What are some of the sex differences influencing diagnosis for Autism?

source of writing www.naturalempathiser.com – feature photo Scottish Loch

Over the course of the past several years, there have been many studies done, creating a number of explosive and insightful discoveries, into the disorder Autism, especially for the Females.  More people have been able to observe how, why or even if, Autism presents differently in females.  A development becoming more openly welcomed rather than shunned, but there is a unique presentation of Autism in females, that is fundamental in helping better identify and treat, those who may have the disorder.

I am terrible with consistency out with my personal comfort and timescales, also I medically pop in and out on paper, for help due to all the labels, stigmas. Worst of all can come from those you put your trust in to help, their treatment can be the most damaging from those claiming, to only be trying to help. Unfortunate but true, sometimes your biased, stuck or uneducated view makes everything extremely more challenging, for all parties involved, especially the patient or clinician.  For me it can put me on the slippery slope of depression, because all the professional words continuously contradicting one another, leave me more confused at times, than when I started

These challenges are for a number of reasons because, not only are females just as diverse as any other groups of individuals with the disorder, but there is a more pressing matter I would like to stress.  I yet again keep hitting a metaphorical brick wall that makes it harder for me to gain access to the help I need, and that is because most autistic screening and diagnostic tools were developed and based, primarily on, observations and behaviours of boys.

I was reading an article by a clinician who was expressing her views and opinions that I happen to agree with.  That was in relation to specialist research and those closest to the individuals in questions, which was the matter at hand of, missing girls with symptoms who do not fit the “typical boys presentation”.  This brings me back to an article I previously wrote with regards to three tests added to the mix, one for the female, one for the male, and a combined more generalised one and see what that produces.  I very much would like a test more relevant to my sex plus a more generalised to give me the answer, it would be very much appreciated. PDA is one of the better questionnaires, especially with wording, that has not had me wanting to pull my hair out.  My next articles will include the different profiles, will include PDA, an area of personal interest I will be delving into.

Anyways this article written by the clinician, helped me to be able to, word, that as a female parent, by my own and many professional opinions, am in fact Autistic, but where I fit seems to be the time consuming and frustrating process, that is like pulling teeth out, the most mentally, invigorating, deteriorating experience I have ever been through, which believe me you, says a lot.  My children are raised by a self diagnosed ASD (awaiting diagnosis if relevant) but a clinically diagnosed ADHD female mum, they are not going to meet the levels of ‘norm’ for your criteria necessarily or to the T, I work really hard flipping their stuck mindset and helping them gain broader and greater understanding.

For that reason, I listen to what my children’s words and body tell me, that is why I listened to my tween’s teacher as she explained, my daughter met the criteria for both ASD and ADHD, she even went for a second opinion, but doctors dismissed it, hitting another brick wall.  Therefore with the 10 years of knowledge gathered between raising the two of them, 30 years of being me, and what others have learnt, written or communicated, I am beginning to find answers and better ways of doing things.  Not everyone has the ability to be a self-directed learner and it comes with its costs and sacrifices to.

My daughter is the double of me in so many ways its unbelievable, she see’s the world in the most amazing way, and like her mum can learn and excel at anything she puts her mind to, but her focus is language.  My 3 year old son appears as a mute in nursery at times, didn’t start communicating properly till 3 and really flags a lot of the criteria.  He took years longer with verbal speech but is a little mastermind, when your truly listening and watching, he has to be comfortable too, he’s a possible mathematical Wizz in the making.  So here are 3 possibly undiagnosed Autistic people, who are unreachable and unhealable by those who could, but simply unobtainable due to stigma and stereotyping.

That is why as a female parent, who by my own and many a professional opinion, am in fact autistic, and now that I am in touch with someone from the National Autistic society I might actually get somewhere with the diagnosis, hopefully one step closer to those that can give it.  Because of how easily dismissing the process can be, (I’ve been in it since 12) I’m scared to let my daughter walk in my footsteps and it isn’t right to be made to feel this way.  I have a feeling things are about to change though, for the better and maybe my trio can be helped

I started by looking and reading a little into biological science, which tells me I’m delving into a subject that is, extremely confrontational and debateable.  As a minority myself I agree and disagree with what is to follow but they are personal opinions, I’m not educated enough and have nowhere near enough information to say anything without a shadow of doubt, but I need to start somewhere.   This is just what I’m coming across on my personal journey for answers into where my cluster fits on the spectrum.

This is the beginning of research, delving into the mystical world that has become the  differences between males and females.  Something I see often happening, is sex differences put solely down to culture differences, but science suggests a biological difference between the male and female, in relation to the brain.  These differences are not absolute, have been generalised as the majority and tend to be skewed depending on ones sex.

I looked through a narrow scope into why males appear geared towards math, where as females language, why women are more emotional, how the sex’s feel pain differently, how males are more likely to suffer neurological disorders, where as women are more likely to suffer mood disorders.  The gender difference’s apparent before birth and, why it appears women handle stress better than men, and finally why we are led to believe males have weaker impulse control.  But what if you are a minority?

Changes are noticeably presentable from birth, but even before that, taken to the development stages when you are still in the womb, things are different.  Gender is determined immediately upon fertilisation, meaning the sperm is the only one that knows what sex it is going to be, and the egg only carries a stationary X.  The 23rd pair of chromosomes establish the sex of the baby.  So to illiterate more clearly, the female egg contains one X chromosome, whilst the male sperm carries either the X or Y chromosome.  Once they meet the egg becomes XX=Female and XY=Male, so in a nutshell

“The baby’s gender is known before it is even consider a foetus” during the first few weeks the external and internal genital structures are the same, but this is just the process within the development stages.

The foetus gonads will either become ovaries or testicles, the phallus either a clitoris or a penis, and finally the genital folds will become either Labia or scrotum, depending on whether or not testosterone is present, which in turn determines the “default sex” of either categories of male or female.  Remember the sex is determined by the males sperm , to the mystery of whether it is carrying either an X or a Y, because the egg holds only an X.

Intersex describes a variety of conditions, where the minority of individuals who are born with, a sexual anatomy that doesn’t fit typical presentations, of a male or female.  Examples would include a person born with genitals that are between the usual descriptions of, male and female parts, or, they could be born with both XX and XY chromosomes.

A way that has been described to try and help understand intersex, were words written to think of gender like the colour spectrum. As sex organs vary in shape size and dimension, of course it seems only common sense, that so would the sex chromosomes determining the default sex.  As these conditions are very rare, however, they do still exist.

“It is argued to be a humanistic way, of categorising people into gender categories, not the original way of nature”

As gender is determined upon fertilisation, at around the 16th to 18th week of pregnancy, the foetus produces a bud called a genital tuber, at the site of the genital.  By the end of the 20th week, the external sex organs should be fully formed for both the male, and female sex of the foetus. At around 26 weeks, the female foetus generally starts developing thicker corpus callosum, which is the part of the brain that connects the right and left hemispheres, than a male foetus.  This information helps explain why women tend to use both, whilst men tend to lean towards the left hemisphere, which leads me on to my next point, that might explain what you have just been reading.

I often hear people saying that he or she is not in their right mind, but if looked at in a biological sense, women are the ones more in their right mind the majority of the time.  I say this because men mostly use the left hemisphere, to process information, where as women are more skilled at using both hemispheres, as we see happens because of differences in the making, of males and females in the womb.  So there is an obvious difference between males and females, which would affect the workings of their mind, would it not?

“So in a literal sense women are the only one’s in their right mind.” but what about the minority of males who do not fit this notion?

It is believed women are more likely to suffer mood disorders, than Autism and ADHD, because male brains, synthesise serotonin, far more quickly than the female brain.  Obviously when looking into biological factors, it’s then placed into categories and researched for many a year, seeing patterns develop, so yes the majority of people fall into the criteria’s described, but now doors are opening for more insight and analysis into the minds of the minorities, who may be more alike to some once classed, part of  majority, than we once thought.

Standardised intelligence test show no statistically significant differences, between males and females. When looking at the brain we can see lots of differences, take the findings that suggest that genders tend to slightly lean towards, categories with regards to their abilities, in maths and language.  Males are said to have a larger inferior-parietal lobules (IPL), than females, which is an area of the brain that is thought to, influence mathematical abilities, which matures in boys about, 4 years earlier than girls?!

The frontal and Temporal areas of the cortex, are larger in females, and are thought to influence language, matured approximately 6 years earlier, than the males.  All these words I have written to date, are just me summarising my findings so far from what I’ve gathered, and this is a subject I do not specialise in, I’m learning for vast and varied reasons now. It is a very debateable subject obviously, because a minority or girls can be maths wizzes or vice versa, minority of boys can be language masterminds, that comes down to individual choices, opportunities and circumstances. Personally I excelled in all subjects at school just some more acutely, some of my most traumatic problem’s arose during high school, with social communication and interactions, where my biggest cost, was my education.  These are the years where I learned to become a chameleon the best, with some of my harshest lessons.

So, from that we see above the majority of males mature quicker mathematically, by approximately 4 years, and the majority of females mature 6 years earlier, than males in language.  There and always minorities and splinter groups, who do not fit where the majority of others do.  Take the way we feel pain, there are even differences there between males and females.  When men experience pain, they tend to activate their right amygdala, where as for women, they tend to activate their left amygdala, which leads us to believe, women feel more pain.

“The left amygdala is more closely associated with the ‘internal functions’, this is the reason behind why it is often thought and expressed, women experience more pain than men do”

According to biological science from where and what I’ve been reading, males are more likely to be dyslexic and autistic, than females, this is noticeably explained in the skewed differences in ratios, between males and Females.  It is also said, that males are more likely to experience Tourette’s  and ADHD.  Females appear to be found, and thought, to be more likely to suffer, mood disorders.  The reasons for this is because, females have larger hippocampus, and deeper limbic systems, than males.  Therefore allowing females to feel the full range and depths of the emotional spectrum, more so than males. Is that why this minority female, keeps getting caught up in the Bermuda triangle effect of, Autism, ADHD and bipolar?

I wonder what a visual image of my brain would give insight into for someone, me in particular.  Since someone once said to me I am like the human equivalence of the Rubik’s cube, it has kind of stuck in my mind since, because no one seems to have figured out the riddle that is me.  If someone specialising in neurology or psychology was to take an active, time-scale appropriate interest, into researching my brain, I wonder what findings would be discovered, as I’m already aware I’m a minority thinker.  Maybe one day that will be possible, but at the moment, it’s a fantasy, my reality is just words, opinions, views, theories and a lot of both reliable, and unreliably communicated evidence, and experiences, in the search for the answers, to my questions.

I’ve been reading that, when it comes to differences in intelligence, between the two sexes, there are more males than females that differ, and become more skewed on the results.  Male IQ has greater variance from one perspective, than the female IQ.  This is why females appear to be more clustered around the middle, where as the males occupy the extreme high and low end, of the intelligence scale.

Studies have shown that the majority of women, handle stress better than men.  Science shows that whilst both the male and female release the hormone oxytocin during stressful events, the difference is by combining oxytocin with the female estrogen, it produces a calming effect, whereas male testosterone only makes men more aggravated.

It is coming to a point in need to finish up writing this article, before I end up writing the never ending story, that never gets published.  I will stress, I am no expert, just someone currently going through the process of life, just like you.  If I’ve worded something that upsets or offends, I assure you that was, and will never be my intention.  I would like to thank everyone who has taken the time to read my words, message me personally, shared and helped me on my feministic journey into the spectrum.  If you have a story that’s related please comment.


I personally am recieving extreme difficulty waiting, like many of my readers and those taken the time to message, just to see someone who can analyse and determine, whether or not i have autism before gaining access to, the help that is available.  I’m aware we do not have a vast number of people that specialise, but something does need to be done here to accomadate.  So the studies indicating it is more challenging for a female, undiagnosed in childhood, to obtain a diagnosis later, i fuly agree with, from first hand experience.  I am living proof this is the case, for getting access to the help already out there, that one requires, firstly you need the label that is the diagnosis.  I was suspected back in spring 2016, referred and awaiting specialist input, many a moon ago.  This week is the first time i have met with someone, who does specialise in an area i need help with, who looks like she can and will help, where she is able, she gave me hope, that things are changing, and that space may be possible.

www.naturalempathiser.com for more reading, understanding and depth

Further Reading

  1. My Feministic journey, into the spectrum
  2. Trip down Memory Lane
  3. Mirror-Mirror, Show me my true reflection
  4. My Journey through Mental health
  5. The words of Lilly falls Beautifully unfinished
  6. Welcome to the natural empathiser

 

Why do women on the spectrum, fall short on some diagnostic tests?

Life can be alienating and challenging at times, especially if you’re driven primarily by both intellect and intelligence, head strong and far to independent in thinking at times.  If your someone who does not seem to fit the female, or any stereo type for that matter, and not so common at all as it would appear, a minority, life can have its more challenging complications in a sense. The more learning done through time seems to highlight, that personally, I don’t think in the common sense kind of way the majority do.

Many a time I have been asked question’s, answered and returned In kind, been given insights and returned them, have helped and been attempted to be helped, for more than half or all my life. In some proceptions and perceptions it hasn’t worked yet though, not in the ways it should, well that has and is my opinion as of late, after what I’ve been reading and learning.  This is yet another branch, and the reason behind the question, why do women fall short on the diagnostic tests for autism? (More acutely me).

A clinical psychiatrist once told me she would be very interested in reading my analysis and views on where I fit on the spectrum.  This is why I am going to be dedicating a separate section headered in my side bar on the Natural Empathiser, titled My Feministic journey into the spectrum, in a question based theme, in the order there done and published, A book Blog so to speak. To many questions needing answered in my head that keep bouncing off one another, needing an out let.

Questions along the lines of what are the statistical differences between diagnosing a male or female? Are the features harder to recognise? In what way do you consider something a repetitive behaviour or restricted interest? What does it mean to show signs or not? What signs would you like me to show you, me or the chameleon? When I show me I confuse, frustrate or simply annoy the person trying to get the answers, becoming disabled or appearing disorderly under certain lights.

Before going further I will give a brief outline of the journey being diagnosed autism entails, from my knowledge and understanding at this time over years of gathering and experience.  Hopefully getting my point across that the diagnosis can come with many terms and labels, as I have discovered.  Names associated with the spectrum include Autism, Autism spectrum disorder, (ASD) or condition (ASC), three types atypical/classic/Kanner autism, Asperger syndrome or pathological demand avoidance to name but a few.

There are constant changes, some more recent than others, being done to the main diagnostic manuals for the ‘autistic spectrum disorder’ (ASD), which is predicted and most likely to become, the most commonly given name when referencing someone diagnosed on the spectrum.  Obviously additional terms will be used for deeper understanding and analysis, but ASD is the one word it is categorised and generalised as, when describing the particular autism profile showcased by the individuals.

Another point to note is, someone diagnosed or symptomatic of the spectrum, may also have learning disabilities, mental health issues and other conditions separate to the diagnosis of ASD, which can and often does, complicate the diagnosis period. In my case the Bermuda triangle, ADHD, ASD and Bipolar type 2, the trio from the start of this journey that still seems quite accurately insightful, but needing further analysis from those qualified. I believe that for more consistent and linkable communication, for all parties involved, possibly lessening the confusion, can be obtained with more frequent periods of time spent with the individual in question.  In my current opinion, if possible, it would help or at the very least give more insight, into the individual whether autistic or not, or so one would think.

If the clinician or person assigned to aiding an individual lacks experience in autism, or other conditions/illnesses, they can make numerous assumptions that are incorrect, both informative and misleading, disabling and influential at times, and vice versa for the patient to the professional.  People or systems, whether consciously aware or ignorantly, that do not take the issues related to autism into account, are part of the problem that needs a solution through teachings and learnings.  The reason I say this, is because you could find your self stuck on the long road around, instead of cutting right through the middle, which can be a dissatisfying and detrimental cycle to become stuck upon.

For years I’ve had professional and unprofessional opinions telling me I am or am not this or the next thing, so who do you listen to when your own voice can be so confusingly frustrating at times, forever entwined with the voice of many? A wise woman pointed out that to much information can be a bad thing as well, but I argue against this to some degrees, it’s knowing what to do with the information in question that can lead to the most interesting discoveries.  Moving this piece, creating or uncovering a new piece to fit the gap,  manipulating and imposing the abilities to expose insights into seeing the bigger, more precise and clearer picture.  Words and how they are implemented paint a picture, body language paints another, and so forth.

Back to explaining the diagnostic manual and the one in question being referenced, being briefly described to give some insight for those interested. It is the tenth edition, which is the most current, for the International Classification of diseases, (ICD(10)).  Inside this book, which I am yet to find time to properly delve into, contains a number of autism profiles such as Asperger’s, under the Pervasive Developmental Disorder heading defined as,

recordable abnormalities in reciprocal and social interactions alongside patterns of communication.  Also restricted stereotyped repetitive patterns of interest and activities determining how they function in all relevant situations

There is a manual that is not most commonly used in the UK, it s the fifth edition of the Diagnostic and Statistical manual.  It is predicted to significantly influence the next edition of the  ICD which is used by many diagnosticians.  It has been recently updated so the diagnostic criteria are simplistically more clearer, and now includes sensory issues, which is where I score extremely high in comparison to the other criteria, followed closely with social and communication.

Here is where my interest spikes because if this is the case, it would be extremely useful to me, and I hope it does significantly influence the next edition of the ICD.  My reasons to support this statement are as follows. I am living proof of how detrimental these issues impact day-to-day living and because I do not have the diagnosis, I can not access the help and support to hopefully change that cycle, impacting my children and those attached.  It also includes support needs and other factors that impact on the diagnosis.  So what is the current criteria for being diagnosed with the official label of Autism spectrum disorder (ASD).

To get a full diagnosis instead of a partial if my knowledge is correct, you have to meet all 3 of the criteria for social communications and interactions, restricted and repetitive patterns of behaviours, activities or interests (including sensory behaviour) present from early childhood, that influences and impacts day-to-day living.  Also you have to be able to answer these questions which can be challenging if communication falls under your disability.

“Knowing where to draw the line is challenging for everyone and is at the end of the day, a choice influenced by vast and varied circumstances, situations or events, but a decision down to the individual.”

The Autism Diagnostic Observation Schedule, documents the behaviour of the adult, when they were children.  I am a 30 year old female adult who’s gender is female, with at least average intelligence, by my own opinion and others. Without a shadow of a doubt, I would now agree and say, that it is in fact, an extremely challenging group of individuals to diagnose. It seems, where women are concerned anyways, the ones diagnosed have dramatic signs in one domain, usually communication or social interactions, and mild to moderate signs in the other two domains.  Whereas more commonly documented research highlights that the majority of males show more moderate signs across all three domains.

The reasons for looking into Autism started off personal, and still is to some extent but runs much deeper now, I don’t know if I would be this persistent if it only involved myself.  Unfortunately or fortunately, depending on perceptions and conscious knowledge and understanding ,when I’m looking into it I have three people in mind, a pre-schooler boy (3-5), tweeny girl (10-13) and a mature female adult (25+).  From what I am learning there seems to be a pattern developing, a focal point seems to be that women more commonly flag up for one criteria, where males more consistently flag up for all 3, this is not always the case though.  Even in the majorities of the minorities, you have splinter groups where they are outnumbered and often missed.

I keep hitting a brick wall where the population seems somewhat divided on their views with regards to sex differences.  I keep hearing quotes and references along the lines of;

“giving the scope of the study, surely if there are sex differences or whatever else they are bound to show up??”

Not necessarily because to me it seems common sense their are differenced between sex’s in some regard or another, taking further to difference in the individual.

The gap between differences in sex and individualism seems confusingly wide to myself and others at times, therefore I intend to look further into this when the time arises.  What I do know is that our body make-ups are different, grouped into the male and female sex at birth.  What stems from that is another story entirely, and one I am still at the baby stages of learning and understanding.

There are current consistent patterns developing over time and analysis in the majority, in relation to repetitive behaviours and restricted interest.  Studies that point to the possibility that both women and men present differently and would benefit from, diagnosis tools that take gender differenced into account.  Is that just me or is that yet not again common-sense to the process of finding answers for the individual?

My opinion is starting to lean toward the notion there should be questionnaire’s structured around these criteria’s and differences considered and implemented.  I’m never going to struggle getting an erection, I do not have a penis??? The medication is not effecting my man hood, or the questions are not relevant because you are aiming it at the wrong sex, therefore the question and questionnaire is a point-less and irrelevant in some shape to me, the individual in question.  Therefore it is just one point that gives credit to the argument, that it is mostly male orientated and research based at this present moment, that can change.

Are we beginning to blur the lines too much between individualism and sex differences, this remains a question pin balling around my head.  Both sex’s and those stemmed from it are stigma and stereotyped in some way, everything can be and is expected to dance to the steps orchestrated and choreographed by societies expectations and wants, from whichever and whatever group you may fall into, given the current timeline.

The ADI-R appears to highlight the possibilities caregivers and parents tend to recall, fewer repetitive behaviours during their childhood for women than men, which then trudges up more questions.  Am I caught up in the loop of researchers relying on the ADI (R) to diagnose me?  If so is that why even the partial diagnosis is so hard to obtain here in the UK for a female, the other diagnosis given beforehand fail in comparison on an emotional wellbeing level.

I thank my persistent, dog with a bone nature or I would probably still be stuck on the slippery slope of depression.  There is no fail safe guaranteeing I will not fall back onto it if all patterns and behaviours were so transparent.  I’m not saying that the ADI (R) isn’t one of the best ways for identifying those behaviours, I’m not saying it is either.  What I am saying is they are all relevant in highlighting different linkable, comparable and relevant information.  What is done from this information is down to the individual and those involved.

Leads me yet again to the thoughts that maybe, 3 test specifically designed and structured for a male, a female and both sex’s combined, as the root basis.  What would branch from there is something unknown and above my knowledge, understandings and education.   By adding 2 gender orientated questionnaires alongside the combined into the mix already there, might increase the likelihood of reaching more individuals.

Many women (men as well for the minority), do not receive a full diagnosis and are often misdiagnosed with conditions such as ADHD and social communications disorder, rather than autism.  The reason for this is because the individuals relevant to this statement do not meet the criteria with regards to their repetitive notions.  I’m forever shifting my compass, from one end of the spectrum to the other just trying to live.

As I have said there are so many different terms associated with the word diagnosis such as autism profiles, diagnostic manuals and tools, alongside varied research and quite commonly said, misdiagnosis.  Life affects everybody in multi-dimensional complex ways on many vast and varied levels of difficulty, depending on the individual.  Subjects I’m focusing on currently are language and cognitive development, emotional intelligence, motor development, avoidance to demands and expectations, anxiety, control and social demands.

One thing I can say that I am sure of,  all these questions both disable and enable, influencing and impacting the individuals involved, both the patient and the professionals.  More so the patient though who is there, probably in crisis but also a choice based on necessity, creating difficulties predictable and not, in obtaining clinical support and access to more useful and beneficial resources.

I for one am extremely clumsy at times, disastrous and end up quite bruised especially on my legs, is this possible dyspraxia. My body language and behaviour is unexplainable to some at times is this border-lining personality disorder. Depending on the current clinician aiding in the search for answers, experiences, insights and views impact what is transpired. Sometimes I am so switched on its intimidating for the majority of personality types, as my passion in what I am discussing or saying, can be mistaken and commonly misinterpreted as aggression, something I’m working on so I don’t retreat back under the rock, I’ve just managed to resurface from under.