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The medical definition of autism is as follows: Autism is a spectrum of neuropsychiatric disorders characterized by deficits in social interaction and communication, combined with unusual and repetitive behavior. Some, but not all, individuals with autism are non-verbal. Each child with an autism spectrum disorder will have their own individual pattern of autism. (Allen 8A)

A common misconception about autism is that autistic individuals don’t like to be touched when the issue might actually be pressure (autistic individuals often prefer deep pressure and often strongly dislike light pressure), hair/fabric brushing against them, smell, the feel of direct skin-to-skin contact or any number of other factors. Research has illustrated that touch is vital for human development and emotional wellbeing for all individuals autistic and allistic. For all humans there are a number of things that influence whether or not touch feels good. Rather than saying autistic individuals dislike touch it would be more accurate to say these individuals like a particular kind of touch. Massage can help the parent/caregiver figure out what touch works best for their child and may help reduce tactile defensiveness.


Another common misperception is that autistic individuals lack empathy. This is often attributed to deficits with mirror neurons (an impaired theory of mind). However, as autistic individuals step forward and share their own experiences (including their ability to discern what others are thinking/feeling) and their perspectives on the topic of empathy this idea of all autistics either lacking empathy or being deficit in empathy is being challenged. Before continuing I would like to note that empathy has a number of different but similar definitions. A google search pulls up the following definitions: the ability to understand and share the feelings of another
-Wikipedia: Empathy is the capacity to understand or feel what another person is experiencing from within their frame of reference, i.e., the capacity to place oneself in another's position
-Meram-Webster (sp): : the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner; also : the capacity for this 2: the imaginative projection of a subjective state into an object so that the object appears to be infused with it
-Psychology Today: Empathy is the experience of understanding another person's thoughts, feelings, and condition from their point of view, rather than from your own. You try to imagine yourself in their place in order to understand what they are feeling or experiencing. Empathy facilitates prosocial (helping) behaviors that come from within, rather than being forced, so that we behave in a more compassionate manner. As a society, it may seem at times that we are becoming more individualistic and self-centered, but neurological research confirms that humans and other social animals, especially primates, are equipped with "mirror neurons," which give us the capacity to display, read and mimic emotional signals through facial expressions and other forms of body language. Mirror neurons help us share emotional experiences and become more empathetic toward others. 

What all these definitions leave out is the role that culture and our nervous system plays in how we express empathy and how misunderstandings often arise from inaccurate assumptions. Everyone, allistic and autistic, can have impaired empathy or impaired theory of mind if they are in pain or operating from prejudice, ignorance, incorrect cultural assumptions, and/or lack of respect for the other person.

Thus rather than saying all autistic lack empathy or suffer from a deficiently in empathy it would be more accurate to say that anyone can suffer from a deficit in empathy and that being autistic doesn’t automatically mean one can not empathize. Often what looks like coldness or lack of empathy could be developmental delay, a way of managing overwhelming emotions, or a defense strategy against sensory overload (note: while unusual responses to sensory stimuli are more common and prominent in autistic individuals not all autistic individuals suffer from sensory issues and a child can have sensory issues without being autistic)  (see sensory processing). The intense world theory postulates that "rather than being oblivious, autistic people take in too much and learn too fast. While they may appear bereft of emotion, the Markrams insist they are actually overwhelmed not only by their own emotions, but by the emotions of others." (see sensory processing)

It is also important to note that in order to be empathic one needs a calm nervous system. All humans when in crisis or in pain find their ability to empathize and socialize affected and possibly compromised. We are born empathic creatures but that innate empathy drive needs to be nurtured and supported by our caregivers. If our environment makes us feel threatened and stressed (ie if are experiencing nervous system dysfunction)  or if we were raised in such a way to hate or distrust certain groups of individuals that in turn impedes our ability to empathize whether your autistic or allistic.  In summary, one can not assume how empathic someone is based on neurotype (i.e. allistic or autistic). Further while some autistic individuals might have difficulty with certain aspects of empathy it would be inaccurate to say that all autistics either lack empathy or all suffer from the same deficits in empathy.

I would like to briefly note that my ability to emphasize, the fact that I was warm and interactive, was the main reason I did not receive an autism diagnosis as a child.  I am not the only autistic individuals who was misdiagnosed because the doctors assumed that all autistics were cold, robotic and lacking in empathy. This myth not only is harmful to autistic individuals by presuming we lack emotion or the ability to discern emotion in others but it also directly affects who does and does not get diagnosis and in turn appropriate support.

Currently, scientists believe that both genetics and environment likely play a role in autism and there are a number of theories regarding autism. One theory argues that autism is a naturally occurring form of cognitive difference that has always been with humanity just under a variety of other names (such as childhood schizophrenia) and personality tropes (the absent-minded professor) (neurotribes) while other theories point to environmental toxins, assortative mating, changing diagnostics, sensory overwhelm (intense world theory see sensory processing), or hormone exposure/hyper male brain to explain autism.  


For reasons scientists are still teasing apart boys seem to be more vulnerable to autism and there appears to be a gender difference in how autism presents. The extreme male brain theory attempts to explain this greater male vulnerability along with the observation that autistic individuals often gravitate toward activities and behaviors that are culturally categorized as masculine. The idea is that just like how testosterone is involved in building male genitalia (see note below on development of sex) it also permanently organizes the brain in a masculine way (male brain), which makes it superior in math, science, and other systematizing fields. This theory postulates that autism reflects an extreme male brain due to exposure to high levels of testosterone while in utero. However, there is an inadequacy of data showing links between exposure of the fetal brain to testosterone and brain “type”. Further, there is no specific kind of sex-typed interest that is consistently linked to prenatal hormone exposures by more than one research model. The theory of the extreme male brain, when one considers the data and the research, doesn’t hold up under scrutiny nor does the idea that we can neatly sort the world into systemizing and emphasizing categories or male/female brain categories. This isn’t surprising considering the fact that masculinity and femininity (what it means to be a man or a women) lacks a stable scientific definition (**) and thus we can not say with definitive fact what a “male” or “female” brain looks like much less what a “hyper male” brain looks like. Furthermore, being male or female is not simply determined at one moment for any individual organism, but is the result of a multistep process. (Fine, 2010, 24*) For clarification on terms:  From a young age children are made aware of how important gender (i.e. being a boy or being a girl) is from peoples inquiry to their gender (often the first question asked) and the different handling of the genders (*/**) to the color stratified toy aisle to being grouped by gender at school. In both explicit and implicit ways children are taught that 1. Gender is important (i.e. you have to be a boy or a girl) and 2. Gender (being a boy or being a girl) is performed a certain way. They learn how to preform gender from the media they consume, conversations they overhear, and interactions with their parents and their peers.


Research shows that children start performing gender (and punishing peers for not performing gender “correctly”) at a young age starting at around 2 and go through a period of rigidity around gender between 5 and 7. “At just ten months old, babies have developed the ability to make mental notes regarding what goes along with being male or female… this means that children are well placed, early on, to start learning the gender ropes. As they approach their second birthday, children are already starting to pick up the rudiments of gender stereotyping…at around this time, children start to use gender labels themselves and are able to say to which sex they themselves belong.” (Fine, 2010, 211) “Children are born into a world in which gender is continually emphasized through conventions of dress, appearance, language, color segregation, and symbol. Everything around the child indicates that whether one is male or female is a matter of great importance. Meanwhile, at about two years of age, children discover on which side of the divide they are located…children, it turns out, are also susceptible to in-group bias to prefer what belongs to their group…in the young child’s world, gender is the social category that stands out above all the others, right from the start…the drive for group belonging may explain why young children insist on girlish or boyish behavior or dress even in the face of parental displeasure… although the literature is somewhat mixed, overall it does suggest that gender identity (I am a boy) and gender stereotype knowledge (boys don’t play with this toy) motive gender stereotypical play.” (Fine, 2010, 227-229) Research has also found that even before children are born parents often talk about and perceive their unborn child through a gendered prism. Therefore, when looking at the difference in vulnerability and presentation between boys and girls it is important to consider both genes and the environment.


It is important to keep in mind that we are the product of our genes interacting with our environment. “When it comes to genes, you get what you get. But gene activity is another story: genes switch on and off depending on what else is going on. Our environment, our behavior, even our thinking, can all change what genes are expressed. And thinking, learning, sensing can all change neural structure directly.” (Jordan-Young, 2010, 177) While boys may have a greater genetic susceptibility to autism we cannot ignore how the environment influences gene activity. Furthermore, “brains develop only in interaction; input from the external world, as well as from one’s own sensory apparatus, is as critical to development of the brain as food and water are to the whole organism…brains change and develop over the lifetime. Few inputs are irreversible. Even the animal experiments on brain organization showed that the “permanent’ effects of early steroid hormone exposures could be eliminated or even reversed by fairly brief interventions in the physical and/or social environment.” (Jordan-Young, 2010, 290-291)


Thus, we must be careful not to rush and declare this or that attribute as being inherently female or inherently male. While research does show that female and males present differently this should not be taken as a given that there are two brains rather it should give us pause and propel us to ask more questions not fall back on a neat tidy fairytale. One question we might ask is how might different handling affect autism presentation? Researchers have found that parents (often unconsciously) interact with infants in different ways depending on sex. For example, studies have found that mothers conversed and interacted more with girl babies and young toddlers and that mothers talk more to girls then to boys and they talk about emotions differently to the two sexes “in a way that’s consistent with (and sometimes helps to create the truth of) the stereotyped belief that females are the emotion experts”. (Fine, 2010, 198) These differences may help girls “learn the higher level of social interaction expected of them, and boys the greater independence”. (Fine, 2010, 199) Perhaps the different ways girl and boy babies are talked to influences how autism presents i.e. girls may be able to mask their symptoms better in part due to this early difference in socializing. There is also the cultural perception of what autism is and how that in turn may influence what behaviors and people are seen as autistic, which in turn influences who gets a diagnosis. For example, girls restricted interests tend to be similar to other girls and often involve people/animals which, because it doesn’t fit with the cultural idea of autism (male, engineering or objects/systems, usually white etc.), results in them either not getting diagnosed, getting diagnosed later, or being misdiagnosed with disorders such as bipolar disorder or OCD. Interestingly, this difference in restricted interest is in line with research that shows girls and boys are in both subtle and not subtle ways taught what toys are appropriate for which gender from a young age.  Autistic individuals, like all individuals, are not immune to the ideas and beliefs that make up their environment and it is quite possible that culturally held ideas and beliefs around gender influences autism and how it presents.


Over all, there is a lot scientists are still figuring out about autism but the one thing we can say for sure is that autism is not a recent invention. Autism and autistic traits have always been with humanity and as we gain a better understanding of autism it is important to keep in mind that autism is an example of cognitive diversity. Rather then seeing autism as a disease that we should fear and cure we as society should instead embrace difference and work toward decreasing the negative side effects of having an autistic brain in this current culture and time and help their natural talents flourish. Society needs many kinds of intelligences to thrive and as a society we should move toward greater inclusivity.



A brief note on the development of sex: In the beginning male/female fetuses both have the same unisex primordial gonads. At around the 6th week of gestation a gene on the Y chromosome causes the males primordial gonads to become testes (in females ovaries). At about week 8 the testes of the male fetus start to produce large amounts of testosterone (often referred to as gonadal testosterone) which peaks at about 16th week. By around the 26th week there is once again little difference in testosterone levels between the sexes until another smaller testosterone surge in newborn boys that lasts for about 3 months. (Fine, 2010, 101)



Massage can help in a number of ways for both child and parent/caregiver:


Benefits for the child:

  • May provide relaxation

  • May help child to become more accustomed to tactile stimulation

  • May aid in body awareness

  • May promote more on-task and social relatedness behavior

  • May decrease issues with sleeping

  • May increase trust and bonding with caregivers


Benefits for parents/caregivers

  • May increase confidence in parenting/caregiving skills

  • Provides a special time to bond with your child

  • Encourages and may increase communication with your child

  • Provides an opportunity to learn your child’s cues and unique form of communication

  • Promotes the release of nurturing hormones and may provide relaxation

  • May decrease the release of stress hormones

*Delusions of Gender: How Our Minds, Society, and Neurosexism Create Difference Cordelia Fine


**Brain Storm: The Flaws in the Science of Sex Differences Rebecca M. Jordan-Young

The new study from Sweden, however, offers robust evidence that maternal PCOS increases autism risk. Hakon Hakonarson of The Children's Hospital of Philadelphia, who studies ASD genomics and was not involved in the work, agrees that the reported association is convincing, given the size of the study and high quality of the data from the Swedish population resource. He adds that the findings fit with a role for altered fetal hormone exposure in a subset of ASD cases. But Hakonarson is quick to point out the full gamut of ASD cases likely involves many different genetic and environmental contributors, because the absolute ASD risk in children of PCOS sufferers remains small. With ASD rates hovering around 1 to 2 percent in the general population, he explains, even an almost 60 percent increase in ASD rates in children born to PCOS-affected moms translates into just a fraction of a percent higher chance of the disease overall. Experts say additional contributors are almost certainly present, because the vast majority of women with PCOS give birth to children who don't develop autism. "For any one woman with PCOS, this doesn't mean that her child is definitely going to get autism," Karolinska’s Gardner agrees. "It just means that the risk of this relatively rare disorder is somewhat increased." For her part, she hopes the study will raise awareness amongst women with PCOS without causing alarm or stress.

“Genes do dictate the basic organization, developmental schedule, and anatomical structure of the human central nervous system, but it’s left to the environment to sculpt and fine-tune the chemistry, connections, circuits, networks, and systems that determine how well we function.” (Mate, 2010, 189/190)


“In the real word there is no nature versus nurture argument, only an infinitely complex and moment-by-moment interaction between genetic and environmental effects… It’s not that genes do not matter- they certainly do. It’s only that they do not and cannot determine even simple behaviors, let alone complex ones like addiction… it is the environment within and outside the body that determines which genes are switched on, or activated, in which cell…epigenetic effects are most powerful during early development and have now been shown to be transmittable from one generation to the next, without any change in the genes themselves. Environmentally induced epigenetic influences powerfully modulate genetic ones.” (Mate, 2010, 212-214)

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