Quantifying and exploring camouflaging in men and women with autism

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Abstract

Autobiographical descriptions and clinician observations suggest that some individuals with autism, particularly females, ‘camouflage’ their social communication difficulties, which may require considerable cognitive effort and lead to increased stress, anxiety and depression. Using data from 60 age- and IQ-matched men and women with autism (without intellectual disability), we operationalized camouflaging in adults with autism for the first time as the quantitative discrepancy between the person’s ‘external’ behavioural presentation in social–interpersonal contexts (measured by the Autism Diagnostic Observation Schedule) and the person’s ‘internal’ status (dispositional traits measured by the Autism Spectrum Quotient and social cognitive capability measured by the ‘Reading the Mind in the Eyes’ Test). We found that the operationalized camouflaging measure was not significantly correlated with age or IQ. On average, women with autism had higher camouflaging scores than men with autism (Cohen’s d = 0.98), with substantial variability in both groups. Greater camouflaging was associated with more depressive symptoms in men and better signal-detection sensitivity in women with autism. The neuroanatomical association with camouflaging score was largely sex/gender-dependent and significant only in women: from reverse inference, the most correlated cognitive terms were about emotion and memory. The underlying constructs, measurement, mechanisms, consequences and heterogeneity of camouflaging in autism warrant further investigation.

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Most cited references 36

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False discovery rate revisited: FDR and topological inference using Gaussian random fields.

Justin R Chumbley, J. Chumbley (2009)

In this note, we revisit earlier work on false discovery rate (FDR) and evaluate it in relation to topological inference in statistical parametric mapping. We note that controlling the false discovery rate of voxels is not equivalent to controlling the false discovery rate of activations. This is a problem that is unique to inference on images, in which the underlying signal is continuous (i.e., signal which does not have a compact support). In brief, inference based on conventional voxel-wise FDR procedures is not appropriate for inferences on the topological features of a statistical parametric map (SPM), such as peaks or regions of activation. We describe the nature of the problem, illustrate it with some examples and suggest a simple solution based on controlling the false discovery rate of connected excursion sets within an SPM, characterised by their volume.

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Biological sex affects the neurobiology of autism

Meng-Chuan Lai, Michael V Lombardo, John Suckling … (2013)

In autism, heterogeneity is the rule rather than the exception. One obvious source of heterogeneity is biological sex. Since autism was first recognized, males with autism have disproportionately skewed research. Females with autism have thus been relatively overlooked, and have generally been assumed to have the same underlying neurobiology as males with autism. Growing evidence, however, suggests that this is an oversimplification that risks obscuring the biological base of autism. This study seeks to answer two questions about how autism is modulated by biological sex at the level of the brain: (i) is the neuroanatomy of autism different in males and females? and (ii) does the neuroanatomy of autism fit predictions from the ‘extreme male brain’ theory of autism, in males and/or in females? Neuroanatomical features derived from voxel-based morphometry were compared in a sample of equal-sized high-functioning male and female adults with and without autism (n = 120, n = 30/group). The first question was investigated using a 2 × 2 factorial design, and by spatial overlap analyses of the neuroanatomy of autism in males and females. The second question was tested through spatial overlap analyses of specific patterns predicted by the extreme male brain theory. We found that the neuroanatomy of autism differed between adult males and females, evidenced by minimal spatial overlap (not different from that occurred under random condition) in both grey and white matter, and substantially large white matter regions showing significant sex × diagnosis interactions in the 2 × 2 factorial design. These suggest that autism manifests differently by biological sex. Furthermore, atypical brain areas in females with autism substantially and non-randomly (P < 0.001) overlapped with areas that were sexually dimorphic in neurotypical controls, in both grey and white matter, suggesting neural ‘masculinization’. This was not seen in males with autism. How differences in neuroanatomy relate to the similarities in cognition between males and females with autism remains to be understood. Future research should stratify by biological sex to reduce heterogeneity and to provide greater insight into the neurobiology of autism.

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Sex differences in the evaluation and diagnosis of autism spectrum disorders among children.

Ellen Giarelli, Lisa D Wiggins, Catherine Rice … (2010)

One of the most consistent features of the autism spectrum disorders (ASDs) is the predominance among males, with approximately four males to every female. We sought to examine sex differences among children who met case definition for ASD in a large, population-based cohort with respect to age at first developmental evaluation, age of diagnosis, influence of cognitive impairment on these outcomes, and sex-specific behavioral characteristics. We conducted a secondary analysis of data collected for a population-based study of the prevalence of ASD. The sample comprised 2,568 children born in 1994 who met the case definition of ASD as established by the Autism and Developmental Disabilities Monitoring (ADDM) Network for ASD surveillance. Children who had a history of developmental disability and behavioral features consistent with the DSM-IV-TR criteria for autistic disorder, Asperger's disorder, and Pervasive Developmental Disorder-Not Otherwise Specified in existing evaluation records were classified as ASD cases via two paths: streamlined and nonstreamlined. Streamlined reviews were conducted if there was an ASD diagnosis documented in the records. Data were collected in 13 sites across the United States through the ADDM Network, funded by the Centers for Disease Control and Prevention. Males constituted 81% of the sample. There were no differences by sex in average age at first evaluation or average age of diagnosis among those with an existing documented chart diagnosis of an ASD. Girls were less likely than boys to have a documented diagnosis (odds ratio [OR] = 0.76, p = .004). This analysis was adjusted for cognitive impairment status. In the logistic model, with the interaction term for sex and cognitive impairment, girls with IQ of 70 or less were less likely than boys with IQ of 70 or less to have a documented diagnosis (OR = 0.70, 95% confidence interval [CI] = 0.50-0.97, p = .035). Boys with IQ greater than 70 were less likely than boys with IQ of 70 or less to have a documented diagnosis (OR = 0.60, 95% CI = 0.49-0.74, p < .001). This finding (less likely to have a documented diagnosis) was also true for girls with IQ greater than 70 (OR = 0.45, 95% CI = 0.32-0.66, p < .001). Girls were more likely to have notations of seizure-like behavior (p < .001). Boys were more likely to have notations of hyperactivity or a short attention span and aggressive behavior (p < .01). Girls, especially those without cognitive impairment, may be formally identified at a later age than boys. This may delay referral for early intervention. Community education efforts should alert clinicians and parents to the potential of ASDs in boys and girls. Copyright © 2010 Elsevier Inc. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Autism

Journal ID (iso-abbrev): Autism

Journal ID (publisher-id): AUT

Journal ID (hwp): spaut

Title: Autism

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 1362-3613

ISSN (Electronic): 1461-7005

Publication date (Electronic): 29 November 2016

Publication date (Print): August 2017

Volume: 21

Issue: 6 , Special Issue on: Women and girls on the autism spectrum

Pages: 690-702

Affiliations

[1 ]Centre for Addiction and Mental Health, Canada

[2 ]The Hospital for Sick Children, Canada

[3 ]University of Toronto, Canada

[4 ]University of Cambridge, UK

[5 ]National Taiwan University Hospital, Taiwan

[6 ]University of Cyprus, Cyprus

[7 ]University of Reading, UK

[8 ]The University of Edinburgh, UK

[9 ]King’s College London, UK

[10 ]Cambridgeshire and Peterborough NHS Foundation Trust, UK

Author notes

[*]Meng-Chuan Lai, Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4, Canada. Email: mengchuan.lai@ 123456utoronto.ca

Article

Publisher ID: 10.1177_1362361316671012

DOI: 10.1177/1362361316671012

PMC ID: 5536256

PubMed ID: 27899710

SO-VID: d3539b3b-20a8-4af2-afb7-f27be3b23513

License:

This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Funding

Funded by: Innovative Medicines Initiative, ;

Award ID: 115300

Funded by: Medical Research Council, FundRef http://dx.doi.org/10.13039/501100000265;

Quantifying and exploring camouflaging in men and women with autism

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Most cited references 36

False discovery rate revisited: FDR and topological inference using Gaussian random fields.

Biological sex affects the neurobiology of autism

Sex differences in the evaluation and diagnosis of autism spectrum disorders among children.

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