Leading on from my previous post about autism and sexuality, this week I’d like to discuss an emerging area of research interest- autism and gender dysphoria.
In recent years, research is mounting that suggests that there is a higher prevalence of gender dysphoria and diversity among autists compared with the neurotypical population i.e. they don’t identify as the sex they were assigned at birth. It has even been estimated that transgender individuals could be 3-6 times more likely to be diagnosed as autistic! 😱
As a cis-gendered woman I cannot personally comment on this issue (apart from thinking it would be a great idea to switch gender at will to avoid dealing with womanhood as a preteen 😛 ), but based on these statistics I would just like to draw some awareness. Life can be hard enough as an autist or an individual with gender dysphoria alone, but when you marry the two, rates of depression and anxiety are reported to be much higher.
While the reasons for gender dysphoria are wide and varied, for autists, there may be a larger biological component as to why many may feel they have been born into the wrong bodies.
As I have discussed previously, MRI scans of autists brains have shown that men with autism have anatomically similar brains to neurotypical women, and women with autism have anatomically similar brains to neurotypical men which could lead to gender confusion. In addition to this, high levels of foetal testosterone in utereo have been linked to the development of autism in recent years. This exposure has been proposed as a possible reason that autistic women may suffer from gender dysphoria, but this does not explain why autistic men may wish to transition. Interestingly the current evidence does indeed support a prevalence of autistic traits among trans-men vs. trans-women. Research is ongoing to investigate the link between gender dysphoria and autism.
Whilst the current evidence suggests that gender dysphoria and autism may be linked, it is important to remember that they are not mutually exclusive. It is useful to know that there may be a link, but bear this in mind when seeking support.
This week I’d like to take a look at the portrayal of autism in the 2020 crime-drama film ‘The Night Clerk‘ starring Tye Sheridan, Helen Hunt and Ana de Aramas.
So what’s the movie about?
The Night Clerk tells the story of Bart, a 23 year old with Asperger’s Syndrome who works as a night clerk in a local hotel. Bart secretly films the guests in the hotel through a number of hidden cameras he has installed in order to observe people and learn social cues to help him navigate the world, becoming embroiled in a murder investigation as a result.
If you haven’t seen the film you can see the trailer here:
So how did the film fare in it’s portrayal of autism?
The film generally get’s a lot of the classic traits right such as struggles with eye contact, colour sensitivity, lack of filter, social awkwardness, stimming, coordination issues (in particular Bart runs awkwardly with his hands flapping at his sides) and echolalia. I particularly enjoyed Bart’s response when people asked him “How are you?” and he replied with “That’s a very complicated question!” As I’ve discussed in previous posts, I have often found in the past that this is one of the worst questions to be asked and it’s great to see that portrayed on screen.
Bart’s voyeurism on the other hand, while well intentioned, does portray the community somewhat negatively and further adds to the wealth of negative portrayals of autism. Interestingly though, it does sort of in a weird way shake things up a bit- yes it’s not the best look for autist’s, but it does highlight that just because you’re on the spectrum, doesn’t mean you can’t also be a bit of a creep 😛
Overall however, the depiction falls into the stereotypical pit showing us a lot of the same tired autistic tropes like Bart’s primarily monotonous tone of voice. Just once I’d like to see an autist show a little bit of varied inflection on screen- every single autist I know uses a variety of tones when speaking; monotonal speech is clearly not as common as film makers would have us believe.
Following on from my recent post about diet and autism, this week I’d like to discuss a biomolecule that is not often talked about in the literature about autism- cholesterol.
When it comes to cholesterol, we usually think of it as a bad thing- that fatty yellow stuff that clogs up our arteries when we eat too much of the wrong foods. But there is so much more to cholesterol than most people realize. Cholesterol is an essential biomolecule involved in the synthesis of numerous other bodily substances such as steroid hormones, vitamin D and bile. It’s also an essential component of our cell membranes.
There are 2 types of cholesterol- LDL and HDL. LDL (low-density lipoprotein) makes up most of the cholesterol in the body. This is often referred to as the bad type of cholesterol as a build up of this can clog the arteries. HDL (high-density lipoprotein) on the other hand, is considered the good kind of cholesterol as it absorbs waste cholesterol and shuttles it to the liver for removal from the body.
So what has cholesterol got to do with autism?
Here’s where things get interesting. Cholesterol is involved in modulating the oxytocin receptor and the serotonin 1-A receptor- neurotransmitters that are dysregulated in the autistic brain which contribute to a number of autistic symptoms. Multiple studies have reported that some autists have hypocholesterolemia (i.e low cholesterol levels). Cholesterol deficits could interfere with the functioning of the oxytocin and serotonin receptors and contribute to autistic symptoms. Recent research has identified mutations in a cluster of genes involved in cholesterol metabolism in certain forms of autism which likely causes these lowered cholesterol levels. Cholesterol and omega fish oil supplementation may be useful to help counter the impact of low cholesterol on the brain.
Leading on from my post about periods and autism, this week I’d like to explore another taboo aspect of life on the spectrum- autism and the menopause.
Apologies once again to my male readers!
I may be too young to give a personal slant on this subject, but I’d like to create some visibility for the often overlooked adult female members of the spectrum. Public discussions surrounding autism are so often centered on childhood, potential issues for adult autists can be forgotten.
The change brings many difficult physical and emotional changes for women such as hot flashes, memory issues, mood swings, sexual dysfunction and issues with mental health. Now imagine how these changes might impact an autist who is already sensitive to change and temperature, sleep disturbances, struggles to manage their emotions and can be predisposed to mental health difficulties?
The autistic life is already a roller-coaster, but throw in the menopause and the cart may just fly off the tracks.
Our knowledge of autism and the menopause is very limited as autism as a diagnosis in itself is only emerging from it’s infancy. Some of the first women to be diagnosed with autism are only now reaching menopause, so there is little available research about their experiences of the change. Of the studies that do exist, experiences of menopause for autistic women vary, however, many reported worsening of autistic symptoms. Some women reported that it they found it extremely difficult to mask their struggles and suffered serious deterioration in their mental health.
We clearly need to start a conversation about menopause and autism so that we can properly develop tools and supports to help women navigate this challenging time of life.
For those of you going through the menopause, have a look at this blog post about “Menopautism” from journalist Jane Renton writing about her experiences of the change as an adult with Asperger’s syndrome:
You can also find some useful additional resources for managing the menopause here:
This week I’d like to talk about a topic that’s not discussed very often in conversations about autism- tics and tic syndromes.
So what exactly is a tic?
A tic is a sudden, repetitive muscle movement that can cause unexpected and often uncontrollable body movements or sounds. Affecting approximately 10-25% of autists, tics differ from stimming and other repetitive behaviours in that they are generally involuntary in nature such as abnormal blinking, head jerking, sniffing, throat clearing, or repeating phrases. Like autism, there is a spectrum of tic disorder’s, with Tourette Syndrome being the most common of these. Tic frequency and severity varies depending on activity levels, stress, boredom and even high energy emotions.
Thankfully my own experience of tics has not been severe, however, in times of serious stress I have been known to develop a bad eye twitch in my left eye. It was first brought on by the stress of my final school exams at 18, and has resurfaced a small handful of times since during particularly stressful work periods. Amazingly, no one has noticed this tic as it’s so mild, but it is a very odd sensation on the inside to feel your eyelid fluttering of it’s own accord. I was initially quite freaked out when it first started, but now I know that it just means I need to step back and manage my stress levels 🙂
But why are tics so common for autists?
Although they are often comorbid, as with many aspects of the spectrum, the research into this phenomenon is once again limited. Recent genetic research has shown that there may be an overlap where genes thought to contribute to autism can also cause Tourette syndrome which could explain why they often appear together. At the biochemical level, tics have been linked to imbalances in dopamine and other neurotransmitters, imbalances that have also been linked to autistic behaviours.
So are there any treatment options?
As the frequency and severity can vary with life’s changes, learning what your triggers are and how to manage or avoid them is one of the best approaches. Comprehensive Behavioral Intervention for Tics or CBIT (a form of CBT) is the favoured interventional approach, however, in some severe cases, medications can be used to help control tics.
Leading on from my previous post about autism and food, this week I’d like to focus specifically on diet and autism. There are a lot of articles floating around about the benefits of certain diets to manage autistic symptoms, but the research is tenuous and in some cases non-existent.
Ketogenic Diet: This is a high-fat, low-carb, adequate-protein diet that drives the body to burn fats faster than carbohydrates and is recommended in the treatment of some forms of epilepsy in children. Research has shown that in some cases, a modified version of the ketogenic diet led to improvement in repetitive behaviours and social communication in autists. The diet is thought to work by increasing the number of ketones in the brain (an energy source produced from fat breakdown when insulin levels are too low to convert glucose to energy) to produce more energy and offset biological stress and dysfunction in mitochondria (the energy producing cells of the body) which contributes to autistic behaviours.
Sugar-Free/Additive- Free Diets: It’s common knowledge that sugar can alter a child’s behaviour, but even more so for autists (there was a limit put on my childhood coke consumption to curb my hyperactivity for example 😛 ). It’s also thought that many autists are unable to tolerate a number of food additives such as aspartame, MSG and E-numbers. On a personal level, this one actually makes a lot of sense as I have had allergic reactions to certain E-numbers that have caused me to break out in hives in the past (not to mention how they used to make me super hyper!). While indeed lot’s of people reduce sugars and E-number’s to manage childhood behaviours, there’s little research on how sugars and additives impact autists.
Supplements: As it’s thought that autists may have impaired or abnormal biochemical and metabolic processes, vitamin supplementation could be used to improve this. While supplements can be beneficial, the research is inconclusive.
Gluten/Casein -Free Diet (GFCF): This is the most popular diet when it comes to autism treatment. Many people report improvements in autistic symptoms following the removal of gluten (a protein found in grains like wheat) and casein (a protein found in dairy) in their diet. It has been suggested that autists have a “leaky” gut that allows gluten and casein to leak into the bloodstream having an opioid effect on the brain and interfering with behaviours, but there is insufficient and inconclusive scientific evidence to support this. Many doctors have recently spoken out against these fad diets as they can be very bad for your health if you unnecessarily remove these foodstuffs. Gluten free diets for example can increase your risk of cardiac problems through decreased intake of essential wholegrain.
Cholesterol: Cholesterol is involved in modulating the oxytocin receptor and the serotonin 1-A receptor- neurotransmitters that are dysregulated in the autistic brain. Cholesterol deficits could interfere with the functioning of these receptors and contribute to autistic symptoms. Research has shown that cholesterol supplementation can help improve behaviours. I will explore this in more detail in a later post.
Phenols and Salicylates Exclusion: Some studies indicate that autistic behaviours could stem from impairment of certain enzymes involved in the metabolism of phenols and salicylates- antioxidants that are found in fruits, vegetables and nuts. While these compounds are healthy, in high levels these seem to increase levels of serotonin in the brain interfering with autistic behaviours, but there is no evidence to suggest that total avoidance of these compounds is beneficial.
Probiotics and Enzymes: There is currently no research to prove the benefits for probiotics and enzymes in the management of autism. However, as I have discussed above and in previous posts, autists are deficient in certain enzymes and bacteria which can interfere with behaviours, so supplementation could be useful.
Yeast Free Diets: As discussed in my previous post about thrush and autism, candida overgrowth in the gut is thought to contribute to autistic behaviours. The theory posits that removal of yeasts from the diet can improve behaviours, but there is no medical basis for improvement.
Fish Oils and Fatty Acids: Imbalances in omega-3’s and essential fatty acids has been implicated in a number of neurodevelopmental disorders and behavioural issues, so it stands to reason that supplementation could improve autistic symptoms. However, there is much more autism specific research required to confirm these benefits.
Continuing on from last week’s post about autism and puberty, this week I’d like to talk about autism and periods. I know, I’m about to alienate about half of my readers (sorry guys!), but this is a very important topic to cover for the often overlooked autistic female demographic.
Periods can be challenging for lot’s of women, however, for autists the experience can be somewhat of an ordeal. There can be a lot of overwhelming sensory issues where periods are concerned- new smells, sensations, and sensory issues related to the use of feminine hygiene products. Autists struggle greatly with change, and periods can be quite unpredictable over the course of our lives due to stress, hormonal changes, childbirth and eventually menopause (which I will discuss in a separate post at a later stage). As a result of this, female autists can develop a number of behavioural issues related to menstruation such as increased aggression and repetitive behaviours, not to mention changes in mood and mental health. Throw in a side of cramps and it’s no picnic!
In addition to the mental and behavioural toll, research has shown that periods are biologically much tougher on the autistic body. Studies have shown that women on the spectrum have higher levels of testosterone than their neurotypical peers (likely caused by dysfunction in the hypothalamus in the brain), leading to a number of menstrual related issues such as severe acne, hirsutism, irregular periods, polycystic ovary syndrome and dysmenorrhea. Premenstrual syndrome (PMS) is also highly prevalent in autistic women. Autists are also known to have high levels of inflammation in the body, which can further aggravate menstrual symptoms. Periods can even cause an increase in seizures in autists who also suffer from epilepsy due to hormonal fluctuations.
So what can you do to help a young autist through her period?
Educate them clearly about their changing bodies– autistic women can be particularly vulnerable, so they need to know exactly how their reproductive system works and the importance of consent. Use clear language that can not be misinterpreted or taken too literally. Understanding their body will also help them to better normalize menstruation so it is far less scary. As discussed in my last post, autistic women enter puberty much earlier than their peers, so it is essential that they are educated sooner rather than later about their changing bodies.
Check out autism friendly books about puberty/periods– there are a number of books available targeted at growing autists to help them navigate this challenging time. There are even books specifically about periods for young autistic women that may help.
Chat about different feminine hygiene options– as no two autists are the same, so no one option is better or worse when it comes to feminine hygiene products. There are far more options available these days to young women than just sanitary towels and tampons- they even make absorbent period underwear which could be very helpful for girls with sensory issues.
Setup a calendar/diary to track periods- the unpredictable nature of life and unexpected change can be particularly frustrating for autists. While periods can oftentimes be unpredictable and don’t always run on time, a calendar can nevertheless be very helpful to prepare an autist for upcoming periods and establish a routine. Knowing that an event is approaching can help to offset the scariness of it.
Break the taboo– reassure them that periods are a normal part of life and that there is nothing to be ashamed of. Periods may be overwhelming for autists, but they are by no means alone in their menstrual struggles.
Hope my female Earthlings at least enjoyed this week’s post! 😉
This week I’d like to talk about a frequently sidelined aspect of life on the spectrum- puberty. So often people focus on childhood autism we forget that autistic children will grow up and go through puberty just like everyone else.
Puberty is a challenging time for everyone, but often even more so for those on the autistic spectrum. Research is limited on pubescent autists, but some studies have suggested that behaviours can worsen in autists during this time, in particular, aggressive behaviours. The smallest of changes to routine can trigger meltdown’s in an autist, so imagine how this response is amplified when your entire body decides to change. You couldn’t pay me to go through puberty again- the raging hormones were a minefield (although there are day’s during this pandemic where I might consider it to travel back to a time when I had freedom 😛 )!
There can be a lot of sensory issues arising from the onset of puberty that can trigger further distress- body odours, sensory reactions to hygiene products, and my own personal hell, the sensory discomfort from wearing a bra. As I’ve discussed in previous posts, I went to war for years with my mother against wearing one as the sensation of it against my skin freaked me out and I was incredibly uncomfortable- but as I was un-diagnosed, this was passed off as just being awkward 😛
During puberty, socialising, an already challenging task for autists, becomes even more complicated. When you’re a child, everything is easier as kids haven’t developed a filter yet, but once those hormones kick in, conversations become more nuanced, boys and girls interact differently and your peers start to become aware of your mind blindness and excentricities. It can be quite a socially lonely time for autists.
So how can we navigate this difficult time in an autist’s life?
Talk openly about the facts of life– Talk them through the changes their body will experience in clear, concrete language. Don’t leave any room for confusion or misinterpretation so that they will be fully prepared and less thrown by the changes to come- there were certainly a few books that I read growing up where overly simplified language such as “a special hug” was used to describe sex that would only confuse and misinform the more literal autist
An important thing to know about puberty and autism is that it can have a much earlier onset in girls. Studies have shown that female autists tend to enter puberty and start menstruation on average 9 and a half months earlier than their peers, so girls need to be prepared and educated about the facts of life earlier than you might expect
Use visual tools– Sometimes words are not enough to create the correct mental picture for an autist. Illustrated books about puberty can be very useful here, and there are now many books specifically targeted at autists which can really help them to navigate this time
Discuss appropriate/inappropriate behaviours– don’t leave it at just the facts themselves. Autists will need to be taught about consent, sexual behaviours and inappropriate conversational topics just like anyone else. As female autists often mask their behaviours, it is especially important that they are taught about these things as they can be quite innocent and may be taken advantage of if not adequately prepared for adulthood
Sensory friendly clothing– For the young women out there, the market is now opening up to produce sensory friendly bras to help combat the issues of traditional brassieres. Bralette’s and lightweight sports bras may also be helpful alternatives
Normalise the experience– Reassure them that everyone goes through this, that it’s a normal part of growing up. Don’t attribute the entire experience to their autism
Be positive– Don’t assume things will be harder for your child as everyone is different. A positive attitude can go a long way to easing your child into the murky depths ahead
As we have just celebrated St. Patrick’s Day here in Ireland, this week I’d like to review a book by a young Irish author- Diary of a Young Naturalist by Dara McAnulty.
Dara is a 16 year old autistic naturalist and author who wrote ‘Diary of A Naturalist‘ to chronicle his fourteenth year on this planet. In the book, Dara gives us beautiful insight into his intense connection to nature and how it provides him with an escape to cope with his autism. The book has won numerous literary awards, making Dara the youngest recipient of the Wainwright prize for nature writing and the RSPB (Royal Society for the Protection of Birds) medal in the UK.
Here’s a video of Dara discussing his experience of how nature helps him manage his autism:
So what did I make of the book?
The book is beautifully written, powerfully evoking vivid imagery of the Northern Irish landscape and it’s local wildlife where Dara lives with his family. You really feel Dara’s intense passion for the natural world through his writing whilst giving us an insight into his everyday experiences of autism. Dara bravely tells us about his struggles with bullying, sensory overload and mental health showing a maturity way beyond his 16 years. Autists so often struggle to describe their emotions (as many of us have alexithymia), it’s a real privilege to have such an intimate insight into Dara’s mind.
Perhaps one of the most powerful aspects of the book for me personally, although small, was Dara’s account of his struggles with change and his mental turmoil as his family moved to a different part of Northern Ireland. I experienced a similar situation when I was 11 after selling my childhood home. We only relocated a few miles down the road (to a new house that was designed in a near identical layout to our previous house), but the change was devastating to my mental health. I always felt ridiculous that something seemingly so small could have such an effect on me, but it’s comforting to know that I’m not alone in this experience.
All in all, this book is a must read for anyone who is passionate about the natural world and conservationism 🙂
Leading on from my previous post about autism and CBD, this week I’d like to explore another drug that is being researched in the treatment of autism- MDMA, the active ingredient in Ecstasy.
Yes, you’ve heard me correctly, the psychoactive drug MDMA is indeed being explored as a treatment option for autists!
So how can a recreational party drug help people with autism?
First synthesized for use in psychotherapy by Merck in the 1910’s, MDMA is the active ingredient in the street drug ecstasy and is thought to improve anxiety, sensory perception and sociability in those who take it. Many autists who have taken the drug recreationally have reported feeling more at ease in their body and increased empathy.
So how does the drug work?
MDMA increases release of neurotransmitters such as serotonin, noradrenaline and dopamine in the brain- neurotransmitters that are dysregulated in the autistic brain. In addition, MDMA is also thought to boost the hormones oxytocin and vasopressin the body which are also implicated in autistic symptoms. These hormones and neurotransmitters are heavily involved in anxiety and social behaviours, so targeting these makes pharmacological sense for autists.
That’s fine in theory, but does it work?
A pilot study (a small scale preliminary study) was conducted in 2016 to compare the impact of MDMA assisted psychotherapy on anxiety levels in autists versus psychotherapy alone. The study found that social anxiety significantly reduced in the group that received MDMA, a positive change that occurred rapidly and show signs of long term duration. This was however only a small pilot study and studies are ongoing with larger cohorts.
The drug does not currently have any legally approved medical uses, but if these clinical trials prove successful, this may change in the coming years.
In case you’re getting worried, the street drug itself is not being explored- ecstasy does not contain enough MDMA for therapeutic benefit, and it is often combined with other substances such as methamphetamine which make long-term use highly addictive and damaging to overall health. However, long-term use of MDMA does hold similar safety caveats such as sleep disturbances, depression, heart disease, decreased cognitive functioning and concentration so further research is required.