Brief Report: Sex/Gender Differences in Symptomology and Camouflaging in Adults with Autism Spectrum Disorder

Schuck, Rachel K.; Flores, Ryan; Fung, Lawrence K.

doi:10.1007/s10803-019-03998-y

Cited by 114 publications

(102 citation statements)

References 42 publications

(56 reference statements)

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“…Camouflaging relates to a set of compensatory or masking strategies or mechanisms that allows individuals to cope with their socialcommunicative difficulties in everyday social situations 16,17,45 . It is known that cognitively able adult autistic females tend to engage in more camouflaging behavior than males [16][17][18] and the extent to which individual females engage in camouflaging is linked to vMPFC function 19 . One of the most important known functions of vMPFC has to do with self-representation 46 and simulating others based on information about the self 47 .…”

Section: Discussionmentioning

confidence: 99%

“…In prior task-evoked fMRI work we found a similar sex-by-diagnosis interaction in vMPFC self-representation response and a female-specific brain-behavioral correlation with camouflaging ability 19 . Given that adult autistic females engage more in camouflaging on-average [16][17][18] , we next tested the hypothesis of whether H as an index of intrinsic E:I balance, would be related to camouflaging in a sex-specific manner. In autistic females, increased camouflaging was strongly associated with increased H in vMPFC (r = 0.60, p = 0.001).…”

Section: Correlation Between H and Camouflaging In Autistic Women Butmentioning

confidence: 99%

“…Sex/gender heterogeneity may also lead to differing clinical presentations and compensatory mechanisms in autism. It is known that many cognitively able adult autistic women engage in camouflaging behaviors that tend to compensate or mask their social-communicative difficulties more so than males [16][17][18] . Prior work has shown that whereas autistic males show reduced ventral MPFC (vMPFC) self-representation neural response, autistic females show intact vMPFC function.…”

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confidence: 99%

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Intrinsic excitation-inhibition imbalance affects medial prefrontal cortex differently in autistic men versus women

Trakoshis

Martínez‐Cañada

Rocchi

et al. 2020

Preprint

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Imbalance between neurophysiological excitation versus inhibition (E:I) has been theorized as a core pathophysiological mechanism of autism. However, a majority of the evidence behind the E:I theory comes from animal models of rare genetic mutations that account for only a small fraction of the autistic population. Scale-free metrics of neural time-series data could represent biomarkers for E:I imbalance and could enable a greater understanding of how E:I imbalance affects different types of autistic individuals and how such mechanisms relate to behavior. Here we show that a measure of scale-free dynamics, the Hurst exponent (H), measured in-vivo in resting state fMRI (rsfMRI) data, is a surrogate marker of E:I imbalance and differentially affects autistic males versus females. In-silico modeling of local field potentials (LFP) from recurrent networks of interacting excitatory and inhibitory neurons shows that increasing the E:I ratio by specifically enhancing excitation attenuates H and flattens the 1/f slope. These in-silico predictions are confirmed in-vivo with chemogenetic manipulations to enhance excitation of prefrontal cortex in mice. In humans, social brain areas such as ventromedial prefrontal cortex (vMPFC), show decreased H specifically in autistic males but not females. However, continuous variation in vMPFC H correlates with ability to behaviorally camouflage social-communicative difficulties in autistic females but not males. This work provides insight into how in-vivo neuroimaging readouts can be utilized to understand E:I imbalance in human clinical populations. E:I imbalance in social brain circuitry may differentially affect autistic males versus females and may help explain sexrelated differences in compensatory phenomena.

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Section: Discussionmentioning

confidence: 99%

Section: Correlation Between H and Camouflaging In Autistic Women Butmentioning

confidence: 99%

mentioning

confidence: 99%

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Intrinsic excitation-inhibition imbalance affects medial prefrontal cortex differently in autistic men versus women

Trakoshis

Martínez‐Cañada

Rocchi

et al. 2020

Preprint

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“…One approach-the behaviourcognition discrepancy approach-operationalises compensation as the mismatch between observable behaviour and underlying cognition; that is to say, autistic 'compensators' should appear more neurotypical in behaviour than their cognitive profile would otherwise suggest. Accordingly, a handful of studies [2,3,13] have quantified social compensatory ability in ASD as the discrepancy between observerrated social skills and performance on social-cognitive tasks (e.g. measuring theory of the mind-the ability to understand other minds [14]).…”

Section: Approaches To Studying Compensation In Autismmentioning

confidence: 99%

Quantifying compensatory strategies in adults with and without diagnosed autism

et al. 2020

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Background: There is growing recognition that some autistic people engage in 'compensation', showing few behavioural symptoms (e.g. neurotypical social skills), despite continuing to experience autism-related cognitive difficulties (e.g. difficulties in social cognition). One way this might be achieved is by individuals consciously employing 'compensatory strategies' during everyday social interaction. However, very little is currently known about the broad range of these strategies, their mechanisms and consequences for clinical presentation and diagnosis. Methods:We aimed to measure compensatory strategies in autism for the first time. Using a novel checklist, we quantified self-reported social compensatory strategies in 117 adults (58 with autism, 59 without autism) and explored the relationships between compensation scores and autism diagnostic status, autistic traits, education level, sex and age at diagnosis.Results: Higher compensation scores-representing a greater repertoire of compensatory strategies-were associated with having an autism diagnosis, more autistic traits and a higher education level. The link between autism diagnostic status and compensation scores was, however, explained by autistic traits and education level. Compensation scores were unrelated to sex or age at diagnosis. Limitations: Our sample was self-selected and predominantly comprised of intellectually able females; therefore, our findings may not generalise to the wider autistic population.Conclusions: Together, our findings suggest that many intellectually able adults, with and without a clinical diagnosis of autism, report using compensatory strategies to modify their social behaviour. We discuss the clinical utility of measuring self-reported compensation (e.g., using our checklist), with important implications for the accurate diagnosis and management of autism and related conditions.

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“…An emerging line of research concerned with social coping examines ways in which autistic people camouflage during neuro-diverse social interactions (e.g. Dean et al, 2017;Hull et al, 2017;Lai et al, 2017;Schuck et al, 2019). Conceptualisations, definitions, and measures of camouflaging are in their infancy.…”

Section: Camouflaging Behaviours Used By Autistic Adults During Everymentioning

confidence: 99%

Camouflaging Behaviours Used by Autistic Adults During Everyday Social Interactions

Cook¹,

Crane²,

Hull³

et al. 2020

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Background Autistic people may modify their innate autistic social behaviours in order to adapt to, cope within, and/or influence the predominately neurotypical social landscape. We term such modified or changed behaviour “camouflaging behaviour.” Conceptualisations and definitions of camouflaging behaviours are in their infancy. Existing qualitative research examining camouflaging behaviours relies solely on retrospective accounts of camouflaging experiences. Methods Using Interpersonal Process Recall methodology (Kegan, 1969), 17 autistic adults (8 women, 6 men, and 3 agender/gender neutral) participated in a brief social task designed to replicate a common day-to-day social situation. Participants then watched a video of their interaction with a researcher, actively identifying and describing camouflaging behaviours. Interview transcripts were analysed using qualitative content analysis. Results Detailed descriptions of 37 camouflaging behaviours were generated. These behaviours were grouped into four categories: masking (hide particular behaviours and/or aspects of one’s identity); innocuous engagement (facilitate passive, conservative, and superficial engagement in social interactions); neurotypical communication (involve communicating in line with non-autistic norms and preferences); and active self-presentation (facilitate active, open, and reciprocal participation in social interactions). Limitations Given the IPR methodology utilised in the study, the results may not generalise to all social environments or autistic individuals. Conclusions This study extends the current understanding of camouflaging by generating novel, specific, and detailed information about camouflaging behaviours. These camouflaging behaviours are discussed with reference to literature concerning interpersonal research and theory within and outside the field of autism.

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Brief Report: Sex/Gender Differences in Symptomology and Camouflaging in Adults with Autism Spectrum Disorder

Cited by 114 publications

References 42 publications

Intrinsic excitation-inhibition imbalance affects medial prefrontal cortex differently in autistic men versus women

Intrinsic excitation-inhibition imbalance affects medial prefrontal cortex differently in autistic men versus women

Quantifying compensatory strategies in adults with and without diagnosed autism

Camouflaging Behaviours Used by Autistic Adults During Everyday Social Interactions

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