Professor Mandy opened the seminar with some general thoughts about autism, particularly the history and changes in how autism has been defined over time, much of this was derived from his own research and clinical practice. Professor Mandy emphasised that the evolution of the definition of autism was driven by both scientific discoveries and social political changes.
When autism was first described by Dr Leo Kanner, some key characteristics were identified, including happiness when left alone, stereotyped movements, spinning with great pleasure, unconventional manner of using language, and gravitation towards objects instead of people. Autism was subsequently conceptualised as having three main characteristics which have been re-categorised as (1) social and communication difficulties and (2) restricted and repetitive behaviours in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (a diagnostic tool used by psychologists and psychiatrists).
Professor Mandy then moved on to discussing some autism myths, to demonstrate how views about autism have evolved during the latter half of the 20th Century. These were:
- That autism is rare, however, Professor Mandy explained that autism is diagnosed in 1-2% of children and adults.
- That most autistic people have a co-occurring learning disabilities (also called intellectual disabilities) but, as Professor Mandy described, 50-70% of autistic people do not have co-occurring learning disabilities.
- That autistic people only experience difficulties. Professor Mandy highlighted that there is a growing evidence-base about the strengths of autistic people.
- That autism is categorically distinct from normal development and other disorders. Professor Mandy explained that this idea has fallen out of favour, and autism is increasingly viewed as a dimensional condition which represents the extreme end of a continuum of traits that extend throughout the general population.
In the second part of his seminar, Professor Mandy began by describing the female autism phenotype, based on a growing evidence-base about sex/gender differences in autism. Professor Mandy began by acknowledging that girls tend to be referred and assessed after the transition to secondary school, which is later than boys, who are commonly referred at around the age of nine or ten. One explanation for this could be the female autism phenotype. It is hypothesised that autistic girls may present slightly differently than autistic boys, for example by being more socially motivated and better able to mask any difficulties.
One element of the female autism phenotype that Professor Mandy discussed in greater detail was camouflaging. Camouflaging has been described as ‘putting on my best normal’ and involves a person masking their autistic characteristics or compensating for difficulties by developing certain skills or strategies to negotiate the social challenges they face. Evidence suggests that autistic people camouflage more than non-autistic people, and autistic people show more variability in camouflaging.
Regarding potential predictors of camouflaging variability among autistic people, Professor Mandy mentioned autism severity, IQ level, executive functioning, and sex/gender. In particular, it should be noted that autistic girls tend to camouflage more than autistic boys, however, it should not be forgotten that autistic men do camouflage; it is not a phenomenon that is unique to autistic women.
Autistic people may camouflage to “fit in” with their peers and Professor Mandy raised an important point about this, in that autistic people feeling the need to camouflage for this reason demonstrates how hostile the social world can be for autistic people. The consequences of camouflaging can be that autistic people feel exhausted and stressed, with evidence suggesting that autistic people who report higher levels of camouflaging tend to experience more anxiety and depression.
Professor Mandy proposed that considering camouflaging as a risk factor for autistic people could change our thinking about the mental health of this population. Despite a clear correlation between camouflaging and mental health difficulties, examining the causal mechanism and the effects of additional variables (e.g., bullying) would be very valuable in understanding mental health among autistic people.
Professor Mandy ended his seminar by elaborating on his longitudinal research to understand sex/gender differences in autism, specifically the patterns of autistic traits over time. His interpretation was that the differences in age of diagnosis may be due to autistic traits becoming more noticeable in adolescence, where there is a mismatch of escalating demands of their environment and their individual capacity to meet those demands.
Hatice Gundeslioglu is a PhD student at the Centre for Educational Development, Appraisal and Research (CEDAR) at the University of Warwick.
Wenyuan Liu is a PhD student at the Centre for Educational Development, Appraisal and Research (CEDAR) at the University of Warwick.
Professor William Mandy is a Clinical Psychologist and Professor of Neurodevelopmental Conditions at University College London.