Uta Frith, women, autism, and what Dr Stock, Helen Lewis etc think...

[Missproportionate]

Helen Lewis and Kathleen Stock have both commented on this article on X, both slightly ambiguously, as if they aren't sure what to think.

Wondered what anyone on here thinks about this? I am also ambiguous, but full disclosure: I have been diagnosed with autism at the age of 50, I haven't told very many people because I see a lot of identifying as 'neurospicy' online, and it seems to be connected to the whole 'I'm not normal, oh no I'm special' idea that I think has parallels with the queer community. I don't want to be on that bandwagon, I just want to make sense of myself.

I was diagnosed through a long process with several professionals, and a 3 hour interview with me, and a 3 hour interview with my mum about me as a child. I fitted in all the separate areas of criteria. I doubt people I work with or interact with superficially would guess ( but they may find me irritating or insensitive or interrupting - I find it hard to tell).

But it worries me a bit that women who are autistic might be seen as 'not real' and lumped in with the trans community in some way. But then how does that
then work? because as has been observed many times, girls who present with gender dysphoria are very often diagnosed/undiagnosed autistic. I think we should be leaning into attending to the autism in girls, and how an autistic girl might find being trans attractive as a way to 'solve' their feelings of not belonging. If we start to question the genuineness of their autism, we risk failing those girls even more. Don't we?

I don't know what to think.

Uta Frith interview in TLS

That is rather simplistic when you've been married 48 years, have no desire to be on your own at this stage in life, and are ND yourself in ways that his ASD traits are helpful for eg meticulous attention to household admin.

I'm not sure if you realise how much your post reads as dismissive, when. I have told you plainly that I feel there is a notable benefit to having a diagnosis?

Thanks. That has helped me to better understand the distinction you are making, and to deepen my own understanding of why CBT is not a helpful form of therapy for everyone. But I don't think that the distinction you are making maps on to the distinction between being autistic-with-anxiety versus being non-autistic-with-anxiety.

For a lot of non-autistic people with anxiety, their triggers are predictable environmental factors, as with autism. They are not hypothetical, and the triggering that they generate is not necessarily mediated by catastrophic thinking.

Take, for example, people with PTSD. Their anxiety will spike in situations that resonate (consciously or unconsciously) with traumatic events in the past. Or take the example of people with physical conditions that are socially challenging, such as IBS or disfiguring dermatological conditions, for whom it is entirely predictable that social encounters will be fraught with specific negative stimuli.

I think the point that I am making is that anxiety has many presentations -- which is to be expected given very many different combinations of neurological, psychological , and environmental components that combine to create the pathway to anxiety. There is no monolithic distinction between autistic and non-autistic anxiety, and CBT is an absolutely ineffective treatment for quite a lot of peolple with anxiety regardless of their autism status.

I feel I might be in a bit of a cul-de-sac here, and that these ponderings might not be helpful to anyone other than me. But the significance they have for me relates to what I said in my previous post: the wider diagnostic category that we now have for autism pulls in some people for whom autism should not be regarded as a 'condition', but as a neurotype that is associated with a vulnerability to certain conditions (specifically, in this case, a vulnerability to anxiety).

Just as with non-autistic people, the mental health condition of anxiety comes into existence when neurological variables (not necessarily those associated with autism) come together in a toxic way with psychological and environmental variables. It is worth remembering that many people who meet the wider diagnostic criteria that we now have for autism do not have mental health problems and are simply living their lives as happily as they would have without autism. (Quite naturally, the people who seek diagnosis in adulthood tend to be the ones who are having problems -- so it is easy to lose sight of the possibility of being mildly autistic and flourishing.)

This recognition does not diminish the need for support, recognition and compassion for people who are struggling with mental health problems partly or wholly as a result of autistic vulnerabilities. But it may help us to move away from a situation in which the people for whom autism is an unquestionably severe disability in its own right are marginalised in their own disability category by people whose autism is not intrinsically a disorder, but is, rather, a vulnerability to mental health challenges.

I think the point that I am making is that anxiety has many presentations -- which is to be expected given very many different combinations of neurological, psychological , and environmental components that combine to create the pathway to anxiety. There is no monolithic distinction between autistic and non-autistic anxiety, and CBT is an absolutely ineffective treatment for quite a lot of peolple with anxiety regardless of their autism status.

I agree with you here 100%.

I wasn't trying to say that other conditions that have a high comorbidity of anxiety aren't deserving of treatment options or that they should be treated with CBT and be happy with what is offered. Simply that CBT approaches are often denied to autistic people because of practitioners unwillingness to adapt their methods.

I agree that CBT often isn't suitable for autism, and many other conditions.

I think here we are saying the same thing, that anxiety deserves understanding and support irrespective of it's source.

My partners experience with GAD is significantly different to my experience with autism.

He is categorically disabled by it, but his outlook is often catastrophised which is why CBT based methods work well for him, but not for me, and similar people who have had experience with the CBT system as an autistic person. I have however had benefits from CBT pre-diagnosis though not to the extent at which was clinically expected.

My original response to noblegiraffe was admittedly a rudimentary explanation of why practitioners justify their refusal to treat children and adults once they've acquired an autism diagnosis. As another PP has said up thread though it isn't that simple, as there are often comorbidities that can benefit from CBT style treatment however they're often refused simply for having an autism diagnosis, and in these cases having a diagnosis has actually been detrimental for them in terms of accessing support.

CBT isn't really trauma informed therapy, which is what would be needed for many of the diagnoses you've listed, and of which there is a woeful lack of available through the national health. As another PP has said they'd be willing to pay for the support if they just knew what support it is that they'd need to ask for in order to get it.

That's all really interesting, @Jimmyneutronsforehead . I don't think I really disagree with you . It was more that some of what you said sparked thoughts in me about some things that I do disagree with , and then I was trying to think things through with my fingers.

It has been a very interesting discussion and I am so glad to be experiencing a thread in which so many questions around autism are being frankly and intelligently discussed.

It is worth remembering that many people who meet the wider diagnostic criteria that we now have for autism do not have mental health problems and are simply living their lives as happily as they would have without autism. (Quite naturally, the people who seek diagnosis in adulthood tend to be the ones who are having problems -- so it is easy to lose sight of the possibility of being mildly autistic and flourishing.)

@MyThreeWords

The diagnostic criteria speak of ‘deficits’ and ‘clinically significant impairment in social, occupational, or other important areas of current functioning’.

I though you had to be experiencing or feeling that impairment to get a diagnosis?

If people are ‘functioning as happily as they would without autism’, if they are ‘flourishing’, if there is no relevant impairment, then why would they be given a diagnosis at all (if they chose to look for one)?

@Chinkoffire I don't know the answers to your questions in any detail, but I guess that there are two things to consider here:

One is that it is impossible to operationalise the notion of a deficit or impairment in a completely watertight way and that diagnosis is going to be influenced by the evolving culture within the diagnosing community. It is also influenced by the kind of pressures that (as I recall) Frith mentions, specifically: clients arriving with a strong expectation of diagnosis and a desire to be diagnosed. Additionally, the increasing prevalence of private diagnoses raises questions about commercial factors that may influence the rate of diagnosis.

The second consideration is something else that Frith mentions: the increasing over-attention by assessors to self-description by the client rather than to clinical observation. In your post, you say I thought you had to be experiencing or feeling that impairment to get a diagnosis. But that isn't quite right. What's needed isn't an "experience" or "feeling" of impairment, but simply having the impairment.
I suspect that the flourishing people with autism that I mentioned, if they qualified for diagnosis, would do so more on the basis of clinical observation than self-description, which (Frith implies) is likely to be a more robust form of assessment. In some cases this may be because they lack insight into their deficits. In other cases it may be that they are fortunate enough to move in social and employment contexts in which the capacities that they lack just aren't engaged or needed.

@MyThreeWords

I suppose I’m one of those who see autism as a disorder. If someone isn’t functionally impaired then that’s not autism imho.

(I do see what you mean by possible lack of insight in the case of your flourishing autistics, but there would be an objective impairment in that case.)

I also struggle with the idea that if the environment (be it social or sensory) were ‘perfect’ then there would essentially be no issue. That’s not my experience of the condition through my son. The environment does have a strong impact of course, but many of his issues are environment independent.
In any case it’s not a realistic construct, to think we can live in a perfect world.

We probably don't disagree fundamentally, @Chinkoffire . I agree that autism is a disorder, I just think that we are arguably over-diagnosing in a way that pulls people in who aren't disordered but who may be more than averagely vulnerable to certain disorders.

My own experience (in addition to being a probably non-autistic person with depression and anxiety relating to trauma) is my son's diagnosis. He was unquestionably seriously enough affected to be regarded as suffering fro a disorder, but he had additional diagnoses and challenges too, notably psychosis and depression.
Two things always struck me about his plight. One was that one and the same symptoms could be ascribed to autism, psychosis, schizophrenia, or depresssion depending on the clinician and on what interventions were being considered. This made me think of autism as something like a gestalt - a possible framing that could be grasped or ditched according to when and whether it was therapeutically useful. I'm not sure how to conceptualise that , except to say that I feel there is something relational/pragmatic rather than intrinsic about this diagnostic category.

The other thing that struck me is that schizophrenia, like autism, is defined not in terms of an underlying causal pathway but in terms of symptom clusters. In neither case do we have reason to believe in a moonolithic cause for all instances of the condition. This lead me to speculate that there is a subset of autism and a subset of schizophrenia that are in fact one and the same condition. In turn, this leads me to believe that not all autisms are the same thing, or even more than minimally related, again undermining the utility of the currently very broad symptomatic criteria.

(So , thinking about it , I don't quite agree that autism is a disorder -- I think it is a range of disorders.)

TempestTost
He's said many times that in his opinion a lot of parents end up crippling their own kids by making sure they don't have to learn how to cope.

I have heard exactly the same said by a person with almost no sight from an early age, both of whose parents were similarly limited in what they were able to see. Because nobody else was there to do it, she learned all sorts of things which sighted parents would have stopped her from doing, such as cooking for herself and doing the washing, and cleaning surfaces in the kitchen and telling whether they really were clean before she started to cook. This stood her in very good stead as her sight got worse, and then after she left home. The coping mechanisms were something she got early, because she needed to.

One thing that strikes me about this discussion of Uta Frith’s article is that she gave the interview to the TES which is a publication for people who work in education, and in it she is discussing autism presentations in children who are diagnosed very young (‘classic’ autism), those who are diagnosed in primary (‘Asperger’s’) and the third group which she says is increasing at an alarming rate of mainly adolescent girls (‘hypersensitive’). She doesn’t mention anything about middle-aged women - does she mention this elsewhere, or are this group identifying themselves with the young girls?

I can think of at least 4 girls I currently teach who are in that group, all missing large amounts of school. In previous years this would have been very rare, so it’s not an increasing group who are being diagnosed despite being less in need because of diagnosis-seeking, but an increasingly large group who are very obviously presenting with issues that represent a severe impairment in their ability to attend school.

That’s not so much extending the spectrum to encompass those who are really coping, but to describe a ‘new’ group who are not fine and not coping.

I think this is the most important point - this group of young women who are receiving a diagnosis in their later teens, as my DD did, are definitely not coping. Their need for support is immediate - it's not a case of looking back in retrospect as reasonably well-adjusted adults and thinking a diagnosis might be useful to understand aspects of your personality or difficulties you've experienced (which I agree is still hugely valuable) but often comes out of sheer desperation when all conventional approaches to managing anxiety, depression, social exclusion, school refusal, self harm etc have failed. For these young women their lives have completely derailed - often to the point of suicidality.

Now we can argue about what the true root causes are, which diagnosis is more appropriate: autism or Asperger's etc but I really don't think this group should be assumed to be 'hyper sensitive' as a new catch all diagnosis for any girl who is unable to cope with social expectations, or at least not before an attempt is made to even the playing field in terms of good quality research into female autistic presentation compared to males. Otherwise, it feels suspiciously like an easy way to reduce the number of people (female people) needing support - support that we've already established barely exits anyway. It just feels like more medical misogyny.

The authors of the scientific study discussed in this article agree with you regarding the research needed @Jamclag.
“These observations highlight the need to investigate why female individuals receive diagnoses later than male individuals,”
www.theguardian.com/society/2026/feb/04/autism-women-men-diagnosis-childhood-adulthood

But what does it change? What if you weren't given a diagnosis? You still have a personality and a way of being whether or not it comes with a diagnosis.

And honestly, defining what is medically accurate is not there to help people feel better in their marriages. That's not what diagnostic criteria is for, it's not really relevant to the question of what appropriate diagnostic criteria are.

There was a thread in AIBU a few weeks ago where someone was kind of complaining that the NHS didn't have people to help them explore their own mind and understand it better. This person seemed to think she was particularly unusual, and more than that, that help understanding her own mind would help her have a better life. It seems to me that is how people are talking about being diagnosed in many cases.

Well this is part of the question I think.

If we now have a cohort of people diagnosed who are in fact doing about as well as the general population (because we don't all flourish all the time, most people have struggles), do they really have a condition? Or are they just a personality type, like other personality types?

This would be my DC group - they managed just but friends of theirs hit crisis points usually during secondary or later and had real problems and then parents often ended up spending money for private diaagonsis in desperation.

I don't see middle age women going for disagonisis so not really a thing on my radar - it's teens and young adults still in education mostly.

I'd been raising concerns way younger as often other parents had as well and it would be blamed on parenting, kids being too senstive - or something but not enough to be put forward for diagosisis or they were struggling but not as bad as other kids- the issues just weren't seen. So they cope till they in serious danger of breaking.

DS has issues but most of his friends got diagnosed much sooner because they couldn't hide the struggles as well. Certainly primary was more willing to consider dyspraxia and co-ordiantion support for DS than for DD1 who had the same problems though they spent a large part of his early years balming him being a summer born boy who would just catch up at some point.

I don’t think we have a cohort of diagnosed people who are doing as well as everyone else though. Do we? We shouldn’t have.

The group Uta Frith was talking about, the ones she thought perhaps shouldn’t be considered autistic, do have genuine issues and need support. That was made clear. Her point was that their problems (hypersensitivity?) could be treated better under a diagnostic label other than autism. She was saying they are different to other autistic people I guess, and that the spectrum shouldn’t be as wide as it is currently. Not that they’re doing as well as everyone else.

Absolutely this. The immediacy is important. But if feels like nothing happens until a diagnosis of <something> but that takes so long. And years are lost.

Firth says that masking has become the issue that has confused things; her use of the term hyper sensitive or highly sensitive.

We just don’t know what that actually means. It can be a neurological difference which needs a lot of Ot input. Or it’s a personality type (so not pathological) but a type that’s more prone to anxiety and depression under certain circumstances.

There’s also the impact of changing hormones - simply not enough support or research there.

One part of the highly sensitive profile is being very moved by the arts and nature and wanting to connect with others, being very nurturing and caring, pro social, but also needing to occasionally completely escape everyone and everything everyone due to overwhelm. This is supposed to be a personality trait that’s in 20-30% of the population. So we really need clarification here. As all these people could be described as autistic.

I also don’t think what used to be termed ADD is supported, recognised or researched enough. This is now a subset of adhd. And may present differently in girls. (Part of me feels that being absorbed by the umbrella of adhd is problematic in similar ways to those Uta described.)

The other discussion is auto immune issues which are much higher in women and girls. I think Uta briefly alluded to that.

That is the issue with the term hyper sensitivity - it’s then dismissed as “pull your socks up love.” These children are really struggling.

The concept of double empathy could apply to a wider range of people to be honest. (Developed by Damian Milton, who’s been pretty awful about Firth and Fisher online actually, rather than engaging in the conversation in ways that add to it)

At least Baron Cohen has engaged and respectfully disagreed on some points, laying out his case.

Im trying to distract myself from a tricky ehcp issue so asked AI what to call this group that sounded less like 'pull your socks up' if the group exists based on her article.

I didnt like any option but it had things like 'high attunement profile' 'deep sensory and emotional perception' 'enhanced sensory and emotional responsiveness'

But autism is apparentky greek for 'self' so they just as easily call it a vague Greek term like that 'aesthisis' (sensation apparently)

Isn't part of the point that with such a wide diagnosis we don't know if we have a diagnosed cohort that are doing as well or not? E.g the stat that only 30% of autistic people are in work - this clearly differs across the spectrum (with a large group whose needs are so high that it will be 0%, which clearly impacts on the overall picture significantly) but without breaking down the diagnosis any further you can't tell whether there is or is not a group with an average employment rate that approaches the population average.

It’s hard to study cohorts and what might help them if the cohorts are so varied that you may have individuals who must have life long 24 hr care in residential facilities with people who’ve become lawyers and work in the city in the same cohort. Or academia.

Which is absolutely not to say that those people have not had a lot of difficulty in their lives - what helped them to get to where they are? As equally, key things may have meant that they didn’t get to where they are.

Speaking to a a psychologist who works in prisons a couple of years ago, they’re starting to look at late diagnosis (for many different things, eg adhd or autism) for many in the prison system.

Though this should be via the lens of rehabilitation and prevention of reoffending, not lessening the responsibility the individual may have for their crimes.

I'm finding your responses to my posts explaining a personal view of answers to your questions, dismissive and now annoying bordering on offensive.

Neither my husband or I took NHS resources though both of us were diagnosed by NHS professionals. Those diagnoses were helpful to us individually and as a partnership and as far as I'm concerned that's what matters.

You will I hope forgive me if I decline to engage any further in this discussion with you.

” What if it doesn't?" is not a question that I can answer.

It did.

Isn't part of the point that with such a wide diagnosis we don't know if we have a diagnosed cohort that are doing as well or not?

I just honestly can’t see how someone is eligible for a diagnosis if they are doing as well as anyone else.

Though they might be employed, they should need to have some type of clinically significant functional impairment that is impacting their lives. Otherwise the whole diagnostic process is a joke, surely? (Are you saying it is?)

Whether that diagnosis needs to be autism vs something else is the question Frith was raising (I thought?)

I’m not pp but I don’t see why a diagnosis wouldn’t help a partner. It helps parents a lot when you can start to view behaviours through the lens of autism and I think this is widely accepted. Understanding a situation, understanding the reasons why a person behaves a certain way, is never a bad thing.
Whether a partner then decides they can or can’t live with the situation is a separate issue, but at least they can make a more informed decision.