Author: Shelby CoxTitle: Diagnostic disparity of Autism diagnoses between sexes.
In this discussion, we focused on the variation in manifestation and diagnostic disparity of autism spectrum disorder (ASD) between sexes. In a review titled “Sex Differences in Autism Spectrum Disorder: Diagnostic, Neurobiological, and Behavioral Features” the authors analyzed the discrepancies in sex ratio of ASD diagnosis and its manifestations of core symptoms along with the discussion of current and past theories that have been used to explain this gap. The prevalence of autism spectrum disorder is about 1 in 44 children and is diagnosed in boys 4.2 times more than in girls. This discrepancy is interesting considering that there is not a very pronounced sex difference in Autism screening. This means despite receiving the same testing, boys are more likely to receive an ASD diagnosis. The standardization of diagnostic tools and criteria has been primarily based on presentation in males, which likely contributes to a lower rate of diagnosis in girls compared to boys. Additionally, it has been found that women diagnosed with ASD later in life often had a history of multiple other previous diagnoses before ASD, whereas men usually did not. After explaining the differences in diagnostic rates, the authors then describe common variation in core symptoms that make it more difficult for women to be diagnosed with ASD. Camouflaging, or minimizing the visibility of traits associated with ASD, is reported much more often in women with ASD, which could result in the disorder going unnoticed. Along with this, women with ASD commonly display more internalizing behaviors such as depression, anxiety, and other emotional issues than men with ASD who commonly display more externalizing behaviors such as aggressiveness and hyperactivity. Externalizing behaviors are more likely to be disruptive to others, especially at a young age in schools, making it more likely for young boys to be tested forASD. Following this, the article gives theories that have been used to rationalize the sex ratio discrepancy. The Extreme Male Brain Theory links ASD susceptibility to morphological differences such as the total size or volume, white and gray matter ratio, or hemispheric connectivity between male and female brains. This theory states that the male brain is more fit for systemizing, while the female brain is more fit for empathizing, and that ASD is an extreme of the normal male profile. Systemizing is defined as “the ability of analyzing a system and understanding the rules that govern it,” while empathizing is defined as “to identify mental states and to respond with appropriate emotions.” This indicates that a person with ASD would have a very good ability to systemize but is unable to empathize. A major issue with this theory is that it reinforces a negative stereotype that people with ASD lack remorse and ability to sympathize and empathize. In contrast, the Female Autism Phenotype Theory states that female specific manifestations of ASD do not fit the current conceptualizations of the disorder. This relates back to earlier mentioned differences in core symptoms as well as the idea that women with ASD have been found to show greater social motivation, capacity for friendship, and pragmatic social communication. Napolitano, A., Schiavi, S., La Rosa, P., Rossi-Espagnet, M. C., Petrillo, S., Bottino, F., Tagliente, E., Longo, D., Lupi, E., Casula, L., Valeri, G., Piemonte, F., Trezza, V., & Vicari, S. (2022). Sex Differences in Autism Spectrum Disorder: Diagnostic, Neurobiological, and Behavioral Features. Frontiers in psychiatry, 13, 889636. https://doi.org/10.3389/fpsyt.2022.889636
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Author: Ashley Lopez-Hernandez Adolescence is a period of emotional complexity, filled with social interactions that shape a young person's identity and relationships. For autistic adolescents, one of the core challenges during this time involves interpreting emotional cues, especially facial expressions. This difficulty in reading emotions doesn't just impact social understanding it can also intensify feelings of anxiety and isolation. How Emotion Interpretation Differs in Autism Autistic adolescents often experience differences in how they perceive facial expressions, particularly in identifying whether an emotion is genuine or safe to approach. A 2024 study published by Bothe et al. found that autistic traits are associated with "...difficulty in perceptual discrimination, labeling facial expressions, discriminating the genuineness of facial expressions, and differences in making social decisions relating to facial expressions" regardless of whether individuals also experienced Alexithymia -the difficulty in identifying and describing one’s own emotions- (Bothe et al., 2024, p. 1333). This means that even without difficulty in recognizing their own emotions, autistic individuals may still struggle to assess whether someone is sincere or emotionally approachable. In particular, the study highlights that many autistic individuals were less accurate in evaluating smiles. It was found that "autistic-like social skills predicted less typical approach judgements of genuine, but not posed, happy expressions, reflecting a reduced willingness to approach genuinely happy faces." (Bothe et al., 2024, p. 1331). This can be confusing in social interactions, increasing the risk of misunderstanding individuals' intentions and emotions. Why Misreading Emotions Contributes to Anxiety For most, facial expressions provide valuable feedback about social safety, inclusion, and rejection. However, when facial cues are difficult to decode, this lack of clarity can contribute to heightened anxiety. Social environments become unpredictable when one cannot determine if a peer is being kind, sarcastic, judgmental, or indifferent. This uncertainty may cause autistic teens to withdraw from social situations or avoid interactions all together. Over time, consistent avoidance behavior can lead to the development of social anxiety or exacerbate existing anxiety disorders. A comprehensive study by Hunsche et al. (2022) supports this connection, noting that poor theory of mind- which refers to the ability to infer the thoughts, emotions, and intentions of others- as well as similar social differences “may lead to greater peer rejection or to a sense of unpredictability and confusion in social interactions, which may then contribute to the development of social fears."(p. 199). This contribution to social fears can drastically impact anxiety levels for some Autistic adolescence. Therefore, it can be inferred that when Autistic adolescents repeatedly misinterpret social feedback, it not only impairs relationship-building but reinforces a sense of being “out of sync” with the social world around them. Addressing Emotional Misinterpretation in Therapy Given the role of misinterpreting emotions in autistic anxiety, treatment approaches need to address both social cognition and emotional regulation. Theory of Mind (ToM) and facial emotion recognition interventions, when adapted for autistic youth, has shown significant promise. The Hunsche et al. (2022) study found that providing social skills training opportunities to autistic adolescence " ...may reduce the uncertainty and confusion of social interactions and provide the option to exercise neurotypical social skills when needed, the pros (e.g., greater social acceptance.."(p. 205). Interventions integrating facial expression training, emotion labeling, and social scripts can help autistic adolescents feel more confident in social environments. Building this foundation of emotional literacy can reduce social misinterpretations and, in turn, lower social anxiety levels. Conclusion Understanding emotions is a key component of social functioning. For autistic adolescents, differences in emotional interpretation are not merely a communication barrier; they are tied to experiences of anxiety. As research from Bothe et al. (2024) and Hunsche et al. (2022) demonstrates, acknowledging and supporting these differences through targeted interventions can lead to more meaningful social engagement and improved mental health outcomes. By validating the emotional experiences of autistic youth and equipping them with tools to navigate the social world, we move closer to a more inclusive and supportive approach to adolescent development. Bothe, E., Jeffery, L., Dawel, A., Donatti-Liddelow, B., & Palermo, R. (2024). Autistic traits are associated with differences in the perception of genuineness and approachability in emotional facial expressions, independently of alexithymia. Emotion, 24(5), 1322–1337. https://doi.org/10.1037/emo0001350
Hunsche, M. C., Cervin, M., Storch, E. A., Kendall, P. C., Wood, J. J., & Kerns, C. M. (2022). Social functioning and the presentation of anxiety in children on the autism spectrum: A multimethod, multiinformant analysis. Journal of Psychopathology and Clinical Science, 131(2), 198-208. doi: https://doi.org/10.1037/abn0000724 By: Janae HerseyThis week's article discussed Camouflaging in autistic adult populations. This qualitative study included the experiences of both clinically and self-diagnosed individuals, providing insight into their thoughts, feelings and motivations behind camouflaging. This study helps shed light on this widely unknown behavior.
Camouflaging is described as the act of appearing more social or mirroring the social behaviors of other people to blend in in social settings. While anyone can camouflage, this is an article specifically focused on autistic individuals. The dangers reported in this article discussed how engaging in camouflage on a daily basis was exhausting and stressful, leaving individuals feeling cognitively overloaded. They described that they felt as though their brains were always working. Others reported that they felt like they couldn’t meet their basic needs because camouflaging was so draining. Some reported feeling better after resting but noted that there isn’t always much time to do so. These reports explain why many individuals related camouflaging to poor mental health outcomes. Depression, anxiety, suicidal thoughts, self-harm, and negative alcohol behaviors were reported in response to avoiding their awareness of social self. The third danger reported was that others often failed to accept the individuals when they were no longer camouflaging. Because of this, individuals reported feeling like they had to keep camouflaging to avoid being bullied, abused, or socially excluded. Not wishing to forfeit social acceptance, individuals continued even despite feeling inauthentic. As a result, many reported that the fear of losing social acceptance led them to isolate themselves completely. The last danger that was discussed was that camouflaging creates unreal perceptions of people with Autism. What the participants meant by this was that other people often do not believe that they are autistic, that they do not get enough recognition of their difficulties, or that people often get offended by them or think they are being fake when they are not camouflaging. Some even stated that camouflaging caused a delay in getting a formal diagnosis. They believe this would have been helpful when they were younger, potentially decreasing being hurt, by themselves or by others. The benefits the participants reported were that camouflaging helped them survive in society. They reported how there weren't many resources for them so camouflaging kept them out of bad places, alleviated bullying, or lessened the threat of being attacked. Some said it allowed them to better access the outside world, get jobs, meet people, make friends, and help with their partners and children. Others reported that they feel like it made them build resilience. They believe they built this resilience as a result of overcoming obstacles in society. When it came to the participants who do not camouflage, there were many different reasons for why they do not. Some reported stopping after they got their clinical diagnosis to preserve their mental health and also to educate others about Autism. Some believed that they were not that good at it and decided it was not worth it while others thought it only benefited the people around them, not themselves. Others reported only doing it around people who they do not know or do not understand, love, or feel supported by. It was also discussed that stopping the action of camouflaging was difficult, but some stated that it was rewarding as they reported feeling more positive, accepted, and confident. In our lab discussion, we brought up that not having to camouflage would be helpful for many people. We mentioned how camouflaging is different from code switching, which is usually only for a short period of time, at a specific event, and does not have the same risks as camouflaging. In general, it was our opinion that there were more negatives than positives to camouflaging. People generally have a lack of understanding about autism. A lack of awareness can cause camouflaging to happen for a long time, leading to the potential risks listed above. As a lab, we will continue working to reduce the need for camouflaging by fostering greater understanding and inclusivity for our participants with autism. Reference: Bradley, L., Shaw, R., Baron-Cohen, S., Cassidy, S. (2021, December 7). Autistic Adults’ Experiences of Camouflaging and Its Perceived Impact on Mental Health. Autism in Adulthood. Retrieved from https://www.liebertpub.com/doi/full/10.1089/aut.2020.0071 Author: Isabelle SutherlandThe impacts of poverty extend beyond having your power turned off and being unable to afford rent. It affects the body internally, particularly in early brain development and cognitive ability. The National Institutes of Health (NIH) has conducted numerous studies examining the development of the cerebral cortex in impoverished children, consistently finding a decrease in volume of gray matter compared to children from more financially secure households. Household eligibility for the federal poverty line is determined by family size and total income. In the United States, the average family typically has two children, with a mean federal poverty threshold of $21,250 per year for this family size (American Council on Aging, 2025). A cross-sectional study with 389 child participants found that those whose household’s income was 1.5 times above the federal poverty line had a 3-4% reduction in gray matter in the frontal cortex (related to higher level cognitive processes), temporal cortex (auditory and emotional processing), and the hippocampus (site of declarative and episodic memory). For children living at the federal poverty line, gray matter reductions were significantly greater, ranging from 8% to 9% (Hair et al., 2015). These results align with a study conducted by the NIH (Tomalski et al., 2013), which used electroencephalogram (EEG) technology to investigate baseline brain activity in the gamma frequency range (linked to higher-order executive functions) of 6- to 9-month-old infants from lower socioeconomic status families. The EEGs recorded lower high-frequency brain activity in the prefrontal cortex, suggesting potential disruptions in cognitive functions related to attention, decision-making, problem-solving, and emotional regulation as the infants mature (Tomalski et al., 2013).
Reduced cortical mass in the brain is an equifinal event that cannot be restricted to socioeconomic status. Restriction of resources extended to the child, such as food resulting in poor nutrition, inadequate housing, and lack of access to healthcare can occur due to many factors and are not exhaustive in contributing to poor brain development. Excessive exposure to loud noises, regular chaos, and conflict among family members can serve as chronic stressors to a child causing the release of the stress hormone cortisol. Elevated levels of this hormone are associated with changes in the volume of the amygdala (a brain region responsible for processing fear and anxiety), as well as atrophy of the hippocampus and dendrites of pyramidal neurons critical to communication between the prefrontal cortex and numerous regions throughout the brain (Liston et al., 2006). Consequently, stress responses that hinder problem-solving and planning could potentially develop heightened reactivity and difficulties with attention and social cognition. Poverty is a multifactorial issue, meaning there is not one solution to resolve it. However, there are actions that can counteract its negative effects. Positive parenting behaviors are attributed to lower cortisol levels in children and higher executive function. Despite the socioeconomic status of a child’s household, they are far more likely to be well-adjusted with a parent that offers warmth, affection, and emotional support. Screening children and their parents for mental health risks, followed with referrals to services is another way to reduce potential stress impact on a child. With the appropriate guidance, improvements in mental health and parenting styles can be achieved (Luby et al., 2018). Several studies have demonstrated that high-quality education can combat poor brain development (Luby et al., 2018) by significantly improving neurocognitive ability, regulation of attention, and the speed at which information is processed (Blair & Raver, 2015). One step in fighting poverty is to help parents build higher levels of human capital in order to increase their federal and state incomes so they can rise above the poverty line (Luby et al., 2018). America’s College Promise Act is a proposed bill that aims to drastically lower the cost of community, technical, and tribal colleges for lower-income adults (Granville, 2023). If passed through legislation, young parents could attend college and strengthen their earning potential to exit poverty and its associated stressors. By helping parents who are struggling financially to rise economically and deliver intentional parenting approaches, impoverished children can have greater opportunities for success, improving their developmental outcomes. References American Council on Aging. (2025). Federal poverty guidelines / levels for 2025 & their relevance to Medicaid eligibility. MedicaidPlanningAssistance.org. https://www.medicaidplanningassistance.org/federal-poverty-guidelines/. Blair, C., & Raver, C. C. (2015). Closing the achievement gap through modification of neurocognitive and neuroendocrine function: Results from a cluster randomized controlled trial of an innovative approach to the education of children in kindergarten. Proceedings of the National Academy of Sciences, 112(43), 13775–13780. https://doi.org/10.1073/pnas.1512276112. Granville, P. (2023, October 17). How America’s College Promise would reshape the free college landscape. The Century Foundation. https://tcf.org/content/report/how-americas-college-promise-would-reshape-the-free-college-landscape/ Hair, N. L., Hanson, J. L., Wolfe, B. L., & Pollak, S. D. (2015). Association of child poverty, brain development, and academic achievement. JAMA Pediatrics, 169(9), 822–829. https://doi.org/10.1001/jamapediatrics.2015.1475. Liston, C., Miller, M. M., Goldwater, D. S., & others. (2006). Stress-induced alterations in prefrontal cortical dendritic morphology predict selective impairments in perceptual attentional set-shifting. Journal of Neuroscience, 26(30), 7810–7818. https://doi.org/10.1523/JNEUROSCI.1245-06.2006 Luby, J., Belden, A., Harms, M. P., Tillman, R., & Barch, D. (2018). Poverty, stress, and brain development: New directions for prevention and intervention. JAMA Pediatrics, 172(9), 810–811. https://doi.org/10.1001/jamapediatrics.2018.1326. Tomalski, P., Moore, D. G., Ribeiro, H., & others. (2013). Socioeconomic status and functional brain development—Associations in early infancy. Developmental Science, 16(5), 676–687. https://doi.org/10.1111/desc.12079 Author: Ashley Lopez-Hernandez Thirteen-year-old AJ Peterman is one of many children benefiting from mobile EEG testing, a groundbreaking approach pioneered by psychologist Caitlin Hudac at the University of South Carolina. As part of her research in the Brain Research Across Development (B-RAD) lab, Dr. Hudac and her team bring their equipment directly into participants’ homes, making it easier for families—especially those in underserved areas—to participate in autism and neurodevelopmental research. According to Erskine (2025) in the article "USC Psychologist Uses Mobile EEG to Break Down Barriers," Hudac and her team share AJ’s experience as a participant in their study. AJ, who is autistic, first joined the research after his mother, Akira Peterman, sought resources for autistic children in their community. Living in Sumter, South Carolina, the Peterman family faces long commutes to access specialized services. To address this challenge, Hudac’s team set up their mobile EEG lab in the Petermans’ home, allowing AJ to comfortably undergo his eighth EEG test while engaging in familiar activities, such as watching videos and interacting with family members. A More Accessible Approach to ResearchThis mobile approach was born out of necessity during the COVID-19 pandemic when travel restrictions disrupted Hudac’s initial research plans. Rather than pause her research, she traveled across the country, testing more than 55 participants with rare genetic conditions such as GRIN2B, SCN2A, and SETBP1 in 90 days. This shift not only made participation easier for families but also improved the testing experience—children felt more at ease in their familiar surroundings, especially those with complex medical symptoms like epilepsy, motor delays, and autism. Now, with funding from the SETBP1 Society, the Orphan Disease Center, and a McCausland Faculty Fellowship, Hudac’steam continues to expand its reach. While studying rare genetic conditions linked to autism, they also rely on neurotypical and autistic participants like AJ to form comparison groups, helping researchers build a more complete picture of autism and neurodevelopmental differences. By comparing EEG measurements across different ages and diagnoses, they aim to understand how rare genetic conditions influence development and their connection to autistic symptoms. Hudac, S. (2025, March 14). "There's a lot of evidence to suggest that all autism is genetic. It's just a matter of have we discovered it or not," Hudac explains. "We currently know about a quarter of autism cases are linked to a known genetic etiology, which is important to emphasize." In Laura Erskine, USC psychologist uses mobile EEG to break down barriers to research. While Hudac’s team has traveled across the U.S. to test children with the SETBP1 gene variant, their long-term goal is to expand internationally to reach more families affected by rare disorders. Expanding and Representation in ScienceDr. Hudac's goal is to make mobile EEG testing accessible not only to participants with rare genetic disorders but also to individuals like AJ’s family in rural communities who face challenges traveling to USC’s lab. By bringing research directly to families, Hudac aims to broaden participation in neuroscience studies and ensure more inclusive representation in autism research. ReferenceErskine, L. (2025, March 14). USC psychologist uses mobile EEG to break down barriers to research. University of South Carolina. https://www.sc.edu/uofsc/posts/2025/03/hudac-mobile-eeg-research.php
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