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Study on ‘extreme male brain’ theory of autism draws critics

by  /  25 August 2014

Gender games: According to the extreme male brain theory, men are more interested in systems and patterns, and women are more keenly attuned to others’ emotional states.

The controversial theory that characterizes autism as the result of an ‘extreme male brain’ gets fresh support from a large new survey, published 16 July in PLoS One1. But critics question basic assumptions of the theory and the methods used in the new study.

Simon Baron-Cohen, director of the Autism Research Center in Cambridge, U.K., proposed the extreme male brain hypothesis more than a decade ago as an explanation for why four times as many boys as girls are diagnosed with autism2.

The theory holds that men are better ‘systemizers’ — more interested in patterns and quicker to spot them in natural, mathematical or mechanical systems. And women are better ‘empathizers,’ more keenly tuned to the emotional state of others.

Men and women with autism are both keen systemizers, but less able empathizers, Baron-Cohen has proposed. He suggests that autism is related to overexposure to testosterone while in the womb.

His group has previously made this case based on online questionnaires given to small groups of high-functioning adults with autism. The new study includes the largest sample to date — 4,700 adults, including 811 men and women with autism. In the autism group, both men and women scored higher on the systemizing survey, and lower on empathizing, than did their counterparts in the control group.

“It’s suggesting that males and females with autism are shifting along this dimension which you could call a masculinized direction,” Baron-Cohen says. He argues that the new results have the statistical power to validate the basic tenets of his theory.

Other researchers, however, are not convinced.

“The idea that people with autism lack empathy is wrong,” says David Skuse, chair of behavioral and brain sciences at University College London. People with autism can feel others’ pain, but they are slower to process this emotion, he says. “[The study] does not explain anything.”

Question marks:

The new study included adults between 18 and 75 years of age. The participants with autism are all high-functioning, and the control group excludes people with any condition that can alter perception of reality, such as bipolar disorder, epilepsy or schizophrenia.

The participants each took three surveys online. The Systemizing Quotient-Revised asks responders whether they are drawn to tables and charts when they read the newspaper and whether they enjoy mathematics and spotting trends in groups of numbers, among other questions. The researchers use these answers as a measure of ‘systemizing’ tendency, an affinity for picking out details and patterns in everyday life.

The Empathizing Quotient includes questions about a person’s social interactions, asking whether they share their feelings with others, or can tell when a friend is uncomfortable or unhappy, for example.

The participants also took a third survey, the Autism Spectrum Quotient, which Baron-Cohen developed to measure features of autism in the general population. The results of this survey are used to indicate what Baron-Cohen calls ‘autistic tendency.’

The men in the control group scored much higher on the systemizing test than the women did, and the women scored higher on the empathizing survey.

But among men and women with autism, this difference between the sexes is less pronounced. Both men and women scored higher in the systemizing test than the typical adults of their corresponding sex. Also, women with autism scored lower on the empathizing test than women in the control group.

The differences are small, however. “I find the interpretation of such small differences as support for some sort of male brain not particularly convincing,” Skuse says.

The survey uses self-reported accounts of behavior, which are notoriously unreliable because researchers can’t verify the answers, Skuse adds.

Catherine Lord, director of the Center for Autism and the Developing Brain at New York-Presbyterian Hospital, is similarly unconvinced about the new findings. “It’s a bigger sample but there’s not much new here,” she says. “It doesn’t prove that there are differences in anything except on the scales [Baron-Cohen] has created.”

She calls for an independent touchstone to verify the assumptions driving the extreme male brain theory: for example, a definition from another expert, behavioral observations or physiological responses to certain stimuli.

Lord says she would also like to see more information about the survey respondents themselves. “If you’re trying to reach conclusions about the nature of human beings, you need to know where they came from,” she says. She is concerned that people who are predisposed to less social behavior may choose to avoid such a survey altogether — in which case Baron-Cohen’s sample would not be representative of the larger population.

Baron-Cohen acknowledges that Internet questionnaires have limitations, but says the tradeoff is worth it. “The great advantage is statistical power,” he says. “Even if some are overestimating [their abilities] and some people are underestimating, the noise in the data is likely to be canceled out by the sheer size.”

Other critics take issue with the participant pool, however. Of the 811 participants with autism, 454 are women. This is in striking contrast to the usual gender bias in autism, and so may not represent the bulk of people with autism, says Thomas Frazier, director of the Center for Autism at the Cleveland Clinic.

It’s possible that these effects are driven less by innate biological differences and more by cues from their parents and siblings about what it means to be a man or woman, Frazier says. People with autism may ignore those cues more than the control group, for example, but the researchers do not account for this social conditioning. “The theory still leaves me saying, ‘So what?’” he says.

Frazier and the others say they do value the survey as a rare look at high-functioning individuals with autism, particularly women, who are an under-researched and underdiagnosed group3.

The researchers collected a variety of demographic information, such as employment status, as part of the surveys. “The implication that if you have a diagnosis of autism, this is going to blight your life forever, this has caused huge alarm to parents,” Skuse says. But, he notes, the 13 percent unemployment rate in the study’s autism group is encouragingly low.


1.Baron-Cohen S. et al. PLoS One 9,e102251 (2014) PubMed

2.Baron-Cohen S. et al. Science 310, 819-823 (2005) PubMed

3.Dworzynski K. et al. J. Am. Acad. Child. Adolesc. Psychiatry 51, 788-797 (2012) PubMed

14 responses to “Study on ‘extreme male brain’ theory of autism draws critics”

  1. PHG says:

    The extreme male brain theory makes sense at the higher functioning end of the scale, where there are so many more ASD diagnoses in males. But at the lower functioning end, isn’t there an almost even split of male/female? This suggests an entirely different type of autism, different cause, different theories.

    Also, interestingly, I am a “broad autism phenotype” mother of a little boy with an ASD diagnosis. I’ve taken Baron-Cohen’s EQ and SQ tests online and score average on empathising, but really low on systemising, not the other way around which I would’ve expected.

    • Greenclogs says:

      Your first paragraph was going to be pretty much exactly my comment! Also, although I haven’t taken the tests, I suspect that I would score similarly to what you have described (I have a diagnosis of AS.)

  2. usethebrainsgodgiveyou says:

    I might suggest a challenge to researchers to find any group of people more mistreated than autistics. They are highly victimized…90% of women being sexually abused, young men are often victims of bullying because they are so vulnerable. Those are things to be looked at, not further testing that proves that they think differently than the nebulous normal crowd. How can we help our children be strong?

    There are a couple of young men with a lot of chutzpah who use positivity to help their fellow Aspergerians, the bulk of the people Dr. Cohen works with. Because it is a disability, at least in regard to learning to live with “normals” who have no regard for them…the “Aspergers Experts” have come up with the idea that teaching social skills to an Aspergerian while they are still in “defense mode” with the fight or flight response button being stuck on “on”, is like teaching an American Soldier in Afghanistan to knit. They might learn a couple of things about knitting but basically their mind is going to be set on survival, not learning to knit. It is time that other researchers quit coddling Dr. Cohen’s pet ideas and begin to look at Autism/Aspergers through the lense of the People who live with it. Hows that for empathy?

    I suggest that Dr. Cohen has a curiosity about, but no empathy towards Autistics/Aspergians.

    • ASD Dad says:

      Time for Baron-Cohen, Lord , Rutter and several other ‘old school’ researchers to move on.

      The damage has been done in any number of areas. Every person is a whole and complete person that needs to addressed as such.

      Time for new perspectives and new futures.

  3. usethebrainsgodgiveyou says: How to treat someone with Aspergers/Autism

  4. Payman says:

    Simon Baron is clueless when it comes to autism. He should not touch autism. Neurologists did a recent study, they performed biopsies on kids brains diseased with autism. The brains had 40-50% more synapses as kids, as they got older there was no pruning. This explains why they stim, why they have more epipletic siezures and why they are so sensory overloaded. The problem is autophagy. With such a study, so precise and so to the point, who cares about what Simon Baron says or does. If researchers care about autism and not that of their individual goals they should push to find drugs that can interven in autophagy, synapses pruning. Synapse pruning does occurr even as individuals get older (teenagers). So there is still a chance to have treatments that can have huge impact on lives of individuals with severe autism.

  5. Elizabeth B Torres says:

    I have two words for you: CONFIRMATION BIAS

    Follow the scientific method rigorously.

    Measure OBJECTIVELY what you are proposing and give us information about negative outcomes too.

    Science is not about glory and fame. It is about serious and rigorous work. This research is not doing that type of work. I

    • Dooch says:

      Everything is confirmation bias. Otherwise you would not investigate theories, or even come up with them.

  6. Peony says:

    I have Aspergers and am a non-identical female twin (and definite ‘systemizer’). My twin sister is unaffected and a definite ’empathizer’. But surely we shared the same pre-natal environment?

    • twoness says:

      Yes, but be aware, that during in utero, you are exposed to both male and female genes. One half father, other half mother. There is more than just ‘one’ thing going on in the womb, because it takes ‘two’ systems working in tandem to make an individual.

    • Degenerate76 says:

      Fetuses produce their own testosterone. It’s a bit misleading when they talk about “prenatal exposure” to testosterone. What they mean is that the high testosterone level has noticeable effects on development prenatally, not that it’s an external exposure coming from the mother.

  7. CC says:

    Biggest load of bunk I’ve ever seen. Confirmation bias abounds. I’m autistic – ask ME about it, not some researcher who pathologizes me and those like me.

  8. adult autism says:

    The hypothesis was proposed more than a decade ago as an explanation for why four times as many boys as girls are diagnosed with autism. The theory dictates that men are better “systemizers”- more interested in patterns and quicker to spot them in natural, mathematical, or mechanical systems. And women are better “empathizers,” more keenly tuned to the emotional state of others.

  9. thelight'son says:

    Would imply that there are ‘two’ brains within a single human system. One is male, other is female. Right and left brains inhabited by both in a single individual. We are our mother and father, not just ‘one’ sex, but two. One is expressed moreso, than the other. ‘Other’ is so called ‘spirit’. Inner voice. Demon, or angel, or voice of God, in religious dogma. You ARE two people. Your mother and father, come together as one. Just as they are their mother and father, etc… Each ‘half’ of the brain is ancestors piled up on one another, using evolution, or progression of the species.

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