Does recent research into autism suggest real differences between male and female handling of consciousness?
Traditionally, autism has been regarded as an overwhelmingly male condition. Recently, though it has been suggested that the gender gap is not as great as it seems; it’s just that most women with autism go undiagnosed. How can that be? It is hypothesised that some sufferers are able to ‘camouflage’ the symptoms of their autism, and that this suppression of symptoms is particularly prevalent among women.
‘Camouflaging’ means learning normal social behaviours such as giving others appropriate eye contact, interpreting and using appropriate facial expressions, and so on. But surely, that’s just what normal people do? If you can learn these behaviours, doesn’t that mean you’re not autistic any more?
There’s a subtle distinction here between doing what comes naturally and doing what you’ve learned to do. Camouflaging, on this view, requires significant intellectual resources and continuous effort, so that while camouflaged sufferers may lead apparently normal lives, they are likely to suffer other symptoms arising from the sheer mental effort they have to put in – fatigue, depression, and so on.
Measuring the level of camouflaging – which is obviously intended to be undetectable – obviously raises some methodological challenges. Now a study reported in the invaluable BPS Research Digest claims to have pulled it off. The research team used scanning and other approaches, but their main tool was to contrast two different well-established methods of assessing autism – the Autism Diagnostic Observation Schedule on the one hand and the Autism Spectrum Quotient on the other. While the former assesses ‘external’ qualities such as behaviour, the latter measures ‘internal’ ones. Putting it crudely, they measure what you actually do and what you’d like to do respectively. The ratio between the two scores yields a measure of how much camouflaging is going on, and in brief the results confirm that camouflaging is present to a far greater degree in women. I think in fact it’s possible the results are understated; all of the subjects were people who had already been diagnosed with autism; that criterion may have selected women who were atypically low in the level of camouflaging, precisely because women who do a lot of camouflaging would be more likely to escape diagnosis.
The research is obviously welcome because it might help improve diagnosis rates for women, but also because a more equal rate of autism for men and women perhaps helps to dispel the idea, formerly popular but (to me at least) rather unpalatable, that autism is really little more than typical male behaviour exaggerated to unacceptable levels.
It does not eliminate the tricky gender issues, though. One thing that surely needs to be taken into account is the possibility that accommodating social pressures is something women do more of anyway. It is plausible (isn’t it?) that even among typical average people, women devote more effort to social signals, listening and responding, laughing politely at jokes, and so on. It might be that there is a base level of activity among women devoted to ‘camouflaging’ normal irritation, impatience, and boredom which is largely absent in men, a baseline against which the findings for people with autism should properly be assessed. It might have been interesting to test a selection of non-autistic people, if that makes sense in terms of the tests. How far the general underlying difference, if it exists, might be due to genetics, socialisation, or other factors is a thorny question.
At any rate, it seems to me inescapable that what the study is really attempting to do with its distinction between outward behaviour and inward states, is to measure the difference between unconscious and conscious control of behaviour. That subtle distinction, mentioned above, between natural and learned behaviour is really the distinction between things you don’t have to think about, and things that require constant, conscious attention. Perhaps we might draw a parallel of sorts with other kinds of automatic behaviour. Normally, a lot of things we do, such as walking, require no particular thought. All that stuff, once learned, is taken care of by the cerebellum and the cortex need not be troubled (disclaimer: I am not a neurologist). But people who have their cerebellum completely removed can apparently continue to function: they just have to think about every step all the time, which imposes considerable strain after a while. However, there’s no special organ analogous to the cerebellum that records our social routines, and so far as I know it’s not clear whether the blend of instinct and learning is similar either.
In one respect the study might be thought to open up a promising avenue for new therapeutic approaches. If women can, to a great extent, learn to compensate consciously for autism, and if that ability is to a great extent a result of social conditioning, then in principle one option would be to help male autism sufferers achieve the same thing through applying similar socialisation. Although camouflaging evidently has its downsides, it might still be a trick worth learning. I doubt if it is as simple as that, though; an awful lot of regimes have been tried out on male sufferers and to date I don’t believe the levels of success have been that great; on the other hand it may be that pervasive, ubiquitous social pressure is different in kind from training or special regimes and not so easily deployed therapeutically. The only way might be to bring up autistic boys as girls…
If we take the other view, that women’s ability or predisposition to camouflage is not the result of social conditioning, then we might be inclined to look for genuine ‘hard-wired’ differences in the operation of male and female consciousness. One route to take from there would be to relate the difference to the suggested ability of women (already a cornerstone of gender-related folk psychology) to multi-task more effectively, dividing conscious attention without significant loss to the efficiency of each thread. Certainly one would suppose that having to pay constant attention to detailed social cues would have an impact on the ability to pay attention to other things, but so far as I know there is no evidence that women with camouflaged autism are any worse at paying attention generally than anyone else. Perhaps this is a particular skill of the female mind, while if men pay that much attention to social cues, their ability to listen to what is actually being said is sensibly degraded?
The speculative ice out here is getting thinner than I like, so I’ll leave it there; but in all seriousness, any study that takes us forward in this area, as this one seems to do, must be very warmly welcomed.