User:BlazethePanda/Sex differences in autism

Background
Hans Asperger was one of the first people to study autism, and all of his four study subjects were male. Another early researcher, Leo Kanner described "autistic disturbances of affective contact" in the group consisting of eight boys and three girls.

Today, Autism Spectrum Disorder is commonly defined as a neurological developmental disorder with symptoms of poor social communication, repetitive behaviors, sensory sensitivities, executive dysfunction, and hyper-fixations. In the modern day, women are less likely to be diagnosed as autistic than men; they are often misdiagnosed or not noticed to be neurodivergent by doctors. Women are also more likely to be diagnosed as autistic at a later age than men. This discrepancy in diagnoses is believed to be caused by Camouflaging, a common autistic phenotype presented in females, which hides autistic traits.

Extreme Male Brain Theory
Extreme Male Brain Theory is an extension of the Empathizing-Systemizing Theory, which categorizes people into 5 different groups based on their empathizing and sympathizing expression. In the general neurotypical population, females have a greater ability to empathize and males have a greater ability to systemize. Simon Baron-Cohen's extreme male brain theory states that autistic males have higher doses of prenatal testosterone and on average have a more systemizing brain, as opposed to the more empathizing female brain. He suggests that autistic brains show an exaggeration of the features associated with male brains. These are mainly size and connectivity, with males generally having a larger brain, which is seen in an exaggerated form in those with ASD. Individuals with ASD were found to have widespread abnormalities in interconnectivity and general functioning in specific brain regions. This could explain the different results on empathy tests between men and women as well as the deficiencies in empathy seen in ASD, as empathy requires several brain regions to be activated which need information from many different areas of the brain. Baron-Cohen therefore argues that genetic factors play a role in autism prevalence and that children with technically minded parents are more likely to be diagnosed with autism. Although autistic females have been documented to have higher testosterone levels, which could support the Extreme Male Brain theory, not all autistic females show male-specific symptoms, leaving the Extreme Male Brain theory with Autism Spectrum Disorder to be controversial.

Camouflaging: Masking, Assimilation, and Compensation
The DSM-5 mainly looks at two categories of autism spectrum symptoms when diagnosing someone: social deficits and restricted/repetitive behaviors and interests. Both of these categories of symptoms can be hidden by an aspect of the autistic female phenotype known as Camouflaging.

Autistic girls tend to camouflage more than boys, this leads to many of their symptoms being hidden and not noticed by professionals. When it comes to social camouflaging, there are three sub-categories according to the Camouflaging Autistic Traits Questionnaire (CAT-Q): Masking, Assimilation, and Compensation. Masking is the act of constantly monitoring one's behavior in order to hide one's autistic traits and/or putting on a fake persona. Assimilation is known as "hiding in plain sight" or trying to blend in with non-autistic peers. Finally, compensation is trying to over-compensate for a lack of social abilities. Examples of this can include mimicking real or fictional people, over exaggerating non-verbal expressions, and creating scripts or rules when having a conversion with someone.

Camouflaging can also be used to hide repetitive/restricted behaviors and interests. In fact, researchers have found that autistic girls are ten times more likely to not originally meet the DSM-5 criteria for restricted/repetitive behaviors. Sensory overstimulation is another autistic trait that can be hidden by masking. Participants of the Hull, et al, would internalize their overwhelming feelings and try to channel it through small and unnoticeable everyday objects. If those objects were not enough to calm them down, then they would try to leave the environment and recuperate by making “ regular excuses '' as to why they needed to leave.

Downfalls of Camouflaging
Studies have shown that high levels of camouflaging is can lead to higher levels of anxiety and depression and can increase the risk of suicidal ideation. Studies have also found that camouflaging can lead to a skewed sense of self. This is especially the case for people who had been masking and mimicking other people for long periods of time. Another factor of masking is mental and physical exhaustion after a camouflaging session. According to the participants of the Hull, et al (2017) study, the longer that autistic individuals camouflage, the worse the exhaustion becomes and the longer these individuals need to rest and recharge. This study had also found that there were increased amounts of anxiety and stress revolving around camouflaging because the participants were often worried that they did not mask enough, did not mask correctly, or did not reach the desired effects of masking in that camouflaging session. Another one of the factors that increased anxiety and exhaustion while camouflaging is the fact that it “involved a constant monitoring of the situation, as if training oneself in self-monitoring, self-awareness, and monitoring others’ reactions, both during and after the interaction occurred."