Category: Wisdom

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Misdiagnosis All Too Common for Women with Autism

00ADHD, Autism, Cognition, Featured news, Gender, Health, Wisdom May, 19

Source: Ryan McGuire at Gratisography, Creative Commons

After twenty-eight years of being “dragged through the system,” Emily Swiatek was finally diagnosed with Asperger’s, a branch of Autism Spectrum Disorder (ASD). For Emily, receiving the diagnosis felt like “coming home to a version of yourself that you have been denied of.”

Research shows that Autism Spectrum Disorder is more prevalent in males than females by a ratio of three to one. But there is increasing evidence that this gender difference may be slimmer than we think, and that autism symptoms in women and girls are frequently overlooked and misdiagnosed. 

In an interview with the Trauma and Mental Health Report, Emily explains her frustration with being shuffled from one specialist to another for years, without receiving an adequate explanation for her symptoms: 

“I’ve been through quite a long journey, being given about 10 mental health diagnoses along the way. It was getting to that point where it felt like I was caught in the middle of a guessing game. I kept coming up against the same response of ‘we don’t really understand let’s keep throwing the labels and see what sticks’.” 

The National Autistic Society survey conducted in the United Kingdom found that compared to males, women and girls are more likely to be misdiagnosed, with 42% of females diagnosed with a mental disorder other than autism when being assessed, as opposed to 30% of males. 

Emily’s experience is not unique. Hannah Belcher, who was diagnosed with Asperger’s Syndrome at 23, shares her experience:

“Throughout my life, I’ve been diagnosed with Anxiety, Depression, Bipolar, traits of Borderline Personality Disorder, and ADHD. Some correct and comorbid, some incorrect and misdiagnosed.”

There is no clear explanation as to why women with autism are often misdiagnosed. Child psychiatrist Meng-Chuan Lai, a clinician-scientist at the Centre for Addiction and Mental Health says that while there is a range of different reasons why women receive a diagnosis of ASD later in life, one possibility is that autism characteristics aren’t so evident in females: 

“Girls and women may be more able to master ‘camouflaging’, so ‘typical’ autistic characteristics could be masked when they learn social skills.” 

Lai describes this as the ability to learn neurotypical social behaviours such as eye contact, gestures, holding conversations, and the utilization of social scripts.  These neurotypical behaviours represent those who are not on the autism spectrum in contrast to the neurodiverse behaviours which refer to differently wired brains and cognitive styles attributed to those on the autism spectrum. 

In the foreword for Safety Skills for Asperger Women by Liane Holliday Willey, Tony Atwood describes this “camouflaging” phenomenon, reporting that young girls mask the symptoms of autism by socializing and interacting with their peers, causing a delay in diagnosis.  

Both Hannah and Emily attribute mimicking socialization patterns as an important factor. Emily explains: 

“I’m not a part of that traditional profile of autism… It never even occurred to anyone who was assessing me that somebody who looks like me, somebody who presents like me, could be autistic because I’m smiley, I’m eloquent, I can probably make eye contact if I have to, even though I don’t like it. I’m a very strong mimicker and that masking and mimicking profile is true for me.  I think I very much fit that ‘well behaved little girl’ image—very intelligent, liked reading, very quiet, maybe they’d say I was shy.”  

Lai notes that another possible reason for the misdiagnosis is that women and girls tend to have restricted and repetitive behaviours that are less likely to be recognized:

“The issue is that some of these narrow interests of autism in males, if you only look at the content, are more traditionally male-typical such as trains, dinosaurs, trucks, and they are most easily recognized by clinicians because of our own stereotypes of autism. For girls, their restricted and repetitive behaviours might not be captured by standardized instruments as they are deemed as less noticeable.”

Recent research has touched on the idea of bias in the way autism is diagnosed. One study showed that girls are more likely to be diagnosed if they had an additional intellectual disability or behavioural issues. However, without these, many women are receiving incorrect diagnoses, or none at all. Hannah agrees:

“Sometimes you might feel like you don’t fit in anywhere, everything everyone thinks about autism is male biased. However, as slow and painful as the journey is, there is always a light at the end of the tunnel. It takes us a little bit longer to get to it, but it is worth the journey.

In a study looking at sex differences between children with autism, researchers recommend new strategies for improving autism recognition in females. In fact, Australia is the first country to form new national guidelines to help increase early diagnosis of women with autism.  Considerations of social camouflaging, anxiety, sensory overload, and depression are being included in these new guidelines.  

If these guidelines are implemented, it will be possible to decrease the number of misdiagnoses in women and girls who have autism, leading to less frustration for these women and more time to learn how to manage their diagnosis. Emily says that since she received her diagnosis, her life has changed for the better:

“It was instant relief the minute I got my diagnosis. It just made sense. It was right. It was instantaneous the difference it made. My general well-being just went up and up and up, and is still on an upward trajectory.”    

-Lucia Chiara Limanni, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

-Copyright Robert T. Muller

This article was originally published on Psychology Today

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Misdiagnosis Is All Too Common for Women with Autism

00ADHD, Autism, Cognition, Featured news, Gender, Wisdom May, 19

Source: Ryan McGuire at Gratisography, Creative Commons

After twenty-eight years of being “dragged through the system,” Emily Swiatek was finally diagnosed with Asperger’s, a branch of Autism Spectrum Disorder (ASD). For Emily, receiving the diagnosis felt like “coming home to a version of yourself that you have been denied.”

Research shows that Autism Spectrum Disorder is more prevalent in males than females by a ratio of three to one. But there is increasing evidence that this gender difference may be slimmer than we think, and that autism symptoms in women and girls are frequently overlooked and misdiagnosed. 

In an interview with the Trauma and Mental Health Report, Emily explains her frustration with being shuffled from one specialist to another for years, without receiving an adequate explanation for her symptoms: 

“I’ve been through quite a long journey, being given about 10 mental health diagnoses along the way. It was getting to that point where it felt like I was caught in the middle of a guessing game. I kept coming up against the same response of ‘we don’t really understand let’s keep throwing the labels and see what sticks.’” 

The National Autistic Society survey conducted in the United Kingdom found that compared to males, women and girls are more likely to be misdiagnosed, with 42 percent of females diagnosed with a mental disorder other than autism when being assessed, as opposed to 30 percent of males. 

Emily’s experience is not unique. Hannah Belcher, who was diagnosed with Asperger’s Syndrome at 23, shares her experience: “Throughout my life, I’ve been diagnosed with Anxiety, Depression, Bipolar, traits of Borderline Personality Disorder, and ADHD. Some correct and comorbid, some incorrect and misdiagnosed.”

There is no clear explanation as to why women with autism are often misdiagnosed. Child psychiatrist Meng-Chuan Lai, a clinician-scientist at the Centre for Addiction and Mental Health says that while there is a range of different reasons why women receive a diagnosis of ASD later in life, one possibility is that autism characteristics aren’t so evident in females: “Girls and women may be more able to master ‘camouflaging,’ so ‘typical’ autistic characteristics could be masked when they learn social skills.” 

Lai describes this as the ability to learn neurotypical social behaviors such as eye contact, gestures, holding conversations, and the utilization of social scripts. These neurotypical behaviors represent those who are not on the autism spectrum in contrast to the neurodiverse behaviors which refer to differently wired brains and cognitive styles attributed to those on the autism spectrum. 

In the foreword for Safety Skills for Asperger Women by Liane Holliday Willey, Tony Atwood describes this “camouflaging” phenomenon, reporting that young girls mask the symptoms of autism by socializing and interacting with their peers, causing a delay in diagnosis.  

Both Hannah and Emily attribute mimicking socialization patterns as an important factor. Emily explains: 

“I’m not a part of that traditional profile of autism… It never even occurred to anyone who was assessing me that somebody who looks like me, somebody who presents like me, could be autistic because I’m smiley, I’m eloquent, I can probably make eye contact if I have to, even though I don’t like it. I’m a very strong mimicker and that masking and mimicking profile is true for me. I think I very much fit that ‘well behaved little girl’ image—very intelligent, liked reading, very quiet, maybe they’d say I was shy.”  

Lai notes that another possible reason for the misdiagnosis is that women and girls tend to have restricted and repetitive behaviors that are less likely to be recognized:

“The issue is that some of these narrow interests of autism in males, if you only look at the content, are more traditionally male-typical such as trains, dinosaurs, trucks, and they are most easily recognized by clinicians because of our own stereotypes of autism. For girls, their restricted and repetitive behaviours might not be captured by standardized instruments as they are deemed as less noticeable.”

Recent research has touched on the idea of bias in the way autism is diagnosed. One study showed that girls are more likely to be diagnosed if they had additional intellectual disabilities or behavioral issues. However, without these, many women are receiving incorrect diagnoses or none at all. Hannah agrees: “Sometimes you might feel like you don’t fit in anywhere, everything everyone thinks about autism is male-biased. However, as slow and painful as the journey is, there is always a light at the end of the tunnel. It takes us a little bit longer to get to it, but it is worth the journey.”

In a study looking at sex differences between children with autism, researchers recommend new strategies for improving autism recognition in females. In fact, Australia is the first country to form new national guidelines to help increase early diagnosis of women with autism. Considerations of social camouflaging, anxiety, sensory overload, and depression are being included in these new guidelines.  

If these guidelines are implemented, it will be possible to decrease the number of misdiagnoses in women and girls who have autism, leading to less frustration for these women and more time to learn how to manage their diagnosis. Emily says that since she received her diagnosis, her life has changed for the better: “It was instant relief the minute I got my diagnosis. It just made sense. It was right. It was instantaneous the difference it made. My general well-being just went up and up and up, and is still on an upward trajectory.”    

-Lucia Chiara Limanni, Contributing Writer, The Trauma and Mental Health Report

-Copyright Robert T. Muller

This article was originally published on Psychology Today

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Wisdom From a Psychopath?

00Behavioral Economics, Ethics and Morality, Evolutionary Psychology, Featured news, Narcissism, Psychopathy, Wisdom April, 15

Source: Ross/Flickr

The word psychopath conjures images of skulking figures and dark alleys.  The media equate psychopaths with infamous serial killers like Ted Bundy and Robert Picton.

But psychopaths and psychopathy are much more complex. In 1980, Robert Hare, a psychology professor at the University of British Columbia, published the most widely used measure of psychopathy to date, the Psychopathy Check List (PCL), including symptoms like callousness, parasitic existence, and criminal versatility. With later studies finding the prevalence of psychopathy to range between 1 and 2 percent in the general population, it is hard not to feel a twinge of fear.

Are psychopaths really the hollow killers the media make them out to be? Kevin Dutton, a research psychologist at the University of Oxford and author of the controversial book, The Wisdom of Psychopaths, doesn’t think so.  Dutton argues that not only are the majority of psychopaths far from monsters, but that psychopathy itself is a potentially useful trait that we can benefit from.

Evolutionary psychologists have conducted studies that suggest the existence of psychopathy as a fundamental part of human development, predating homo sapiens.

Dutton claims that when it comes to getting ahead, from a financial or social perspective, psychopaths often come out on top.  He points out that the majority of psychopaths are, in fact, affluent members of the community.  The all-important distinction, in his view, lies in how high their “psychopathy dial” is turned.

Dutton’s research has yielded eight aspects of psychopathy, seven of which are seen as potentially beneficial for everyday life, and one that is harmful.

The harmful characteristic consists of symptoms typically associated with Antisocial Personality Disorder (ASPD), like difficulties with impulse control and irresponsibility.  In Dutton’s view, when these traits are present, psychopaths often turn their minds to crime and violence, seeking immediate gratification of lust, greed, and vanity. Since psychopaths lack morality, the only check on their disregard for rules is conscientiousness and the ability to plan long-term. This ability helps them predict negative consequences like getting caught and being punished, and reins in their wilder, more criminal tendencies.

While the impulsivity of psychopaths is unlikely to benefit most people, Dutton argues that the other seven traits may. These characteristics vary in intensity among individuals.

The first two of the seven traits are persuasiveness and a self-serving attitude. These traits make up the core image of the smooth-talking, egocentric individual who has no trouble lying to get ahead. For most, the wish to lie is thwarted by conscience, but psychopaths have developed two complementary traits to aid their machinations:  emotional detachment and alienation from others.  These two traits ensure that psychopaths are unable to feel pity or empathy for victims, contributing to their reputation as cold-hearted manipulators that walk over others without remorse. But it is also these traits that contribute to success in business and some professions.

Apart from morality, another characteristic that stops most of us from trying to fly under the legal or moral radar is fear. But two traits that psychopaths exhibit are rebelliousness and fearlessness, making them not only unafraid of getting caught, but actually excited by the prospect of subverting authority.

Even the greatest manipulators are sometimes found out, but even here psychopaths have a trait they benefit from, calmness under pressure, which ensures that if they do get caught, they are able to talk their way out of an otherwise career-ending situation.

So why aren’t these traits seen more widely?

Dutton explains that while certain levels of psychopathy are likely to net gains for an individual, they do nothing for a community.  As humans are largely dependent on social structure for survival, psychopaths essentially pit themselves against the world.  Too many of them in the group, and they outwit themselves into extinction.

And perhaps this is where the real lesson lies.  In a world where unbridled self-interest rules, Dutton’s psychopath may be viewed as effective…at most.  But wise?  This seems like a stretch.

This seems like a stretch.

On a small scale, radical self interest may be enticing.  Imagine being wholly unencumbered by morality, conscience, or altruism. You certainly could go far.

In aggregate though, not only does this prospect seem rather unwise, but it represents a world far more terrifying than that of Ted Bundy or Robert Picton.

– Contributing Writer: Nick Zabara, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today