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

It's really significant that questioning the new orthodoxy over autism provokes such heated feelings, even when it comes from someone who has been a pioneer in the field.

For a start it comes in the middle of a heated debate over disability benefits with the accusation that parents ‘push’ for a diagnosis for their non-autistic child in order to get benefits, a free car etc etc. Suggesting that autism is over diagnosed will always get pushback because of this.

Some people think this is about self-identification but Uta is probably referring to the increasing number of girls receiving a professional diagnosis. The ‘hypersensitive anxious’ ones. And this is an increasing group, but not a frivolous one. These girls, as she says, are the ones increasingly likely to drop out of school. I can think of at least two girls I currently teach that fit this description who are recently diagnosed. What’s interesting is that previously I had spotted ‘quirks’ about them that would make me think of autism even before the anxiety really became an issue. I can also think of late-diagnosed boys who presented in a similarly hyper-anxious way.

Are they not ‘really’ autistic and being misdiagnosed when something else would be a better label? I don’t know. They certainly need help and support though.

It's an interesting discussion but in a way impossible to resolve. The problem with neurodivergent conditions (and mental health conditions) is that they are human constructs. Autism is a term invented by humans to describe certain kinds of behaviour, personality trait or learning difficulty. Ditto ADHD, dyslexia, dyspraxia and so on.

I'm not saying that those things don't exist, I'm just saying that the diagnosis of these conditions rely entirely on boundaries and definitions drawn up by humans. It's not like measles or chicken pox where you have a primary cause (a virus) and then you diagnose it through a set of symptoms. In the case of neurodivergent conditions, the symptoms are the condition.

It's then entirely up to humans where they draw the line - do we include people with mild symptoms in the definition of the condition, or do we invent a different name for what those people have, or do we say that their personality traits simply fall within the normal variation of human personality?

I don't see how we can answer that. But you only need to look at the way DSM definitions and categories have changed over the decades to see that there isn't a clear, reliable way of defining autism, or indeed any other neurodivergent or mental health condition.

Yes exactly this! I really hate the term 'hypersensitive'. It smacks of 'hysterial' and 'neurotic' (even though neuroticism is a proper term used in psychology, out there IRL it's a term used against women)

For clarity - I'm autistic, both daughters are autistic and DH is definitely not neurotypical. I'm also trained to carry out the ADOS (which is a cracking cognitive leap to have to make when you're autistic yourself!)

I hate the self-appointed gobshite element of the internet autistic community who hijack everything, control the language used and tend to have quite a lot of crossover with the trans/non-binary agenda. We autistics would have the world organised a lot better, horrible bright lights banned, everything in the place it should be and everything - if they didn't turn every bloody discussion into angst about pronouns, jigsaw puzzle pieces and bashing the parents and carers of individuals who are extremely impacted by their autism and the parents are just trying to do the best bloody job they can in a really tricky situation.

(Rant over but it does my fucking head in - to the point I avoid all the ASD support at work cos it just achieves nothing but comparing fucking pronouns)

I "coped" through school in that I got great grades. I also got my head kicked in regularly, dragged into classrooms of upper year groups because "you gotta see this girl - she's so fucking weird" and spent most of my time lonely as fuck and knowing I didn't fit in but didn't have a clue why. DD2 (probably my most-impacted by autism of the pair of them) goes through life with access to the SEN base if the playground is too much, some social skills groups that have helped her find friends and the attitude of "I'm brown haired, green eyed, autistic and like K-Pop" - it's one part of her personality and not her entire identity. DD1 is very much a "oh I'm autistic - OK what's for tea". I'd rather they have that awareness that, some things are going to be trickier, it's just one aspect of how your brain is wired and you're fucking fabulous - than the attitude I had in the 80s and 90s where I was just... a freaky odd person who needed a good kicking. We did pick their secondary incredibly carefully to avoid the "zero tolerance" hellhole where neither would have thrived - they go somewhere a bit tattier around the edges but where the staff have a much more nurturing approach to the kids but still take no shite from DD1 who can be a gobby little sod. I have had to be very careful when supporting the kids to understand their diagnoses about where I pointed them for support because the overlap terrifies me at times and DD2 is easily socially swayed - as are a lot of these autistic girls who follow rules, people please and just want to fit in - we've done a lot of work supporting her to just be confident to say no when she needs to.

Although I'm "high functioning" autistic (varies according to day and caffeine intake) - actually when I work with adults with LD and autism - there is still a hell of a lot of common ground. Carers wondering why they're uneasy and clearly bothered by something - and there's a slightly flickery light driving me mad too; or one where they tell me their client's said something that seemed "rude" - and I point out the perfect logical steps that have been behind it if you don't grasp (or pretend to grasp) the intricacies of social nuance.

As an addendum to the inevitable "benefits chasing" one that gets thrown around - we claim nothing - we're above the level for child benefit on income so don't even get that. Applied once for DLA for DD2 (was hoping to fund private SALT) - was rejected as "she is a well behaved child"

I can identify with this. I read a few days back about someone's child with ADHD being given longer to submit essays at uni. That often wouldnt help someone with ADHD at all, and it doesn't in the case described, she flunked the year. From personal experience and training from childhood, only the deadline will trigger action. Extending the deadline only extends the prevarication.

I do quite strongly believe that children who have the capacity should be being trained to live in the world they inhabit and not expect the world to bend to their likes and dislikes, because the older they get the less it's going to do that.

This only applies, of course, to that subset of children whose autism allows them to learn those lessons, and who have parents who will insist on it in spite of obvious (and distressing for both parties) short term pain for the child.

Many on Twitter, that hot bed of critical and nuanced thought seem to think Uta’s piece means many girls who’ve been given a diagnosis will suddenly loose that diagnosis or be ignored.

I feel that she’s bringing it back to original key points in diagnosis, which is primarily speech, comprehension and language processing difficulties or differences (which impacts social interaction, and then obviously may impact anxiety levels and emotional regulation skills). Some of this can be addressed in the early years / ks1 and greatly benefit a child. There is often, alongside this, a similar difference in terms of sensory processing. Skilled occupational therapists can work absolute wonders and indeed the main thing they can help to address is anxiety / emotional regulation etc via physical activities that are identified as calming or altering for the individual child. Schools need to have correct access to the right professionals to support teachers.

In an ideal world you’d have an OT and SALT working in ever single school. In the US, access to OTs is much much higher due to insurance.

Some children I’ve taught really do have physiological/ neurological differences in their field of vision or their motor skills which hugely impacts ability to do all the things schools require. I remember one boy who came to our send school mid ks2 who had great knowledge and understanding of the world, was keen to learn, had been diagnosed with autism, was very chatty and sociable, but his key difficulties lay in his physical and neurological processing skills. He had ended up at a behavioural unit prior to the autism diagnosis, which meant he accessed a send school. If he’d had OT and salt working with him in the early years the autism diagnosis may not have been necessary, or only considered later because it was seen as important. Instead he languished in school, clearly displaying “challenging behaviour” (distress) with his true needs not being met.

I know this thread is more about girls - I can think of two girls where the story was similar. I just know the OT details more for this story. (He’s now doing some GCSEs I believe)

Point to note; the bloke in the NE who’s had a few threads on him here for his cross dressing and nappy wearing has made a lot of money going into local schools selling his fuddle toys; that money should be being spent on real professionals.

Teacher training courses do not really include SEND at all. We need more professionals who understand all these things, in schools.

About 40/30 years ago there was a specific diagnosis called ‘semantic pragmatic syndrome’ which was eventually abandoned and absorbed by the term autism; it was a specific speech and language / comprehension difficulty. With the right intervention, understanding and support, children could remain in mainstream and “challenging behaviour” was correctly understood and supported with targeted SALT learning sessions as a language difficulty.

Sorry rather long - trying to illustrate why the diagnosis is too broad and isn’t always helpful in real terms.

I wonder if it might be helpful for you not to be overly concerned with the labels of autism or anxiety or hypersensitivity and think of it more as a subset of challenges you face which is not typical, but also you are not the only person who struggles with these things. The autism assessment has identified these challenges and it feels right to you and makes you feel better to have that understanding of yourself.

Then focus on managing them in a way you find acceptable. It sounds to me like you are not bothered by the label or other people making accommodations but more the understanding that you are not alone and other people feel this way and how to live in a way you are not constantly stressed.

Medicine and psychology have had a lot of ideas over the years and I think we are probably a lot further behind understanding the mind as we do the body. We used to think “fever” was a condition but now we know it’s the bodies reaction to an infection and can have many causes. Maybe neurodiversity will end up being understood like that, who knows. Ultimately living in a way which suits you as well as you can in the environment you are in and considering the other people around you is never going to be a bad thing.

This is all very interesting to me.

I have two young adults who have struggled w their MH (mainly anxiety disorders - diagnosed)/social cues/fitting in esp at school/‘disproportional acting-out behaviour (DS in particular).

I thought DS could be autistic when he was very young (he had Camhs involvement at around 8), but I was too ‘scared’ to mention it as I suppose I thought he was too ‘clever’ and he had friends so he couldn’t be on the so-called spectrum. He’s always been very personable/cheeky/charming as well so this hasn’t ‘helped’ re a diagnosis- at school he was mainly fine but he’s let rip at home, teachers could never believe it. He could never control his emotions and still finds it a struggle.

Conversely DD completely internalised her feelings. In later years DD has told me that she did it partly because we (me and dh) struggled w her brother and she didn’t want to add to that. She thinks she prob has inattentive ADHD but I’m not sure. She still struggles daily according to her, but you wouldn’t think so if you just met her so she def ‘masks’. DS does a bit but he’s def more his genuine self and has a lot of sensory seeking behaviours. They both did v well at school academically but towards the end DS needed accommodations for exams. Uni was much better for support in general.

The big ‘thing’ is that DD identifies as non-binary, has done since going to uni at 18 post the first lockdown. Also totally captured now by the far-left ‘cult’. I’m sure this is some manifestation of a ‘special interest’ - the two seem to go together with being ND or st least having mental health issues. Even DD knows the incidence of identifying as trans is higher in the ND community but doesn’t see it as social contagion - but I can totally see the non-fitting in at school or with girls in general (like DD from a very early age) would make you look towards being the ‘opposite’ gender or at least non/binary.

I agree the diagnostic criteria is too wide. You can’t compare a non-verbal, intellectually challenged, non-toilet trained autistic child to one that is academically sound but really struggles w anxiety and social interactions.

i do know though that issues have to be present from childhood and while I could spot a few w DD, I could give you a whole list for DS.

Kathleen Stock has clearly got the bit between her teeth on this: a new article today on Unherd discussing the Ute Frith interview. I think she's absolutely right on masking. We all 'mask' if what that means is suppress certain aspects of our personality and character in order to function properly in society. Who hasn't got home and, metaphorically speaking, taken her bra off with a sigh of relief?

unherd.com/2026/03/the-feminisation-of-autism/

I also think the diagnosis of social anxiety isn’t taken seriously enough, and also isn’t given enough appropriate support. And certain school approaches definitely cause anxiety / social anxiety. Anxiety is astoundingly crippling. Chronic anxiety ca have physical health implications. But the correct therapies and accommodations can really help.

Correct Autism diagnosis is very important here as the therapy offered may need to be very different, but should definitely not mean the individual doesn’t get support if it’s not autism. This lack of support, if it’s not autism, will have led to some clinicians giving the diagnosis knowing that it will lead to better support. (I have been told by someone who works in the field that this does happen.)

Not read it yet but the term masking is not one that has come from professionals I’ve worked with. I also think it’s the incorrect term as can be misinterpreted.

Have to go and do shit but will
come back to this.

I think that really resonates from my experience - that some of the driver is a sense that if you can't get being a man or woman right, it might be better to not try at all and identify as either the other sex or as other entirely. And while I don't have experience of PDA, the link you make between being distressed by other kinds of demands and seeking to avoid the 'demands' of your natal sex and wanting to be able to choose something else makes instinctive sense to me.

I am absolutely certain I would have identified as non-binary, or perhaps trans, if it had felt like an option when I was a teen. As it was, I fantasised about not having a body at all. I really struggled with the pressures and expectations of having a female body, and at that point would gladly have exchanged my future fertility to opt out of it.

I also think that, for me, there is a similar root to the growing diagnosis of neurodiversity and trans ideology - an increasingly tight delineation of 'normal'. Some of the discourse about neurodiversity makes it sound like to be neurotypical is to be entirely free of challenges and to always be able to operate optimally - and if that's not you, you must be neurodivergent. Similarly, trans ideology is so driven by a really tight sense of 'female' and 'male' presentation - and if you don't fit them, you must not be cis after all. I have a 7 year old who is quirky, emotionally immature for his age, not very social, and who loves painting his nails and who has never been interested in traditionally 'male' interests. I think he is just, like every other child on earth, an individual. I am scared about him growing up in a world that tells him that those things probably mean he's neurodivergent and trans.

This where my pet theory is that, for him anyway, the trans thing comes in - having been roundly schooled in it. Frightened about growing up into a Man and having to do Manly Grown Up Things? Think Andrew Tate is a loser and worried about being that sort of Man? Fear not! Leave all that behind and become a woman! So as much as a Peter Pan thing, it's about trying to avoid the inevitable demands of adulthood. As I say, that's my pet theory for why my son has fallen into the trans rabbit hole at uni. I don't know if that resonates with anyone else?

Yes, I feel similar. I feel it can be a case of not wanting to be like that sort of man and also feeling vulnerable and scared going out into the world as a teenager and identifying those feelings as 'feminine' feelings.

In contrast, the world treats them at times with suspicion simply because they're a teenage boy. We saw this in the difference my son was treated when under suspicion of buying a child's ticket without id to prove he was 14, compared to the female friends he was with who were treated more kindly. There will have been dozens of smaller moments where adults feel their in the wrong place at the wrong time while emitting more testosterone than they realise!
It wouldn't take much of a leap to draw conclusions that the person treating them like that assumes they're 'that sort of man', or actually sea something of it in them and/or that the feelings of vulnerability it provokes means they might be a girl.

ahhh Kath says it much better than me

Echolalia is a very common skill that many children with autism have (copying is a skill all humans have).

I feel that masking has been the wrong term to describe what many children who have undiagnosed autism do; copy and rely on those around them a lot to get through the school day. And older siblings at home too.

some masking is this, but an autistic child wouldn’t understand the nuanced concepts going on behind the behaviour enough to perhaps transfer to different contexts. And as teens grow up those concepts get more nuanced and complex. Some children without autism may struggle to understand some of it as it moves into more tribal teen behaviour. This is one reason why many children are being missed and then struggle when they hit the teen years.

Puberty is also an important time for physiological brain changes. This is another key time and reason why autism may become more noticeable as some important communication skills may not have been developed (and hidden by the child via copying strategies).

Again why the early years need so much careful SALT work.

I do know that the tories made the English curriculum much heavier in terms of writing and grammar, squeezing out a lot of more early years language development work. As I was trained in the previous curriculum. A great deal that was taught in yrs 3 and 4 was taken down to year 2.

Yes some kids can do it. But not all. And at the expense of a great deal of early communication concept building.

The other masking discussion is around ‘stimming’ (another term rarely used by professionals I’ve worked with. Have to stop there as nothing it’s getting done!)

I think its fair to say people are very dismissive of social anxiety as a diagnosis or general anxiety and maybe people would be less keen on autism as a diagnosis if social anxiety diagnosis brought the correct support in.

But, my son had a diagnosis of anxiety at the same time as the autism diagnosis and it was actually very hard to work out what was anxiety and what was autism. Its all him and all his brain they are intrinsically related. The anxiety was pretty much a fight, fight, freeze, fawn response to situations resulting from the core autism symptoms. After years of help and medication he no longer had an anxiety response to all these things (still prone to feeling anxious but not to a disorder level) but he still had those core autism symptoms. He still couldn't process verbal and non verbal communication at the same speed or as accurately as most, his speech pattern is still unusual. but no longer panics him.

So I suppose what I am thinking is if these girls are 'hyper sensitive and socially anxious', what is the root of that sensitivity and anxiety if not autism. There must be something.

This seems very sensible to me. And I think it highlights the difficulty with all this, which is the degree to which we see certain personality types or behaviours as pathologies.

I was intensely anxious as a child, and still am anxious as an adult. My mind always races towards the worst possible outcome in any situation. But I always used to think of that as a slightly embarrassing personality flaw. It's only in recent years, it seems, that people have begun talking about "suffering from anxiety" and seeing extreme anxiety as an illness that happens to them rather than an aspect of their personality. I don't know how I feel about it. Would it make me happier to think that my anxiety was an illness, rather than a weakness in my personal make-up? Maybe it means people treat you more kindly. On the other hand, it doesn't tell us if it's true or not.

Agree with all these points. Anxiety is horrific. It also a condition that spans all other diagnoses.

Anxiety has been recently known to mean an individual is exceedingly good at spotting nuance and details, hyper alert to little things, which apparently are skills the FBI deliberately seek out.

Anxiety is your super power by Wendy Suzuki is really good. (In classic me fashion I’ve not finished it. But will one day🤣)

@RoyalCorgi I find what Dr Lucy Faulkes writes about anxiety really interesting and useful for this conversation

https://www.theguardian.com/commentisfree/2023/jul/09/psychologist-anxiety-personality-trait-children-sick?CMP=Share_iOSApp_Other

As someone who also struggled/s with anxiety, particularly social, I find these paragraphs pertinent.

But growing up now would only be better if it meant access to support, and I’m not sure most teenagers have that. Awareness-raising efforts in schools, online and elsewhere have flooded teenagers’ minds with the concept of anxiety, but funding for services has not caught up, and light-touch school interventions often aren’t enough.

We are now in a situation where many teens know or believe they are anxious but aren’t getting the help they need to manage it. I’m not sure that is better than not having the awareness at all.
Adolescence is a period of identity development for everyone. Like many teenagers, I was introspective and ruminative. My friends and I dissected our personalities, thoughts and behaviours all the time. If I had repeatedly been offered the word “anxiety”, without any decent one-to-one treatment, I think it would have been cemented into my self-concept before I had even turned 13.

Critically, I think that would have changed my behaviour in a really unhelpful way. Today, as an academic psychologist, I am frequently emailed by teachers, clinicians and university staff who say there has been a huge increase in the number of young people who ask not to do things because they are anxious – and these requests are being granted. The people who email me are concerned that, in the long run, this is setting young people up to fail, and I agree with them.

I’ve always felt this article hits some similarly important points for adolescents

https://www.theguardian.com/society/2024/apr/13/i-was-the-poster-girl-for-ocd-then-i-began-to-question-everything-id-been-told-about-mental-illness?CMP=Share_iOSApp_Other

What needs highlighting is a lot has been made of teens being ‘anxious’ when really they are feeling ‘nervous’. But these late diagnosed girls are generally being diagnosed off the back of a mental breakdown, usually involving self-harming behaviours or even a suicide attempt. They are not merely ‘nervous’.

Very anecdotally, but this is how my DH feels, and why he is quite against us seeking any sort of assessment of DS1 (my own view is that I would consider it if school recommended or raised it, or if I could see an obvious struggle for DS, but neither has happened so far, only a few essentially random people saying he should be assessed). I personally think that if DH was a child today he would absolutely have been assessed for autism - he is fairly 'textbook'. He also had, after a stellar performance at school and university, some 'failure to launch' issues in his early 20s, which again is fairly classic. But his view is that it would have been disastrous for him if he'd had a label at that point - that he was struggling with being outside his comfort zone and would have grabbed onto anything that justified him not doing so and which supported his belief that he 'couldn't' rather than 'wouldn't'. But that he thinks that would have been a very negative outcome for him and would have held him back for life.

As I said, totally anecdotal, and I am not so convinced that it is as clear cut, even in his own individual case, as DH thinks it is (he's a bit of a black-and-white thinker!). I think it worked out well for him but there would have been many others in the same position who would have benefitted from diagnosis. But I can also see his point.

This is so interesting. I hadn't noticed, but you're so right about attachment disorders which were so in vogue really not that long ago. It seems like a lot of the more psychotherapeutically-informed terms/ways of understanding difficulties have gone out of fashion but personally I found reading about insecure and avoidant attachment very helpful when I was trying to make sense of my own feelings about my husband and first baby. (Quite a while ago now, as the baby is a teenager.) Reading the Frith piece I was also reminded that 15 years or so ago (maybe more?) there was quite a vogue for describing some children as "highly sensitive" -- I think a lot of the children those books were about could now be described as ND (at the lighter end).