🌷identifying female autistics & how mild traumas can create ptsd in autistic people (🧠new research)

[Music] in light of some recent research that supports the concept that individuals on the Spectrum have a particular susceptibility to PTSD through a recent article I'm going to link the post in my comment section down below and it says this and we're going to use this because I think this is how we get into all of these conversations about is it autism is it trauma why is relational trauma such a part of the autistic experience and what I think many of us are trying to understand about our own brains where might there be autism or neurod Divergence in some place how does the trauma play A Part we're going to briefly discuss this article I'm going to summarize it and then we're going to dive into is there really a female phenotype of autism and how should we be thinking about it in terms of understanding ourselves and the current emerging research so really quickly this article looks at the link between Autism and PTSD and it says this that the research demonstrates that even mild stressors those which typically wouldn't affect other people can trigger PTSD in those with autism exacerbating core autistic traits such as repetitive Behavior remember that's one of the parts of the current diagnosis of autism the study pinpoints specific brain circuit alterations in the prefrontal cortex responsible for this hypers sensitivity This research could really change our approaches to how we diagnose and treat PTSD and those with autism and the key facts are this number one that those with autism tend to have an incre inreased sensitivity to even mild stressors so this is the key part of this too is that things that we would not consider to normally be traumatic can actually create PTSD and relational trauma potentially for those with autism brain circuit alterations researchers found and identified changes in the brain's prefrontal cortex that contribute to increased stress and sensitivity in autism and the impact is that PTSD can aggravate those core symptoms now what's interesting though is this piece that for many people on the Spectrum this susceptibility also means that what they found potentially mild stressors things like um sensory traumas you have an experience maybe somewhere with your sensory issues communication challenges that you have that are traumatic social rejection friendship issues a parent who yells or screams I mean imagine I keep saying I think a lot of autistic people for different reasons had parents who had a hard time managing their own emotional regulation issues from their own autism to their own to their own traumas to even parenting you know lack of parenting awareness or philosophies on exposing kids to things like yelling so being denied access to things learning disabilities being singled out for your differences like dyslexia perhaps certainly relational trauma relationship trauma toxic grandparents siblings whatever you think can imagine basically that could impact that even we might not say well you know that interaction shouldn't have been traumatic but it absolutely can be if you're on the Spectrum like I said School traumas medical events like crazy so many medical events testing and things like being misperceived right and so or you know judg in a certain way so this is really important research that was done on mice there'll be more to come I'm sure but it really made me think a lot as well as I'm really diving into this autism and Trauma piece it's where I'm finding myself returning again and again and when I read the book unmasking autism and the current kind of conversation about a year ago it felt like what was being said was don't single out autism in any way right there's not female autism and I understand the core of that and I want to respect all of that but had I not seen the research and the conversations around this female phenotype this what autism might look like in women I don't know that I would have found myself on this deep dive and it keeps coming back and I'm going to share three research articles from 2020 2022 and 2023 in this video and I'll link them down below as well that refer to this concept of a female phenotype that again and again and again seems to show that because of the way autism has been really focused pretty narrowly and deeply on pretty much one population anyone outside of that population has not really been studied and so we have these layers of our genetics of our culture Society expectations and all of those things can make a difference in our generational patterns of how we might present and so I think it's important that you know the current framework many of these people who are identifying as female phenotypes of autism having those traits would not necessarily be identified and that is what the research is showing in something like the DSM and in fact when we get to the last article we're going to talk about this really interesting project where they looked at uh through all these different surveys and and tests and stuff and it was self-report but the bottom line is they tried to use different different things like the AQ and I'll link that down below it can be a great way that's a way for you to assess could I be autistic and I jump off from that point on the website Embrace autism.com they have great they have the AQ and other tests the autism quotient but the point is that they took probably autistic women and autistic women and a very small group of men and they started looking at the similarities and differences and so there are a lot of us who I think would fall into that we think we probably are we were diagnosed recently late diagnosed autistic women and so we're going to talk about what came out of that research project the second research project I'm going to just reference is really about well what's happening in the diagnostic World among counselors and therapists and those in the know I have a cat ha and both of those I believe were done in the UK so always keep those limitations in mind I'm not going to go into each of these different research project limitations but make sure you check those out if you want to read those articles no research project is perfect or anywhere close but it is important to understand kind of the lens they were coming at it from and the lens they couldn't get to or see for whatever reasons so the first article is really about this idea of the female phenotype of autism talking about the fact that women tend to present differently and it has been a big problem and it does show in the statistics that because because of number one more often than not males tend to externalize their problems and females tend to internalize their problems so if someone is showing an external Behavior you know it's more likely to have you're going to have more eyes on it also we're going to talk about the social piece the camouflaging the masking for females for for for girls especially that it's taking longer to get diagnosed because we learn and we're the rules of the social engagement world are pushed on us and the expectations are different even a shy girl child versus a shy male child in at least a US culture and and many cultures that say men should be assertive and they can't be shy so a shy male child would maybe catch the eye even more than a female shy child where we say oh you know she's just shy that kind of thing when quite honestly it might they might both have similar levels of the same Dynamic with autism might not get all the language right I'm going to try to repeat what the Articles say it's important for me to be respectful to everyone and so I want to keep saying that even though I'm talking about the female phenotype it is not to say that males or anyone else no matter how you identify might relate to these same qualities but along those lines for example in that last research project they had to look at those who identified as female versus male and those for example who ident identified as other could were not used because there's not enough of a social comparison group to look at um statistically and things like that but I always want to say that and if that language bothers you that I'm inclusive I'm sorry uh I'm actually not sorry I think it's important to be respectful of everyone and so just want to get that straight and also keep in mind I'm a psychologist we are trained to be at the Forefront of accepting people and supporting them for for who they are and certainly as the parent of a gay child it is extremely important to me to be um a supportive member though I don't speak out on a lot of issues with respect to things with my clients it is important to me so I try to keep something separate out of out of respect for them but that's important okay so let's get into it this Dynamic of the female phenotype is this that there are these underlying Dynamics happening like I said earlier often they are inter Ally being experienced that might prevent a diagnosis from being uh more identified and so it says one explanation of the underdiagnosis of females is that their presentation is qualitatively different to the typical male presentation this female autism phenotype or behavioral expression of autism that's more common in females represents similar underlying characteristic istics as those described in the current diagnostic criteria meaning that females are doing their own version of repetitive restrictive interests special interest you know deep interest in things interactions that are socially challenged it's just it just looks different and so that's part of the reason why we have obviously missed them right so the first part is with regard to social relationships this is one of the Hallmarks historically around identifying autism it's one of them and the FP the female phenotype autism Theory suggests that the nature of these May differ depending upon the person's gender some research has suggested that autistic females may have fewer social impairments fewer social difficulties than males autistic females tend to have higher levels though of social motivation than males on average so what we're saying is that we're more motivated for whatever reason to push maybe the ground there on social connection however sorry I just hit my mic however autistic females may find it harder to maintain long-term friendships or relationships than autistic males despite having similar levels of motivation for social relationships as non-autistic females so what we're saying here is even if we are able to be more motivated maintaining friendships and for many of those of us late diagnosed this has been a big like light bulb moment and how friendships have gone or played out for many different reasons conflict and social relationships may be more difficult for autistic females to cope with than autistic males or non-autistic females now I've talked a lot about conflict avoidance And self-silencing in regards to trauma being a woman but it's really interesting to look at and even eggshell parents obviously at the core if conflict was dangerous in our homes but this is interesting to say that the idea of how we might deal with conflict might inherently be problematic and difficult for us and another reason why not just because of potential trauma and exposure in our childhoods and so it says these findings suggest that in addition to assessing the maintenance of social relationships Research into female autistic experiences should also compare to non-autistic female characteristics to obtain an accurate evaluation of relative social abilities when compared to autistic males females may appear to have fewer social difficulties overall but may struggle with other aspects of socializing especially in comparison to non-autistic females so the thing is the diagnostic criteria are comparing autistic females to autistic males and because that's where the criteria have been formed on and not comparing us to non-autistic females and that is important because that's where you're going to really maybe see more same same and then same different the other thing is relational interests and so another big piece of the gender differences has been around repetitive interests and how we engage in repe ition and routine for example and so this part talking about relational interest says that however some have argued that autistic females special interests may be in different areas and so may be underestimated especially if these are not considered atypical and so it's come out that a lot of the research talks about with autistic males focus on things like mechanical Dynamics computers physics and that for many autistic females their interests are more on topics with relational purposes such as animals fictional characters or psychology now think about that in addition to maybe a special interest if it's people and fitting in you might wear makeup and look a certain way you might go higher on the attempt to to appear social and maintain connection and be girly to fit in and fact some of the research said that even with autistic girls they've learned how to gossip and have conversations it's like they know the things to do even if they don't necessarily know why are we doing this or making eye contact we know that making eye contact is not the appropriate way to say you're autistic you're not autistic especially for those of us who have been socialized to understand how important eye contact is for different reasons and that could be anyone like you're a little boy and you have a very strict you know parent saying look that person in the eye and it could also certainly be a girl culture you know pushing those social dynamics nevertheless the differential nature of special interests may result the differences in underestimation of autistic characteristics for autistic females which therefore reduces the likelihood of them receiving a clinical diagnosis and many studies talk about not only do women tend to get uh an ASD diagnosis they get they tend to get it last so they tend to get misdiagnosed and in fact we'll talk about borderline being very commonly diagnosed and one article goes into like the different mental health challenges but that autistic males generally get diagnosed a significant amount of years six seven years earlier I think the mean was and then females that much later and not only that but it's coming earlier in their diagnostic repertoire for men and coming often last and so many late diagnosed women talk about seeing therapists for years having the same conversations and no one ever raising it and I would have been someone like that even now if I had not started this deep dive there are still so many so many clinicians that are living in another world when it comes to identifying autism in anyone but the original populations of study but especially women people of color and things like that the next thing is the internalizing issues like I mentioned and so it talks about the female pheno the female autism phenotype looking at different features around internalizing that don't necessarily look like what are part of the clinical presentation to diagnose autism with it says in contrast to externalizing problems a kid is aggressive at school kicking the wall acting out um difficulty relating with others things like that internalizing problems describe the inward expression of emotional difficulties including anxiety depression self- wounding and eating issues I have to phrase that a certain way or else YouTube Flags the video but we all know that those e disorders are very common especially in autism especially with women most research demonstrates that autistic females are significantly more likely to have co-occurring internalizing disorders to a much greater severity and extent than males although some studies with young younger children find no variation autistic males are more likely much more likely to have co-occurring externalizing disorders such as behavioral problems in attention and I think a lot of boys have been diagnosed with only ADHD and they may also be autistic and or only autistic but that has been also a classic part where I think you know we've struggled with all these kind of stereotypical lenses it says there are two ways in which this may impact the identification of female autism firstly more severe expression of co-occurring conditions so more things that you're struggling with anxiety depression things like that OCD may serve to mask the underlying autistic characteristics such that females receive a diagnosis of the co-occurring condition anxiety depression OCD only and their autism remains unrecognized and that's been quite commonly reported by many autistic women secondly if males tend to express their co-occurring conditions in more disruptive ways than females this may perpetuate the gender bias in autism recognition and referral especially in school so it's like it keeps that that stereotypical lens going the needs of autistic males may come to the teachers's attention sooner like I said earlier than females who were seen as anxious or shy females internalizing difficulty therefore not only leave them vulnerable to serious mental health conditions but also reduce the likelihood of their autism being recognized so the problem is oh you're you know you're not autistic you have anxiety you have depression you have borderline treat treat treat treat treat oh it's not working there we're hitting a wall here we're hitting a wall because the underlying Dynamic is not being addressed and people will say like I just feel like there's a piece of the puzzle missing and autism can be really helpful in that regard I'm not going to go into it now but some articles talk about in the article we'll get to next about whether or not it even is even beneficial for many uh High masking women to get a diagnosis because of often the different resources that don't exist or should exist and because they've been managing it and the label could actually uh prevent them from certain things in certain countries a diagnosis of ASD can impact access to the military to adoption things like that so make sure you do your research I think to tell an autistic person to do your research for the most part though not always true is most likely going to happen but that's important and then the last part which I could go on for this video forever it talks about the role that camouflaging plays in misinterpreting or understanding the female phenotype recognizing what autism might look like in women and that we've had to develop all of these strategies to mimic and to appear you know like we are able to participate in Gossip for example or to force ourselves to make eye contact that all of that that uh camouflaging creates a lot of issues and makes it harder for us to see in ourselves and certainly difficult for clinicians especially if they are not trained in identifying autism and anything outside of that original really white male population and boys not even adult men I think mostly even just boys and I'm imagining that it also presents differently as men age so all these things are important and so it talks about that you know all of these things even as back as early as 1981 Laura Wing hypothesized that some autistic girls without intellectual disability and that's the issue too if they have intellectual disability in girls they are much more likely to be diagnosed earlier may be missed in clinical assessments and that this may be related to females appearing to have better social and communication abilities than compared to males this has come to be known as the camouflaging hypothesis so the bottom line about all of this is that we've learned to pretend to be normal that's the language talks about in the research and that this female phenotype um can really vary and what I am concerned about is us not wanting to also say it's you know there's this version and that version to be more inclusive but also not to recognize the significant value in our underidentification and why we need to understand how it could present in many different types of people that have not been studied before or recognized because it affects the diagnostic criteria 100% so the last the next study it talks about I know I was going to go longer but it's too much talks about how people have been or not clinicians teachers you know are they really changing there's been no real formal changes obviously to the autistic diagnostic process in really significant ways and so what they said when they surveyed different people was that well many of them understand this different presentation perhaps in girls and are individually modifying how they assess but that's kind of concerning when you think about you know well this clinician assesses for this way and this one doesn't this way it's quite objective in many ways and even of course many of the autism assessments I've even found as I've gone back you know I think that as I've gotten older and as I've done this process I have understood myself more and I some things are more rigid and some things are less rigid and so it's really difficult to I can remember my childhood and I can remember how in my 20s and 30s especially even my 40s there's a even a stronger level of rigidity and and disregulation in things and then part of my you know social isolation avoiding things now is also less triggered and not I'm not raising little people and being put in classrooms with parents and going going to big events and dreading School parties and things like that so you know I'm imagining as we look at the data uh the Aging autistic late diagnosed person who's more High masking is going to be evolving through the course of time alongside hormone changes genetics time things like that maturity so anyway the bottom line is that people are modifying some things but not there's no uniform modification and understanding in clinicians the last article was the one I referenced which is really fascinating that looked at as I said autistic people who were diagnosed with autism women and probably autistic women meaning that they gave them a bunch of Assessments and their AQ scores were 32 or above and by the way I'll link it down below to take the AQ that the cut off is about 32 and it's pretty reliable and pretty a pretty good test in that regard it's just a matter of it is self-report but I do think that self-report is very valid and so in terms of autism I think we know ourselves best and so the point is there's no big score for being autistic also it's more about accepting yourself understanding yourself and carving out a path to maybe approach your life and treatment in new ways so it looked at the different Dynamics and said that previous evaluations of the female phenotype Theory have compared the behavioral manifestations of autism between as I said earlier autistic women and autistic men and that is why this study is so interesting because it looked at autistic women and those who probably would have or would receive an autistic diagnosis because diagnosed autistic women will have presented with sufficient classic autistic traits what is that saying that's saying that those who have been who have been diagnosed given our lack of awareness are going to look in some ways more like the male presentation of autism they're going to be really more obvious and less likely to represent the full female phenotype uh perspective right so they are looking like they're they already got they already got diagnosed so they look more like or check the boxes more for the traditional diagnosis that has been built around males in the present investigation we took the novel approach of recruiting men and women and comparing the traits and as I said there the men group was quite small here and then they also looked at things like their diagnostic histories in terms of psychiatric mental health issues their friendship issues all kinds of different assessments were used and they looked at sort of like how did these probably autistic women how did they how they look there's a bunch of different there are two there are two main parts of this study study one and study two with different Dynamics from empathy which is also a big piece of this and and social interaction and functioning but they found that more often than not the probably autistic women were more similar to the autistic itic women than to the non-autistic women on a bunch of things from their behaviors Recreation Independence activities all of that and so in terms of friendship and all of that it talks about what they expected they thought that there would be some similarities and differences around friendship and they said that for example we found no evidence that probably autistic women had stronger friendship motivation quality than than diagnosed autistic women so the bottom line of that is that they thought that well these probably autistic women were going to outperform because they were going to be able to do better because they weren't you know as far on the clinical scales and yet they found that a lot of the struggles were were quite similar so it's basically saying that we found no evidence that probably autistic women had stronger friendship motivation and quality than diagnosed autistic women so they thought that they would perform better in some regards or have higher motivations and it turns out they were actually quite similar in many regards to the diagnosed autistic women and another study says likewise this study by Baron Cohen and wheelright failed to find a difference on the Friendship quotient between autistic diagnosed women and diagnosed autistic men suggesting that quality of friendships might not be a good indicator of the female phenotype of autism so my camera stopped working my uh my card was full I'm not sure where I finished off but what I want you to get out of this is that there was really important information from this study that looked at how those women who were probably autistic as I said compared to those who were autistic and that as I said just a few minutes ago I know that it got that part was that using the Friendship Dynamic to assess is probably not a good tool given the way that those who have autistic Dynamics might struggle and it says indeed regardless of whether or not have an Autism diagnosis autistic women may find themselves ostracized by non-autistic people due to their social differences and so socializing is a difficult thing to manage and then it talks about this idea that if a distinctly female phenotype of autism exists then it likely reflects both biological and social influences for example women might have an evolutionary Edge and empathy izing and social behaviors compared to men but also experience stronger socialization pressures to develop competence in these domains so we're we might have an advantage but we're also pushed to have one interestingly an empathy Advantage was also displayed by non-autistic women relative to non-autistic men and they scored significantly higher for both self-monitoring and friendship quality so even within the non-autistic men and women the women scored higher on empathy right so there's many potential reasons for that that can explain in some reasons in some regards why some things can feel inherently challenging regardless of who we are so it says while these findings hint at a general female superiority in empathizing and aspects of social functioning that might make autism less obvious when it occurs in women it cannot be ruled out that the gender difference was more to do with reporting of behaviors so how we report remember this was a self-report study rather than the behaviors themselves that is the internalization of gender Norms what I'm supposed to do may lead women to rate themselves higher on scales that pertain to empathizing and social behaviors so it might not be right there's Evolution there's there's how we internalize our roles it's quite complicated the bottom line of this study I think is really important is comes back to what is this telling us about recognizing those who might be autistic versus what we already know so far about those who are and we have to look at those who are especially among the women the phenotype dynamic as likely potentially also depending upon intellectual ability and time of diagnosis that they may present more that way they're on a different presentation that's more obvious and that does doesn't mean though that those that those that don't present that way are not autistic so in conclusion our demonstration of an empathy and social functioning Advantage among probably autistic women relative to diagnosed women is in line with female phenotype Theory additionally our findings highlight the difficulties experienced by many autistic women in getting a diagnosis this article is the one that talked about women getting their diagnosis last as opposed to earlier in the process and that we should be looking at things and ruling out in our psychiatric assessments things that might affect the typical interpersonal functioning social functioning developmental histories we want to look at that in full and not just rule out autism because it doesn't look like it given our current criteria which you already know this but I thought it was really important and in this specific research project it says women presenting multiple times to clinicians with Psych atric difficulties should be routinely screened for autism especially those presenting with borderline borderline was the most common one that these probably non-autistic that were autistic women technically were had received that was a diagnosis and then it should look at also how we look at and perceive things like repetitive behaviors routines these different ways of engaging in the world that we might have not thought were autistic that could be that they might present in different ways because of these internalizing versus externalizing factors so there's a lot in this article it's so interesting I sat for hours this morning I went through like about five different articles line by line all of them had this concept of the female phenotype as part of it and there just continues to be emerging research and I just maybe I'm it's part of my age and I would love to hear from those in the community um I understand like I said earlier wanting to say this is female autism but I just don't know how to talk about it without acknowledging because it needs to be I believe in the diagnostic criteria there needs to be these different valuations and presentations of autism especially in high masking populations that do not have intellectual disabilities or difficulties I should say challenges or differences because we can be missing a lot of people and it is a great fallacy to believe that just because someone is time asking and has made it so far that they have not suffered that every day is not a slugfest that they're not struggling in significant ways that they haven't spent hours and years in treatments and therapies and medications that haven't worked that deep inside they haven't internalized that what is wrong with me why am I like this like this has been and someone so sweetly commented I think a week or so ago they're like I don't know what's going on with you but since you've been on this journey I feel like you're being more yourself and I'm like I think that is number one true I really do it's also helping me understand why I'm such a pain in the ass sometimes and don't mean to be why I've been misperceived at times not so much within therapy but maybe but more so like when I have to be on in a social world and why I struggle with so many things but everything has to be a certain way and I just thought that that was normal and you know or it was like back in the days of Harry Met Sally called you know you're what is it you're the worst kind you're high maintenance but you think you're low maintenance um I was always like yeah that tracks but I don't not that high maintenance and it turns out yes I probably am and I was and it is really helping me understand so I think the combination of Aging I'm very curious like I said to understand aging and late diagnosed women um because there is something about hitting 50 and not caring about certain things but also getting kind of more stuck in your ways it's really interesting and so I'm I'm very curious to understand the role of autism in that but the bottom line is to say in this whole video that the highlights are internalizing behaviors are important looking at things like borderline how that can mask understanding how differently it can present that it can present differently in the female phenotype and I'm quite certain that within other minority communities places where we've not studied autism that there's also a different presentation and type within each of those and amongst those and so most of these studies are done like I said in the UK in certain populations many of them were done on people who were students who were educated like there's a whole vast group we're missing right and so those things are so important so and also if you are a clinician if you work around anyone as a social worker therapist psychologist please please please please do your own extra work I'm going to spend all of most of my ceu units we have to earn those every two years on autism trainings it is so important to me to understand um not so much in doing the diagnosis I don't do diagnosis right now um but to understand how to work with and treat and identify and and just really speak to those on the Spectrum so anyway I hope this was helpful like I said from the beginning it is even more impactful when you think about we're missing diagnoses and yet there's a a susceptibility to trauma in the first place even more likely at things that we might say well that's that's not trauma yeah it could be trauma it absolutely could be and to not understand how like I said earlier deeply impactful these struggles can be and I also think how freeing and how much information between me and my kids we're having these conversations and you know turns out if you are or one of your kids are probably both of y'all are somewhere in there there my text list coming out but the bottom line is if it's in the family system it's probably in the family system more than you recognize maybe just the traits maybe the subclinical traits but it's in there and so whether it's me exploring it more accepting it more I don't know but I think that it's important to keep sharing and right now my blast has been really about helping people take the jump off the diving board to their own further research and to say oh what if I am autistic that's kind of where I'm at now and so I'm just taking you with me as I evolve I hope to keep sharing what I've learned so thanks for being here have a good day take care and stay safe and I'll see you soon bye [Music]