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To what extent can autism be described as a 'male brain' disorder?
Hans Asperger, one of the earliest academics to write about Autism, was the first to informally suggest the idea that the traits of Autism were 'extreme male brain' traits – "The autistic personality is an extreme variant of male intelligence…. in the autistic individual the male pattern is exaggerated to the extreme." (Translated and cited by Frith, 1991, pg. 37, chapter II, "Autistic Psychopathy in Children").
Recently, compelling comparisons have been drawn between the psychometric profile of a typical 'male brain' and that of an 'autistic brain'. Research has suggested that the 'autistic type brain' does in fact resemble an extreme form of the normal 'male brain'. In order to assess what extent Autism can be described as a 'male brain' disorder, it is important to analyse the idea of male/female brain differences, relate these to autistic traits and also to look into the research evidence and the possibility of a biological basis for the assertion.
There has been much evidence cited for the hypothesis that male and females differ in cognition style. In a review of this evidence, Baron-Cohen (1999) summarises that females as a group have been found to be typically stronger on language tasks, tests of social judgement, measures of empathy and co-operation, pretend play and ideational fluency. Men have been found to be stronger at mathematical reasoning, the embedded figures task, the mental rotation task and spatial skills. Baron-Cohen (1999) conceptualized the two cognitive types as 'folk psychology' and 'folk physics', with 'folk psychology broadly defined as 'mind reading' and 'folk physics' as an understanding of physical objects. It was suggested that the 'female type brain' is more adept at 'folk psychology' and the 'male type brain' is more adept at 'folk physics'. More recently (Baron-Cohen, 2002), this idea has been developed into 'The Empathising – Systematising Model', which proposes two psychological dimensions – empathizing and systematizing. It is proposed that it is these two dimensions that the male and female brain types differ upon. Systematising is defined as the drive to analyse and build systems, with the aim of understanding and predicting non-agentive events and empathizing is defined as the drive to identify emotions and thoughts in others and to react to these appropriately. It is thought that systematizing is shown more strongly in the male type brain and empathizing more in the female type brain.
It has been noted that males tend to represent a disproportionate majority of cases of Autism. Gillberg (1989) found a ratio of 10:1 males to females being diagnosed with Asperger's syndrome (thought to be a higher functioning Autism). This observation has therefore lead to researchers looking closely at the male brain type traits that manifest with the disorder. It has been proposed that autistic traits represent extreme male brain characteristics (Baron-Cohen, 1999, 2002), that is; autistic individuals are extreme systematisers and very poor empathisers.
DSM IV (1994) diagnoses Autism on the basis of abnormal social development, abnormal communicative development, and the presence of narrow, restricted interests, and repetitive activity along with poor imaginative ability. These features of Autism do seem to be extremes of the normal male brain traits discussed earlier; the lack of social and communicative development as well as poor imaginative ability seem to relate to individuals being low on the 'empathiser' dimension. Indeed, a lot of research into the causes of Autism has centered around the idea of autistic people lacking a 'Theory of Mind'. Theory of mind can be described as the ability to attribute mental states to the self and others. Clearly an intact 'Theory of Mind' would be crucial in order for an individual to be an 'empathiser', suggesting that autistic individuals are indeed lacking in this 'female brain trait'. In a similar way, the characteristic repetitive behaviour and the presence of restricted, narrow interests can be seen as indicative of the extreme presence of the male 'systematiser' trait. People with this trait have a drive to understand the world through regular rules and systems and are therefore more likely to show the obsessional traits found in autistic individuals. Indeed, the observation that many autistic individuals have 'islets of ability' in areas such as mathematics would support the view of them as extreme 'systematisers'. Various observations by researchers seem to provide evidence for this idea of Autism as an extreme male brain disorder. For example, normal males are slower to develop language than females and autistic individuals are even more delayed in language development (Rutter, 1978). Similarly, normal males are found to be slower than females in social development and autistic individuals are even more delayed in social development (O’Riordan, Baron-Cohen, Jones, Stone, and Plaisted, 1996). In 'theory of mind' tasks, which involve 'mind reading', girls have been found to perform better than boys and children with Autism to perform even more poorly (Happe, 1995).
Clearly, on initial observation and comparison of autistic traits and 'male brain traits', the suggestion that Autism can be described as a 'male brain' disorder does therefore seem very feasible and seems to make immediate 'sense', however for this claim to be fully evaluated, empirical research relating to the parallels between males in the general population and autistic individuals must be considered.
Early research carried out by Baron-Cohen et al (2001) indicated that males in the general population showed more autistic traits, which would indeed be expected if Autism is indeed a 'male brain' disorder. In this study a questionnaire style instrument was developed in order to test an individual's Autism-Spectrum Quotient (AQ). It was found that males scored significantly higher than females on this measure and whilst no 'normal' females scored extremely highly, 4% of males did so.
One prominent feature of Autism is a lack of social interaction and social bonding behaviour. Baron-Cohen and Wheelwright (2003) investigated sex differences in this area using a new measure – the friendship questionnaire (FQ), which was designed to assess individual attitudes to friendship and social interaction. It was found that females scored significantly higher than males on this measure – showing that they enjoy close, empathetic, supportive, caring friendships that are important to them and also that they like interacting with people. When the test was subsequently given to a group of individuals with Asperger's syndrome, it was found that this group scored significantly lower than both normal male and females. Again, this supports the idea that Autism represents an extreme of the 'male brain' type, since the autistic group showed an exaggerated version of the difference between normal males and females.
To test the relationship between normals and autistic individuals on the specific 'male' and 'female' dimensions of empathizer and systematiser, two measures were developed – the Systematizing Quotient (SQ) (Baron-Cohen et al, 2003) and the Empathy Quotient (EQ) (Baron-Cohen and Wheelwright, 2004). Using these measures on a general population sample, it was shown that males demonstrated higher SQ and lower EQ scores than females did, as would be expected by the systematiser – empathizer theory of sex differences in cognitive domains. It was also shown that individuals with Asperger's syndrome scored even higher on the SQ and even lower on the EQ than male normals. Again, this is very compelling evidence suggesting Autism is an extreme 'male brain' disorder.
It has been suggested that rather than having a bias towards systematizing, as this research suggests, these results could be indicative of individuals with Autism suffering from 'weak central coherence' (Frith, 1989). In this theory, it is suggested that autistic individuals lack the cognitive ability to see things as a whole and rather they can only see the components that make the whole. The behaviours seen in autistic individuals may represent a focus upon local processing, arising from a deficit in global processing. The weakness of these people on empathizing tasks is explained by this theory as the individual not being able to take the whole context of the situation in to account and therefore not having a full understanding of it. Whilst this theory does raise another possible explanation for the findings above, it does not seem to corroborate fully with observations of autistic ability. It has been noted that autistic 'savants' are able to successfully understand overall rules for a system, which is not as weak central coherence would predict, whereas the systematiser theory predicts exactly this type of behaviour.
A weakness of Baron-Cohen's theory seems to be that it does not provide an explanation of why Autism represents extreme male brain traits. There have, however, been some attempts to understand the biological basis for this 'extreme male brain', focusing upon structural brain differences and possible reasons for these. As yet this evidence is limited.
Various studies have found differences in the structure of the brain of autistic individuals that are also found between normal male and female individuals. For example, it has been found that normal males have a smaller corpus callosum than females and that people with Autism tend to show this difference to more of an extreme (Egaas, Courchesne and Saitou, 1994). Whilst this study does suggest a biological link between the autistic brain and the typical male brain, it is unclear why this link causes the specific traits that have been discussed. Promising early research has suggested that the amygdala may be directly involved in empathizing (Baron-Cohen et al, 2000) and it has also been found that autistic people have an abnormally sized amygdala. This route of research may be able to provide an explanation of why autistic people show the 'male' trait of low empathizing ability, however, as yet, evidence is limited.
Recently, studies have looked in to the role of foetal testosterone levels and the effect that these have on the ability to socialize in childhood. This research may be able to help to explain why autistic individuals are poor at social abilities and instead show extreme 'male' patterns of ability and interest. Lutchmayer, Baron-Cohen and Raggat (2002) measured foetal testosterone in amniotic fluid and compared individuals on amount of eye contact in mother-child interactions at the age of 12 months. They found that there was a relationship between levels of testosterone and amount of eye contact, with higher testosterone levels producing less eye contact. Similarly, Knickmeyer et al (2005) found that foetal testosterone levels were negatively correlated with quality of social relationships and positively correlated with restricted interests in boys. These findings indicate that testosterone levels pre-natally affect the dimensions of empathizer and systematiser, since eye contact and the quality of social relationships can be measures of empathy and restricted interests can signal a strong systematiser. Clearly this could be the key to understanding why it may be that autistic individuals show extreme male traits – it may be that they have experienced abnormal levels of testosterone pre-natally. Whilst this appears to be a promising theory, what is necessary is a longitudinal study in which data relating to prenatal testosterone levels of children who later present with Autism is gathered. It might be expected that these individuals have very high levels of testosterone, which in turn leads to the development of an extreme male brain. This theory has the advantage of being able to explain why some females are found to have Autism. It has been suggested that the extreme-male-brain hypothesis is weak because it does not explain how it is that females come to have Autism. The prenatal testosterone hypothesis could explain this, since both sexes are affected by early testosterone levels. This theory would also explain why it is that more boys are found to have Autism, since presumably boys have a higher 'base level' of testosterone, so it takes a smaller imbalance to produce extreme testosterone levels.
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It seems that the extreme male brain theory of Autism is a very successful tool at describing the disorder and provides good explanations of the array of symptoms involved. What does seem to be a current weakness in this theory is not so much the extent to which it can describe Autism, but rather the extent to which it can explain the aetiology of Autism. Inroads have been made into relating this theory to biology and the involvement of prenatal testosterone and also of the amygdala seem to be promising routes of research that may provide a leap in our understanding of Autistic Spectrum Disorders in the future.
Bibliography
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