I think the fundamental problem of why we cannot understand the difference between males and females with autism is because we look at the condition as a overriding layer of a person’s self, and do not consider that whilst this does colour a lot of our thinking and behaviours, there is still the influence of personality, external inputs such as society, gender, past experiences, birth order, star signs, past lives (too far!?).
The point is we are all individual and unique already, and the autism mixes in with that. For example, when you see two people experiencing depression they may appear nothing alike. One may be bed bound, refusing to eat or talk, they have completely given up on life. Another may be found sobbing loudly at work as soon as anything goes wrong, telling people she’s just met about the Prozac her Drs recently prescribed her and how her therapist thinks it’s due to her mother’s emotional neglect. Yet there are also people who you wouldn’t even know had depression, they externally have not changed in the slightest. What makes people react so differently to the same illness? It is unfair to say it is due to severity, often those who commit suicide from depression are the ones you did not even suspect had any problems at all.
What it comes down to is individual personalities and experiences. The extravert who loves to be around people and who has never experienced rejection may be more likely to sob in public and not fear being seen, whilst the introvert who has been rejected in the past may keep their illness completely hidden, believing they are stupid to feel this way. Whilst we consider conditions like depression an illness, there is a similar affect with all psychiatric, developmental, and neurological conditions. This is why we become stuck with the very strict criteria of what autism is and what it looks like. We have a set off core symptoms that should be found in anyone with autism (social communication problems and restricted and repetitive behaviours), our mistake is to believe that these should look the same in everyone. It would be a much easier diagnosis if they did, but can we say that just because someone makes good eye contact they cannot be autistic? No, because there are many factors that make people more or less prone to make eye contact. The impairment is with social communication as a whole, and this may be something a person struggles with internally more than externally. For example someone with autism may really struggle to make small talk with another individual, but may have learnt ways to introduce themselves and keep a conversation going. It may be painfully awkward inside but outside not noticeable, that doesn’t mean the impairment isn’t there. What happens if you get an extremely extraverted autistic person? Will this look the same as an extremely introverted autistic person? What if you have an autistic person who has 5 brothers, compared to one who is an only child? Are they able to socialise better with their peers and be less rigid and self-orientated? The point is that impairments can be expressed in hundreds of different ways depending on an individual.
So when we compare males to females with autism, are we really looking at individual differences and how these play a role? If we take the Extreme Male Brain Theory, which attempts to summarise autism as an extreme form of the male brain, whereby individuals on the spectrum are quite low empathisers and high systemisers, we see a very set way or viewing autism which does not allow for individual differences. Instead of viewing autism as an extreme form of the male brain I would argue that autism is more a extreme hyper focussed selective brain. If you test mainly males for an extreme male brain, then of course you will find many have an extreme form of maleness, because they become hyperfocussed in their interests, and as they are men these will mostly be male orientated. So if more males are systemisers who like physics, then for sure autistic males will be even stronger systemisers who obsess about physics. If we look at the common obsessions females with autism have, they look completely different to males. Females with autism often obsess over soap operas, books, animals and psychology. It could therefore be said that autism is an extreme form of the female brain too, when actually autism is just an extreme brain. I am often surprised by just how different two people on the spectrum can be, and in my field of research and work come by a really diverse mix of people with autism. What binds them all is their similar difficulties in socialising, and the extremeness of their obsessions and sensory stimulations.
It is not helpful to keep trying to box autism more than it already is. No two people’s brains with autism look exactly the same, just as no two people’s without autism do. When we assess for autism we must look beyond the physical manifestations of the disorder and stereotypes we have all been fed to make our lives and work easier. We all respond to the world differently, and just because a person has autism doesn’t mean they don’t have their own personality and experiences too.