Gray Atherton, Ph.D., details the socialization of the female gender experience and how that plays into autism gender biases. The speaker discusses the experiences of autistic women, highlighting that gender is a critical barrier to diagnosis and care. Atherton details recent investigations into implicit gender biases in autism and their impact on medical care and autism understanding. She evidences contemporary shifts in the zeitgeist of gender and autism and provides suggestions for future research. The presenter offers sources and acknowledgments before the Q&A, where she discusses masking, minorities and misdiagnosis, videogaming and autism, and much more. 

In this webinar:

1:00 – Agenda and introduction
4:40 – Gendered development & autism descriptions
8:00 – Female protective effect
10:00 – Male brain theory
12:35 – Gender and autism
16:20 – Masking
18:50 – Study 1: Age of diagnosis and quality of life
26:10 – Effects of late diagnosis
30:00 – Gender biases and a new ratio
35:12 – Study 2: Implicit gender biases against female autism
40:11 – Findings
42:40 – Study 3: The zeitgeist of gender and autism
44:50 – Summary and future research
48:08 – Q&A

Female gender experiences

Atherton discusses the construction and socialization of the female gender experience, underscoring observed differences in toys, colors, expectations, and language used with female versus male children (2:15). She explains that females show more relational aggression (indirect) compared to males by age four (4:40) and tend to consider hierarchies and reputation in social interactions and communication from a very young age (6:15). These differences, the speaker continues, result, in part, from contrasting developmental pressures and environments between females and males. 

Gender and autism

Historical descriptions of autism are skewed toward the male presentation due to classic gender biases (6:40). Atherton outlines two prominent hypotheses that aim to explain observed gender differences in autism: the Female Protective Effect (8:00) and the Male Brain Theory (10:10). While these theories have been widely investigated, contemporary understandings of gender and autism reveal them to be limited in scope and understanding. 

Atherton cites research showing higher rates of gender diversity in autism, where transgender and gender-diverse people are three to four times more likely to be autistic than cisgender people (12:35). She discusses masking (16:20), or the process of copying other people and learning how to socialize, and how repetitive behaviors and other signs of autism can be easily mistaken for the expected “nice” “quiet” or “organized” qualities of girls and women (13:35). 

Age of diagnosis and quality of life

The speaker details a recent investigation into the effect that age at autism diagnosis has on an individual’s quality of life (QoL) (18:50). The study found that women are significantly more likely to be diagnosed in adulthood compared to men and that women actually reported higher thresholds of autistic traits, but were still missed by practitioners (21:13). QoL scores were negatively associated with age of diagnosis and masking. In a subsequent interpretive phenomenological analysis of lived autistic experiences, participants reported that their gender kept them from receiving a diagnosis – that they would have received a diagnosis much younger if they were male (22:16). These findings suggest that women do have autism at least as frequently as men and that women are primarily underdiagnosed in adolescence, which leads to lower overall QoL (25:05).

A study by Rodgaard et al., 2021 found that women who received a late diagnosis were misdiagnosed at least once with depression, anxiety, sleep issues, etc. (28:35). Atherton underscores that without early diagnosis and proper medical care, individuals are more likely to develop co-occurring conditions. In fact, 26% of late-diagnosed women have co-occurring conditions compared to 13% of late-diagnosed males and 3% of the general population (26:10). 

Implicit gender biases

The presenter outlines a study by Burrow et al., 2022 where researchers conducted direct assessments of autism symptoms at six to nine (6-9), twelve to fifteen (12-15), twenty-four (24), and thirty-six to sixty months (36-60) (30:00). Data revealed a 1:1 gender ratio of male/female children with “high concern” for autism – a stark contrast to the historically accepted 4:1 ratio. Clinician notes often referenced ‘monitoring’ girls over time but not needing a diagnosis in the same way as the boys did (33:00). These findings, Atherton asserts, suggest that although there is no biological bias, there seems to be different symptoms in females, perhaps as a result of female socialization, and subsequent bias in autism understandings and diagnosis.

 To determine whether there are implicit biases held against female autism, Atherton and her team paired vignettes of autistic descriptors with male and female names and asked participants to say how autistic each vignette seemed (35:12). She explains that implicit biases may never be cognizantly acted upon, but that they still affect the way we understand and respond to information (38:15). Results from the study showed that participants were slower to respond and made more mistakes when autistic descriptors were paired with female names compared to male names. Item-by-item differences were also recorded, where words that were explicitly autistic were viewed as male, and those that were the opposite of autistic were considered female (40:11). The speaker asserts these findings show implicit biases associated with females being autistic. 

Conceptualizing autism

To properly care for autistic individuals, it is critical to understand the zeitgeist or cultural climate around autism and gender. To test this, the speaker collected photos that represented autism from 163 people. Many participants sent pictures of females and wrote about the struggles that autistic women face. Many participants also noted that we need to reimagine autism in accordance with gender (42:40). 

The speaker summarizes her presentation, highlighting the difficulties in diagnosis and care faced by autistic females, that women have the same amount or more autistic traits compared to men, that there are implicit biases against autism as a female experience, and that the cultural zeitgeist of autism and gender is changing according to the unique struggles and voices of autistic females (44:50). Atherton provides signup information for individuals interested in participating in future research projects about female autism trait presentation, gender diversity in autism, and adult experiences of neurodiverse people, specific to improving QoL (45:50). She provides references and thanks before the Q&A session (48:08). 

Dr. Gray Atherton, Ph.D., explores the connection between autism and anthropomorphism. She provides a brief historical and social context for anthropomorphism in our daily lives before diving into the prevalence and advantages of anthropomorphism in autism. The speaker details recent studies that challenge prevalent theories about socialization, Theory of Mind, and anthropomorphism in autism. Atherton asserts that many autistic people use anthropomorphism prolifically in everyday life and often outperform their non-autistic peers in this aspect of Theory of Mind. The presenter highlights anthropomorphism as a strength for many autistic individuals and suggests using it to support learning and interventions for autism. 

Handouts are online (.pdf) HERE

In this webinar:

1:58 – What is anthropomorphism?
5:00 – Importance of anthropomorphism
8:05 – Autism and anthropomorphism
10:00 – Social Motivation Theory of Autism
14:00 – Study 1: Theory of mind processes in autistic adolescents
18:50 – Study 2: Review of studies with anthropomorphic stimuli
23:45 – Study 3: Reading the Mind in the Eyes Test – anthropomorphized
29:00 – Study 4: Intellectual disability and emotion recognition
32:25 – Study 5: Verbal anthropomorphism and theory of mind
35:30 – Study 6: Pets and anthropomorphism in everyday life
39:50 – Recap
41:30 – Flip the narrative
46:00 – Applications and interventions
48:20 – Q & A session

History and importance of anthropomorphism

Atherton defines anthropomorphism as the attribution of human-like qualities, emotions, or behaviors to non-human entities, such as animals or objects (1:58). Examples of anthropomorphism are seen throughout history in our deities and legends, who often assume human characteristics. The speaker explains the importance of anthropomorphism in religion, connection, and socialization. She explains that wanting to understand something that isn’t human drives us to anthropomorphize and highlights that anthropomorphism is frequently related to loneliness (5:00). Atherton touches on the presence of anthropomorphism in childhood media and notes its increasing use in contemporary care work and technology (6:25). 

Autism and Anthropomorphism

The presenter discusses the Social Motivation Theory of Autism and outlines publications supporting the claim that autistic people are less socially motivated than their peers (9:00). Theory of Mind (ToM), or the capacity to ascribe emotions to other people based on facial expressions and personal characteristics, is closely related to anthropomorphism. Atherton outlines a study that tested ToM in relation to a video of moving shapes. Results showed that non-autistic respondents used human-like adjectives to describe the shape interactions, while autistic participants used more concrete descriptives and less mental state language (10:56). Given the contrast in responses, researchers concluded that autistic people have lower ToM and are less likely to anthropomorphize or use human-like descriptors. Atherton describes her own professional experiences with autistic individuals as totally contrary to these assumptions and asserts the need for further exploration into ToM and autism (12:10). 

Study 1: Theory of Mind processes in autistic adolescents 

To explore the Theory of Mind experiences of autistic adolescents, the speaker conducted an open-response interview and interpretive phenomenological analysis (14:00). The study revealed four overarching themes concerning how autistic people engage with ToM processes: honesty, humor, visualization, and anthropomorphism (15:00). Atherton presents sub-themes and quotes from participants that reflect their prolific use of anthropomorphism in daily life. She asserts that these findings challenge accepted notions that autistic people have low ToM and social motivation (17:23). 

Study 2: Review of investigations with anthropomorphic stimuli

Although anthropomorphism isn’t often explicitly studied, many investigations use anthropomorphic stimuli as a control in comparative studies (18:50). In reviewing such studies, the speaker found that autistic individuals perform significantly better on ToM tests when the stimuli are non-human instead of human (20:00). She outlines three publications that revealed:

1. Autistic people prefer anthropomorphized images over human ones.
2. Autistic people actually have an advantage in this area of ToM compared to their non-autistic peers.
3. This advantage may have to do with the expertise or familiarity that autistic people have with non-human social agents (22:30). 

Study 3: Reading the Mind in the Eyes test – anthropomorphized

Reading the Mind in the Eyes test (RME) is a classic ToM exercise where participants determine emotions based on photos of a person’s eyes. Atherton and colleagues created a cartoon (anthropomorphic) version of the RME and compared autistic and non-autistic group responses for both versions (23:45). Results showed that the non-autistic group had higher success on the human RME test but that the autistic participants outperformed their counterparts on the cartoon test (27:00). These results, the presenter posits, suggest that anthropomorphism may be a strength for autistic individuals, further challenging the preconceived notions that autistic people have low ToM and emotion recognition capabilities.

Study 4: Intellectual disability and emotion recognition

Around 40% of autistic individuals also have some co-occurring intellectual disability, and many are non-verbal. Atherton explains how communication barriers often exclude this part of the autistic community from research participation (28:00). She outlines a recent study that took these differences into account and assessed whether the prolific use of anthropomorphism revealed in previous studies defines the entire autism spectrum (29:00). Researchers used a combination of human faces and animal face filters to test ToM. They found a significant increase in correct answers for the photos with animal filters on them, suggesting participants better understand anthropomorphized stimuli compared to human faces (31:20). The presenter discusses study limitations, noting the aspect of visual salience. 

Study 5: Verbal anthropomorphism and theory of mind

To see if anthropomorphism extends beyond visual context, Atherton and colleagues used a verbal ToM Faux Pas test (32:25). They tested participants’ ability to determine whether someone said something awkward in both human and anthropomorphized stories provided in text. Similar results to previous studies were found: autistic people struggled with human-based wording but performed at the same level as, if not better than, the non-autistic group with anthropomorphized stories (34:00). Atherton asserts that these findings suggest anthropomorphism may play a critical role in how autistic people engage in perspective-taking and conceptualize ToM. 

Study 6: Pets and anthropomorphism in everyday life

As human beings, we often anthropomorphize our pets to relate to them and create connections. Atherton describes a study on differences between autistic and non-autistic groups in their anthropomorphism of pets. Results showed that the autistic group was equally attached to their pets and used similar amounts of anthropomorphism as their non-autistic counterparts. Interestingly, the presenter states, Autism Quotient scores correlated with anthropomorphism and autistic people were more likely to substitute pets for people (mediated by social avoidance) (35:30). Interpretive phenomenological analysis of 16 interviews with autistic pet owners showed that pets can often act as a social alternative and/or a social lubricant. Participants frequently noted that with animals, “you don’t have to wear a mask – they don’t know what social rules you may be breaking” (37:15). 

Atherton states that these real-life examples show how autistic individuals intentionally create anthropomorphic connections to compensate for social deficits or avoidance. These intentional connections manifest in various ways, from donating to animal charities to becoming a cat behaviorist. The speaker asserts that we need to understand anthropomorphism as a strength and something that autistic people may be particularly good at. Perhaps, she continues, they are engaging with and becoming experts in anthropomorphism because it’s a way to have connections that don’t feel judgmental or forced (39:00). 

The big picture

The speaker summarizes the presentation, highlighting that evidence suggests autistic people anthropomorphize at least to the same degree as their non-autistic peers and that anthropomorphism may play a role in the way autistic people conceptualize or engage in ToM and perspective-taking (39:50). She presents a diagram of the Social Motivation Theory and suggests that we flip the narrative. Instead of saying autistic people have decreased human/social motivation or recognition, we can say they have increased non-human attention to faces and understand non-humans much more (41:30). 

The presenter notes that anthropomorphism may vary across developmental stages and cites a multi-age study where anthropomorphism decreased with age (44:15). She suggests leveraging anthropomorphic stimuli, like cartoons, in educational and therapeutic settings with autistic individuals. For example, a pilot study using Hololens glasses is underway, which could allow for more meaningful interactions using anthropomorphism and digital projections (46:00). Atherton invites viewers to share their real-life experiences with anthropomorphism and provides her contact information (47:15) before beginning the Q & A session (48:20)

Kelly Barnhill, MBA, CN, CCN, summarizes emerging research on nutritional approaches and supports for autistic people. She outlines recent investigations on sensory processing and nutrition, dietary changes, and supplementation. The speaker discusses recent systematic reviews, highlighting general consensus and gaps in research. Barnhill describes several ongoing studies and future avenues of investigation before the Q&A session.

In this webinar: 

1:30 – Goals and objectives
2:45 – Critical aspects of current discourse
5:28 – Sensory processing and diet
9:15 – Dietary changes
13:40 – Dietary supplements
14:30 – Systematic reviews and meta-analyses
19:00 – Significant findings from the last year
22:00 – Ongoing and future research
29:03 – Q&A

Current discourse and recent publications

Barnhill outlines presentation goals and objectives and highlights the challenges faced by researchers during the COVID-19 pandemic before diving into research updates (1:30).

She summarizes a study that found that 43 autistic participants had significantly higher histamine and lower thiamine than non-austic controls. The speaker asserts that these findings suggest the need for further research into potential interventions and screenings that target these biomarkers (2:45). A study on the impact of dietary quality on executive function found a correlation between poor dietary quality (high intake of processed carbohydrates) and impaired working memory, executive function, and organizational skills (3:58). Barnhill states that dietary factors impact development trajectories and that improving diet quality can improve educational outcomes (4:25). 

Sensory processing and nutrition

The presenter summarizes a study that found autistic children exhibit higher sensory sensitivity to food than their non-autistic peers. Study data also showed lower levels of calcium and vitamin D in the autistic group compared to non-autistic controls. These findings, she continues, reinforce the clinical perspective of food sensitivity in autism, which also emphasizes the impact these sensitivities have on food choices and eating aversions (5:28).

Barnhill cites a study that revealed family units of individuals with food sensitivities also present with different eating profiles (6:00). Another sensory study on BMI found that almost 60% of participants met units for being overweight, and 12% met criteria for thinness or failure to thrive (7:00). These and other studies show autistic children have different eating and feeding styles than non-autistic controls. Barnhill notes that a lot of work is being done to profile how autistic children participate in feeding environments, what their preferences may look like, and appropriate interventions (8:00). 

Dietary changes and supplements

Barnhill explains that a growing body of evidence supports dietary changes and vitamin supplementation in autism. A study involving 400 males and 130 females across multiple facilities in the UK tracked nutrition and development over time. Results showed that adopting a ketogenic diet, with professional support, can be a feasible and appropriate intervention for autistic children (9:15). The speaker cites a survey study that revealed no significant differences in routine while starting a ketogenic diet and that it is easy to assist children in starting the diet if necessary (11:00). Barnhill suggests screening for autism in children who present with significant feeding disorders. 

The speaker describes two animal model studies examining the effect of ketogenic diets on mouse behavior. The first study found that mice on ketogenic diets had reduced social and cognitive deficits and repetitive behaviors and an increased abundance of beneficial microbes in the gut, with no adverse side effects reported. A second study found similar results and also indicated that ketogenic diets may restore histone balances in affected mice (12:15). A third mouse model that tested zinc supplementation saw improvements in social interaction and fear but had no effect on social novelty, or the initiation of new circumstances (13:40).

Systematic reviews and meta-analyses

Barnhill presents a review that found low choline and B vitamins and abnormal amino acids in autistic children compared to non-autistic groups (14:50). Another review on probiotic supplementation found evidence that dietary change can increase oxidative stress. The presenter suggests monitoring oxidative stress as a mark of microbiome changes in the future (16:05). Clinical literature reviews assert that autistic individuals are often deficient in vitamins A, C, B6, and B12. Across reviews of gluten-free/casein-free (GF/CF) diets, there is consensus that GF/CF diets are quite feasible and carry few adverse effects (17:03). Barnhill highlights a review of dietary interventions by Amadi et al. as an excellent source for big picture concepts and detailed questions (18:23). 

The speaker highlights significant studies from the last year that looked at nutrients/probiotics as anti-inflammatories/modulators (19:00), prenatal diets as a modifier for environmental risk factors for autistic traits (19:50), and assessment and data collection methods across studies (20:35). She explains that to best represent typical dietary intake, three-day real-time collection across weekdays and weekends is needed (21:22). 

Ongoing and future research

Barnhill outlines an ongoing study in Florida that explores the impact of eating program interventions (22:25). She also highlights an ongoing longitudinal study assessing the effect of therapeutic GF/CF diet and physiotherapy on the gross motor and cognition of autistic children (23:18). Enrollment is currently open for another exciting study that looks at using folic acid to promote language development (24:01). Finally, the first large study on the impact of mitochondrial function and nutrient intervention is also currently being conducted (25:31). These studies, the speaker asserts, represent a continuous efforts to advance our understanding of autism and identify targeted interventions. 

Barnhill considers future avenues of research and underscores that the most significant barrier to nutritional research is a lack of funding. Contemporary research, she continues, should focus on targeted dietary intakes and anti-inflammatory factors. While GF/CF diets are feasible and effective, she warns against having tunnel vision and reminds viewers that we must always consider more than one avenue (26:30). 

Q & A

During the Q&A (29:03), Barnhill discusses picky eating and nutrition in adulthood (31:40), feeding therapy and dietary changes (36:00), paleo diets and multivitamins (38:00), and Celiac and autoimmune diseases in autism (44:50). She also considers good sources for protein (51:45), vitamins (55:15), and multivitamins (57:05).