James Cross
Psychology is a relatively young science, as far as sciences go. The father of psychology, Sigmund Freud, only started his studies and writings in the 1920’s, and there were both major strides and major missteps in psychological research in the early days of the field. One of the major missteps is the understanding and study of Autism Spectrum Disorder, and a new study has only highlighted those major flaws.
Autism and the Field of Psychology Go Hand In Hand
Studies into the disorder that would come to be known as autism go back as far as the formal field of psychology itself. The first reference of “autism” was made in a paper written about schizophrenia in 1911, and at the time, autistic children were misdiagnosed with childhood schizophrenia.
Formal studies into autism weren’t staged until the 1920’s, when a female Soviet scientist named Grunya Sukhareva began to detail her observations of children in the boarding school that she worked in. She is credited with some of the earliest accurate observations of the disorder, with her writings closely mirroring the contemporary symptoms that scientists use to diagnose today.
Research Ramped Up During WWII
Research into autism ramped up in the 30’s and 40’s, with Hans Asperger and Leo Kanner scientifically describing two related conditions. Asperger in particular was a German children’s psychologist who wrote on the symptoms of autism in a similar way to Sukhareva’s writing’s 20 years earlier. Under the reign of the Third Reich, he assisted in diagnoses of children who he deemed unfit for service to the German cause.
Asperger is controversial in contemporary science for the fact that he took children who were likely autistic and diagnosed them purely on how “fit” they were to integrate into German society. This perception of autism as a hindrance to normal societal behavior is one that continued on through the decades, until the 1980’s when autism was first introduced as a distinct diagnosis in the DSM-III.
Distinction from Schizophrenia
The distinction of autism as a diagnosis separate from schizophrenia marked a distinct separation between historical and contemporary research into the disorder. The diagnosis was divided by clinical symptoms with more severe symptoms being called “autism” and less severe symptoms being called “Asperger’s Disorder” after Hans Asperger.
Research into autism ramped up in the 80’s and 90’s, with scientists seeking both definitive symptoms as well as causes. At the same time, some early behavioral treatments began to be tested, and children who were autistic began to receive treatments for their symptoms and behaviors that drew greater attention to the disorder.
Boys Appear More Symptomatic than Girls
Autism is characterized by a group of related symptoms. The symptoms include social difficulties, repetitive behaviors, and strict resistance to change. Diagnoses of autism often include – but does not require – symptoms appearing early and persisting throughout childhood, without recourse or remission as an individual grows.
Autism, from the early days, was considered to be a primarily “male” disorder, with little boys being diagnosed at significantly higher levels to little girls. It was understood that autism was a childhood disorder, but the symptoms that often present in boys are vastly different to the symptoms that present in girls, leading to differential observations on potential diagnoses.
A Male-Centric Feedback Loop
As the disorder has been studied over the years, though, a theory has arisen, stating that women were being significantly underdiagnosed for autism due to the methodology of diagnoses. Due to the preconception that autism was a disorder only for little boys, little boys were the only people studied when examining symptoms.
This notion has, over the years, created a sort of feedback loop when it comes to scientist’s understanding of autism, particularly in regards to how it presents in little girls. Since the diagnostic criteria are male-centric, more boys are referred for diagnosis and then subsequently diagnosed, at a rate of four boys for every one girl.
Gender Bias in All Areas of Medical Research
This gendered bias in research of autism has led to a cultural bias towards the disorder, with women being silenced and misdiagnosed when they discuss their personal experience of psychological and behavioral symptoms.
This is unfortunately common in medicine. There is significant evidence – both anecdotal and quantifiable – of misogynistic attitudes in medicine. Women are underdiagnosed for many disorders, including heart disease, which is the number one killer of women in the United States.
Studies Looking at Gender
A growing movement of late-diagnosed autistic women has prompted researchers to reconsider these attitudes, and a recent study emphasizes the flaws in the reasoning from the get-go.
A team out of the Hebrew University of Jerusalem devised a study to examine the synaptic development and impairment in mice, using two well-established models of autism spectrum disorder. They used two different mouse lineages, with human-based mutations in order to study their theory.
The Causes of Autism Are Murky
While it’s still not fully understood what causes autism, it’s generally accepted that there is a strong genetic component to the disorder. It often passes from parent to child, with children of autistic parents being significantly more likely to be diagnosed with the disorder.
This understanding, as well as understanding how synapses in the brain work, helped researchers to design their study. Researchers examined the social behavior of mice as well as their brain development in order to draw conclusions about the mice, conclusions that could be extrapolated to humans.
Examining the Mice’s Brains
The study in question looked at the mice’s social behaviors in relation to their brain development. In order to get better data, the scientists were looking at the neurons in the mice’s brains, the synaptic connections, and the levels of protein required to create synaptic signaling.
Brains function on neurons, which are cells that send messages all over your body to allow you do everything from breathing to thinking. Synapses are the spaces between neurons where messages jump from cell to cell, and they’re incredibly important in brain research when understanding developmental disorders like autism.
Looking at Gendered Differences
The theory that the scientists were testing was whether or not there was a noted difference in the behavior of female mice versus male mice, as well as the resulting changes in brain chemistry that could be quantified.
A going theory for many years is that the reason that young girls are diagnosed at a lower rate to young boys is because their symptoms present “less,” and therefore women must have some sort of biological resistance to presentations of autism. This study sought to confirm, or deny this theory.
Brain Differences in the Mice
The first clear result of the study is that the mice with mutations in the study had observable differences in their brains. Notably, the model mice had lower spine density in their neurons, and lower levels of the signaling proteins that the doctors were measuring.
This was the first clear conclusion: the mice with mutations that mimicked autism in humans had brains that developed differently than the base group. It’s been theorized for years that individuals with autism have different brain development than allistic individuals, and these results confirm it.
Social Deficits
The model mice were also observed to have social deficits, meaning that they didn’t interact with the other mice in a way that would be typically expected. This also reflects the social presentation of autism in humans.
But, perhaps most crucial of all, the mice showed zero difference in behavioral presentation between the sexes. Male and female mice reacted to the mutations the same way, decisively undermining the theory that girls have a so-called “protective effect” that keeps them from presenting with autism.
Women Need to be Studied, Too
This supports the theory that women are underdiagnosed because they present differently than men. Scientists also hypothesized that the lack of recognition of autistic symptoms in women can be attributed to women socializing themselves to behave more like allistic people, a practice known as “masking.”
While not definitive, the study underscores the importance of including both men and women in future studies regarding autism spectrum disorder. The gender diagnosis differential is only becoming clearer the more we understand about autism, and it will require a swift and drastic correction in order to move forward properly.
Ongoing Research into Autism
Research into autism is an ongoing and fascinating field of study. As brain imaging gets more advanced and our understanding into the behavioral presentations increases, it will hopefully become less of a social stigma to be presented with a diagnosis.
Reducing that stigma requires, from the beginning, acknowledging that autism is likely much more common than any of us have understood up to this point, and that boys are not the only ones who can claim a diagnosis. Including women in studies and research going forward is the bare minimum, but it is what must be done for progress.
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