Autism is under-diagnosed in women | Hacker News Reader

Autism is under-diagnosed in women

bbc.co.uk

64 pointswhatami23 comments

Discussed several months ago: https://news.ycombinator.com/item?id=16679469.

Wikipedia states that the cause of different rates of diagnosis in men and women is not a settled question: "Boys are at higher risk for ASD than girls. The sex ratio averages 4.3:1 and is greatly modified by cognitive impairment: it may be close to 2:1 with intellectual disability and more than 5.5:1 without. Several theories about the higher prevalence in males have been investigated, but the cause of the difference is unconfirmed; one theory is that females are underdiagnosed."

I suppose if one holds the view that men and women are mentally identical on average, it would lead one to the conclusion that the gender disparity in diagnosis rates is due to social factors (or some kind of medical discrimination).

Several genetic conditions are much more prevalent in males than in females. A hypothesis is that this is because the Y chromosome is very small and contains little gene overlap with the X chromosome. Any genetic variations in the X chromosome thus have a much higher impact in a male than the same X chromosome in a female would have.

We know ASD has a strong genetic component, so combining these results in another hypothesis for the higher prevalence of ASD in males, namely that it is affected by the X-Y chromosome dichotomy.

Men only have one copy of both the X and Y chromosomes, whereas women have two copies the X chromosome. This means that any recessive genetic disorders (on either the X or Y chromosome) will be expressed in men whereas women will only be a carrier unless they have the same mutation on both chromosomes.

This isn't just a hypothesis, it's a well-documented fact. See https://en.wikipedia.org/wiki/Sex_linkage for more info.

All articles about underdiagnosis of autism in girls stated "it manifests differently in girls" and "girls are better at masking it due to them using strategies little boys don't".

The whole "people must assume that there is everything exactly the same and only differences are social" is strawman.

Also, it is possible to have lower rates and simultaneously have those underdiagnozed.

> I suppose if one holds the view that men and women are mentally identical on average, it would lead one to the conclusion that the gender disparity in diagnosis rates is due to social factors (or some kind of medical discrimination).

It might be easier to think about this on a different level of granularity. The problem has a self referential issue (requires social to evaluate social) if discrimination is the largest factor considered. Aggregate social factors over time yield discrimination - can't be corrected if the solution defines the problem.

Surely a contributing factor must be it has been well-established women with aspergers are much less likely to experience problems from it. we all know how guys with aspergers end up when they are not exceptionally talented. that is not as true for girls and women with aspergers. Not that they do not experience problems, but they will have friends, partners, children eventually. because autism diagnosis relies on social problems, it is much harder to diagnose in them.

To be fair, women generally have a better knack at finding partners (see the distribution on how many matches an average woman gets on Tinder vs. an average man). So those social problems man be alleviated easier by autistic women.

You say "we all know how guys with aspergers" but I'm pretty sure people in general have no idea what the diagnostic criteria are (or were if you want to go that way).

If you consider the low prevalence, most people don't even know anyone with the different behaviors grouped under Asperger syndrome.

(lots more people have social problems from depression and anxiety than autism spectrum disorders...)

Well established where, outside of the minds of autistic men? Everything I’ve ever seen has shown that women on the spectrum are evaluated about twice as negatively on measures of approachability/awkwardness by their peers [1], are more likely to commit suicide[2] (even though women in the general population are less likely to), less likely to have friendships after age 10 [3], and less likely to get married [4]. There seems to be a period in early childhood where women are either better at masking or not disruptive enough to be noticed, but the long-term outcomes are worse on every measure.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5286449/

[2] https://www.cambridge.org/core/services/aop-cambridge-core/c...

[3] http://psycnet.apa.org/record/1995-97924-000

[4] https://link.springer.com/article/10.1007/s10803-007-0441-x

A related fact, though I don't have a citation at hand, is that masking behaviors are often associated with worse mental health and overall outcomes. Third-parties might perceive an autistic person who masks their behaviors as "higher-functioning", but it's often bad for the individual.

i'm sorry my comment seems to have offended you. so far most of what i read on it has been pop-science. newspaper articles. books. the like. this is pretty interesting and brings a different perspective.

Yep, often misdiagnosed as BPD or one of the Cluster B's, come to find out Asperger's is on the same spectrum. One of the most confounding situations I've ever experienced.

https://en.wikipedia.org/wiki/Cluster_B_personality_disorder...

Maybe so, but autism isn’t mentioned on the wiki page on Cluster B you linked to.

A common theme seems to be the feedback loop of attention from other people - from being unable to handle, to not being able to perceive, to seeking too much.

That sounds like that could stem from discomfort being within oneself, in their body or with their emotions and thoughts, so needing to keep the mind active/distracted.

One of the common traits is an inability to access higher-order cognitive functions such as empathy and being unaware of their inability to do so. This often means they're in a chronic state of anxiety and confusion because the intentions of others make no sense. Conflating empathy for low affect feelings of sympathy while assuming an identity of the most empathetic and most sympathetic person in the world, maybe even thinking they're HSP. Here's one way you can find out and discover to what extent that's factoring into the mix.

Next time you find yourself in a situation where they are behaving contrary to what you would expect, don't assume malice. Make sure you carefully and clearly articulate your feelings and perspective, have them voice their concerns, and then ask them to rearticulate what you just said. Ask them to put into their own words what you are thinking and feeling, to rearticulate what your perspective is and why. Ask them to explain the cause and effect of their actions. And then shut up and let them answer, see what happens. Pay close attention to how they respond, to what extent they can empathise even if it's just simply repeating back what you said. You both may be shocked -- them by the question, you by the response -- but it'll be an enlightening experience. And after a time or two of that, at least you'll know where you are.

The title here is editorialised and the article provides no evidence to back it up.

If you or anyone can suggest a more accurate and neutral title, preferably using representative language from the article, we can change it again.

How about "Anecdotes from adult women who were recently diagnosed with Autism"?

"Anecdotes" has a pejorative connotation these days.

"Anec-datum aren't data" again?

The title is funny but oh man, why trolling so hard.

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