 61 percent of children with autism.
    • More than half of children with autism have one or more chronic sleep problems.
    • Anxiety disorders affect an estimated 11 to 40 percent of children and teens on the autism spectrum.
    • Depression affects an estimated 7% of children and 26% of adults with autism.
    • Children with autism are nearly eight times more likely to suffer from one or more chronic gastrointestinal disorders than are other children.
    • As many as one-third of people with autism have epilepsy .
    • Studies suggest that schizophrenia affects between 4 and 35 percent of adults with autism. By contrast, schizophrenia affects an estimated 1.1 percent of the general population.
    • Autism-associated health problems extend across the life span from young children to senior citizens. Nearly a third of 2 to 5 year olds with autism are overweight and 16 percent are obese. By contrast, less than a quarter of 2 to 5 year olds in the general population are overweight and only 10 percent are medically obese.
    • Risperidone and aripiprazole, the only FDA-approved medications for autism-associated agitation and irritability.

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    Asd Prevalence In Males And Females

    From the first published descriptions of autism, it has been a male-typical disorder: 8 of the 11 cases described by Kanner , and all 4 cases described by Asperger , were male. Prevalence surveys conducted since have reported a range of male biases from 1.33:1 male:female to 15.7:1 , and a commonly referenced consensus ratio of ~4:1. Intelligence level affects this sex ratio: males are substantially over-represented among high-functioning cases, and males and females are more equally represented among cases with severe intellectual disability a 1999 review reported median sex ratios of 6:1 among normal-functioning subjects and 1.7:1 among cases with moderate to severe ID .

    Comorbidities And Developmental Trajectories

    According to recent literature , in the present study, both males and females presented a high percentage of co-occurring conditions . The most frequent comorbidity in both groups was ADHD, co-occurring in about 70% of cases, without significant differences between males and females. This evidence differs from previous literature in which ADHD comorbidity appeared more common in males . In accordance with other authors, we hypothesized that the diagnosis of ADHD was underrated in females since females with ADHD have different, more hidden, symptomatology, showing inattentive rather than hyperactive manifestations . Concerning internalizing disorders, our findings were different from previous literature reporting a statistically significant prevalence of internalizing disorders in females, in that we rather found a non-significant trend for anxiety, depressive, and eating disorders in the female group . The mean age of the sample could justify these findings since internalizing and feeding disorders often occur in adolescence or adulthood. In this study we found that caregivers ask for a first specialist medical consultation at different ages and for different reasons: females were referred later to clinical services, particularly for level 1 ASD . This finding fits with previous literature , also showing how females who received an early diagnosis of ASD often have intellectual impairment.

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    What Causes Autism And Why Are More And More Kids Being Diagnosed With It

    Does a friend or family member have a child with autism? Autism rates seem to be skyrocketing. Among children who are 8 years old, autism has nearly doubled from 1 in 150 to 1 in 68 for children born in 2002.

    Autism is part of a larger group of related conditions, called autism spectrum disorders , all of which usually involve delayed verbal communication and difficulties in social interactions. Studies suggest that children with autism tend to have other problems with how their brain functions, with as many as 20-30% developing seizures or epilepsy.

    Is Acs An Extreme Expression Of The Male Brain

    Ask an Autistic #3 – What is Autistic Burnout?

    The Extreme Male Brain theory of autism extends the Empathizing-Systemizing theory of typical sex differences , which proposes that females on average have a stronger drive to empathize , while males on average have a stronger drive to systemize . Whilst sociologists still debate if there are any sex differences at all, and if so whether these are purely the result of cultural conditioning, biologists have long known from animal research that sex differences in behavior exist in primates and are influenced by biology as well as the environment.

    On the Empathy Quotient typical females score higher than typical males who score higher than those with ASC . On the Systemizing Quotient , individuals with ASC score higher than typical males who score higher than typical females . Additional psychological evidence shows thatirrespective of the direction of sex differencepeople with autism show an extreme of the male profile. Note that the EMB theory does not state that all psychological sex differences will be exaggerated in ASConly those relating to empathy and systemizing.

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