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Comment by Mz | Hacker News Reader

But the big statistic is that autism in all of its forms is around four times more common in males than females. In other words the genetic components have a biologically sex-based component.

Does this account for the fact that women tend to be underdiagnosed? I have read that female autistics are very often a) not diagnosed and b) pressured to learn social skills anyway simply because they are girls.

PS: I am a girl. I could spot the bottom figure in the top, though it took me a few seconds. I have an unusually strong math background for a girl (perhaps especially a girl my age). I think it is ridiculous this is a test for autism. Why on earth is this is a test for autism?

I am pretty darn sure I am not autistic. My ex husband and both our sons probably all are and I taught all of them a lot of the social skills they have. My ex husband once told me that he was good at the technical aspects of his job, but his ability to manage people once he was promoted to that level in the military was largely rooted in what he learned from being married to me.

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"Why on earth is this a test for autism?"

I agree. There is a clear gender difference in seeing color [1][2][3][4]. The use of colors here would invalidate the test for autism, at least in the context of gender difference, since it would be testing for how well you see shapes versus colors.

1: http://jov.arvojournals.org/article.aspx?articleid=2191999 2: https://www.livescience.com/22894-men-and-women-see-things-d... 3: https://www.colormatters.com/color-symbolism/gender-differen... 4: http://news.nationalgeographic.com/news/2012/09/120907-men-w...

I've heard that autism can present slightly differently in girls than boys in terms of coping strategies, etc etc, which makes sense due to different external factors. This may lead to the underdiagnosis - it doesn't "look like" autism in boys.

Some studies make it quite clear that parents treat boys and girls different from the get go and even outright interpret identical behaviors differently depending on the gender of the child. Recent HN discussion about that, with citation:

https://news.ycombinator.com/item?id=14875643

I have heard first hand that there is a general rule among psychologists that its wrong and unethical to diagnose someone with neurodevelopmental disorder when there are no signs of impairments to the individual.

So if a person has impairments and visit a psychologist, the psychologist might use several tests to aid and guide them towards the right help (or cross out wrong ones). The image test in the article might be good to do that (I would not know), but without the initial impairments it does nothing to imply if a person has autism or not.

> I have heard first hand that there is a general rule among psychologists that its wrong and unethical to diagnose someone with neurodevelopmental disorder when there are no signs of impairments to the individual.

I've always found this a bit funny. I kind of understand why this is done this way, but it does imply that a person with a given disorder could end up diagnosed, or not diagnosed with it, depending on what kind of society/culture they're in, which doesn't sound right.

I would argue that things like autism should have a solid diagnosis regardless of how it influences a person's life in a given society. The reality seems to be that we're just very poor at diagnosing these things, so we diagnose by proxy.

It doesn't seem crazy that there should be differing diagnoses by culture. Autism falls along a spectrum, and there are obviously varying degrees of anxiety, depression, attention deficit, and many other symptoms of diagnosable disorders. The question of when it crosses the line to "impairment" is pretty arbitrary.

I find it similar to how a doctor diagnose malnutrition. The exact amount of vitamins, minerals, and proteins needed for each individual varies, so you can't be sure within the natural variance when a problem occur by just measuring each level in the blood. So you end up with lists of symptoms that may indicate a problem by malnutrition, but the existence of those symptoms (like fatigue, stress, sexual behavior) are all interpreted by the society/culture you are in.

I think the most important part is that people should not end up diagnosed unnecessary. Rather than rigid diagnosis, I rather have solid professional standards that require the psychologist to have a similar education and use techniques that will reduce cultural and social norms as influences.

But... you don't see a problem with this? I don't know if nutrition is the example you want to use. This is science we're talking about. It can't afford to be wishy washy like this and we don't change our ideas about how planets align based on which culture you're in. You suddenly not have appendicitis because you're screaming in pain below the acceptable cultural threshold.

In one society, being gay causes immense stress, and may therefore be classified as a mental disorder. As it was. Yet it isn't a mental disorder, obviously. Problems caused by the difference itself, and problems caused by society's attitude towards the individual must be separated.

On the other hand, certain problems, like autism, are fairly solid as to whether they exist or not. Whether you live in a society that mistreats autistic people or a society that idolizes them, there's a distinct difference people may possess.

Confusing disorders with inability to cope with an unaccepting society is very dangerous, because it leads to precisely what you're saying: overdiagnosis, and using diagnosis as means to shut people up and avoid critiquing society itself, and other things.

Autism in females shows itself differently to autism in males, it tends to be a lot less obvious because the traits that they display are unlike those displayed by autistic males. Further they tend not to cause academic issues and as such are not picked up by schools. I am no expert but I have a friend who has an autistic daughter and both her and her partner are child psychologists and we had a discussion about it only 2 nights ago, which was the point that I learned that one of their daughters was on the spectrum (she is approx 6 years old) comparing this to another friend of mine who has an autistic son and the signs that he was on the spectrum were apparent even at the age of 2.5 years old.

Took me a few seconds too, but I didn't think to rationalize it as "though it took me a few seconds", I thought "wow gee I got it in only a few seconds".

Assuming you are male, that may be the real sex difference: Girls aren't supposed to be good at anything, they apologize for not being "good enough" even when they perform as well as the guys and then if they are excellent, no one believes them.

(I think this is literally true, but it is intended as sort of humorous observation so maybe imagine there is a winky here and interpret that to mean "look, this is an injoke of sorts!")

"Girls aren't supposed to be good at anything"

I don't think anyone at all is claiming that. At most people are claiming that girls are better at verbal and emotional skills, while boys are better at visio-spatial things.

When the explanation for women being paid less / having less power overall is that men have superior bodies for tasks (from athletes to programmers), it does seem to come off that way.

It's little help that women have better verbal and emotional skills if they do not appear to be valued in our society.

The highest paying jobs are managerial not technical. If anything emotional skills are much more valued in our society.

Yet high-paid managerial and control jobs are dominated by men.

This is because emotions and empathy are a small part of management.

Bulk of it is politics. And politics is a ultra-competitive space which it own demands.

You should take care to separate these two very different questions.

You should also not forget that there are values other than monetary. I'm sure most people "value" their midwives or nannies infinitely higher than their plumbers or even bankers.

Yes, that is why nannies and so many other Pink Collar Ghetto jobs are paid so poorly: Because we value these people so much.

I don't know if this is sarcasm or too deep for me to grasp, but my point is that there are many forms of value. Not just economic. Income is not decided based on how much the majority of people value occupations, it's not even a factor.

Soldiers are usually highly valued but earn very little. Monks have often had even higher status and made no money at all. Money lenders were reviled but rich. Etc etc etc.

EDIT: Soldiers do earn little considering the risks they take, and the status of the job. This is still true in countries with modern professional armies, but it was much more true historically. So much so that many higher class people would actually _pay_ for the privilege. They had no shortage of money but wanted the glory that military service could bring.

Soldiers are usually highly valued but earn very little.

My father and ex husband were both career military. You are misinformed.

In the US, soldiers get relatively little cash pay because they are provided free room and board, free medical, a free burial, free life insurance, and can access a host of other free amenities for merely flashing their ID card, such as access to free legal services for some purposes. If they serve at least 20 years, they get a retirement check for life. If you join at age 18, as most soldiers do, you can retire as early as age 38 and readily pursue a second career. Unless you were maimed in war, you will still be young and able-bodied.

They can buy a house with no down payment and the federal government will help them pay for college. Military retirees tend to be in quite good financial shape. What the federal government does not give them in cash pay it more than makes up for in countless benefits.

People who say they value what you do but do not want to pay you adequately for the job are basically taking advantage. Women are routinely expected to do things out of the goodness of their hearts, because they care.

I am a woman. I have been homeless for 5.5 years. I am incredibly sick of people acting like "we love what you do!" And then not wanting to pay me anything. I have spent a lot of time deconstructing this problem space and I very much expect to get paid these days. I do a lot less giving it away for free. Because the vast majority of people expecting me to benefit them because I care absolutely do not care that I struggle to get enough to eat every month and I need money to get off the goddamn street and back into housing.

Poverty in the US is overwhelmingly an issue for women and children. If we valued women so much, this travesty should not be true.

>Poverty in the US is overwhelmingly an issue for women and children. If we valued women so much, this travesty should not be true.

This is incorrect. 14% of women are under the poverty line, to 10% of men. That's not "overwhelming". On the flip side, a significant majority of the homeless are men.

The gender difference seen in the poverty statistic is in my estimation due to the fact that women are generally less motivated than men to earn money, and thus less willing to make sacrifices to do so (which is why men overwhelmingly work dangerous jobs, and are 10X more likely to die in a work place accident as a result). This will result in the lower income levels seen in the female demographic, which will extend to more women having income levels that fall under the poverty line.

So, about 40% more women are poor than men and you think this is not substantial? We have expressions like the feminization of poverty and the pink collar ghetto for a reason. This has been studied and there are scholarly resources on the subject.

You explanation is a big fat blame-the-victim position.

I am aware there are more homeless men than women. The reasons for that are complicated. They typically tend to be less pathetic than homeless women. It in no way justifies acting like the difference in poverty rates is small and due to personal laziness on the part of women.

I tend to believe they're highly interrelated.

The belief in the superiority of a gender could very well lead to the belief in the superiority of both their abilities and the value of said abilities.

We live in a capitalist society, where both value and power is expressed through money. If you are to tell me that midwives and nannies are worth more than they are paid, what is your explanation for that?

It's all the same thing.

No, value in general is not expressed through money, only market value. For some things they correlate, for others not at all.

The reason a nanny makes very little is because of supply and demand. On the supply side most young women can become nannies, it requires no special education. Demand wise people would not hire them if their cost approached what the parent that would otherwise stay home makes.

At the same time you entrust your children, that you doubtless value more than anything in the world, to the nanny.

Same with midwives. The "value" they create is infinite, their salaries are not, mostly because it is not _that_ difficult to become one, so if the supply is low you can just raise the salary slightly and demand would catch up. You could even argue that the _economic_ value they create is many times what they earn. Without midwives a significant proportion of children would not survive, and GDP would fall appreciably. Yet they can not bargain with that, since they don't have a monopoly. If they won't deliver children, someone else will. That is not true for olympic sprinters or Fortune 500 CEOs, the supply of talent is so much smaller.

On the other hand you have particle physicists and accomplished poets. The supply of them is also very low, but so is the demand. I also suspect that neither group is very income sensitive, they do what they do because they have to, not because it pays more than something else.

Clearly income and value are very different things.

So what you appear to be saying is that the only thing women are good at is something they're all good at about equally and immediately.

And something that the current system is completely unable to properly monetarily register and the system just relies on them giving it away for free while getting nothing in return.

That all sounds very convenient. It's also interesting that all of these things seem related to children. Why don't you add childbirth to the mix.

I am not saying any of that, no.

I'm simply explaining why nannies don't earn much. Still, they earn more than monks, who in some societies are seen as pillars of existence in a very literal sense.

My point is again that income is set by supply and demand, not value in some deeper sense. The market "knows the price of everything and the value of nothing"

Well, there's also a lot of supply of sprinters. Anyone can be a sprinter. There are far more sprinters than the world needs. Yet, nonetheless, there is value found in the Olympic sprinter. Or the NCAA sprinter. Why? Well, because a high skill in sprinting is valued as opposed to a lower skill in sprinting. It's something you can train at, get better at, and get recognized for. Something that would set you apart from all the other sprinters. Well, where are the Olympic nannies earning millions of dollars, then?

If you're going to talk about supply and demand, you may want to think about why there's demand for something. Why is there demand for Olympic sprinters? Why is there no demand for Olympic teachers? That's really the question.

Simple. Teaching doesn't scale, an olympic sprinter will do their thing in front of hundreds of millions of viewers.

Of course no one is going to claim that and expect to be taken seriously. But as a fellow girl, in my years socializing in groups I have certainly experienced this sentiment. There seems to a tacit agreement that girls that are good at something traditionally male-dominated, like programming or math, are an exception to the rule. In other words, there is a rebuttable presumption of mediocrity in these areas. If you excel at them, good on you, you must be a true whiz to do so in spite of your gender.

Apparently physics checks your gender if you approach it and if it finds you female suddenly makes itself at least twice as hard.

At least this is the impression that a large part of the population seems to have, according to what they tell female students of physics.

It would be funny if it weren't so sad.

"good at something traditionally male-dominated"

Yeah but that's different, I was replying to someone saying that the general opinion was that girls are not good at anything at all. That is simply not true, almost nobody believes that.

... over the hole world, on average, and in the past?

I interpreted Mz's comment as a somewhat facetious internal monologue I myself am all too familiar with. I agree with you, most people don't believe that, but it is nonetheless a belief that some women internalize after years of the socialization I described above. Yes it's not true that we're not good at anything, but there are subtle and pervasive forces at work in groups that cause women to believe this about themselves.

People usually do not have to proclaim things that the larger culture implicitly agrees is simply so true that "it goes without saying." You will tend to not be aware of such implicit assumptions, because they aren't typically overtly signalled, unless you, yourself, regularly run into social friction for defying cultural expectations. At which point it will be maddeningly obvious, and the thing that is most crazy-making is the degree to which other people act like you are a deluded fruitcake or radical feminist or something for stating the obvious.

I would argue that there's a lot of friction you're not feeling by holding the mainstream position. For me, it's baffling that every disparity is assumed to be caused by discrimination despite so few actual cases of confirmed systemic bias, or that every conversation about inequality only examines the particular facets of life that are harder for women. It feels sooooo obvious to me that there is no significant anti-female bias, and it's almost certainly the case that men and women are bimodal in our preferences, and society is organized to accommodate the centers for each mode such that life is harder the further your preferences are from your gender's average.

Edit: The comment I replied to has been substantially edited, as has the follow-up reply to me. Thus, for people reading this, it may look like what I have said is "crazy" or reactionary or otherwise bad behavior on my part. I assert this is an additional means to be dismissive and disrespectful of me and I see no reason to try to further engage this individual. No good will come of it. But I am leaving this comment here anyway.

---

I was one of the top three graduating students of my high school class. I fully expected to be part of a two career couple. That never happened. Instead, I was a homemaker and full time mom for a lot of years.

So I have spent a LOT of time trying to parse how and why my life got so completely flushed down the toilet and did not turn into what I and so many other people expected of it. (One family friend bluntly told me "We all expected you to be a self made millionaire. What the hell happened?") This involved reading quite a lot of research about how and why the lives of men and women turn out differently.

We may well see it differently, but that sounds to me like a polite way to trivialize my conclusions. My conclusions have not been drawn in a trivial manner. There has been quite a lot of study involved in drawing them.

It's not an attempt to trivialize; I'm pointing out that other people have equally strong contrarian feelings, and that they can make the same arguments for their position (and then some).

I don't doubt that you've been compulsive about researching the subject (as have I).

Just saw Mz's edit. For those reading along, I posted initially and then immediately rewrote it for clarity, because I didn't think I did a good job articulating. I didn't think anyone would have seen it, but it probably took me longer than I thought as I'm posting from mobile. My edit was substantial, but my points are the same, so I'm not sure why the parent thinks this is an attempt to dismiss her. (Nor do I know why she thinks I'd try to dismiss her, I have better things to do with my time than plot conspiracies against strangers in the internet...).

Well that's sort of the idea of stereotype threat, in that it can warp your perceptions of not just other people, but also yourself, and that the self-doubt will cause you to do worse or drop out in the long run.

I recall we had a comment exchange awhile ago about optimism/pessimism in the parable of The Two Travelers and the Farmer. In this case both the parent commenter and I may have had the exact same score in terms of seconds to an answer, but we both perceived the significance very differently.

I also shared the idea that "it's easier to change ourselves than it is to change the world". I think this might be an example of where that could be applied. (Of course easy for me to say, I haven't lived my life with subtle social cues that told me not to be good at math or spatial reasoning, but there are other areas in life where I get to apply the same lessons).

I have spent a lot of years working on changing myself. My default preference is to focus first on what I have the most immediate control over.

A) I think it is debatable whether or not it is easier than changing the world.

B) For things like sexism (racism, etc), there comes a point past which the world needs to change if your life is to have any hope of actually improving.

> I think it is debatable whether or not it is easier than changing the world.

What if the inverse was true and changing the world was easy, and changing yourself was hard?

If somehow you managed to change the world and not change yourself, then the world will be entirely fine, but you yourself will still suffer from the same perceptions as before (this is entirely possible, I've seen many a white male strongly believe that the world is prejudiced against them, and I recall some stats showing an increasing number who believe similarly in polling). In that case, the world is relatively good to them, but the mind creates its own interpretation of reality.

Unless you believe people are un-changable, and changing the world means raising the next generation right and forgetting ours.

Anyways, I'm not advocating to forget about activism, just saying I recommend looking inwards first before helping others. Like on airplane safety directions. And that's not a comment directed at you specifically, just a general observation to those looking outwards before looking in (it sound like you've done your share of introspection).

I don't know where or in what decade this has been true, but in the United States for all of my life, media, every level of the education system, corporations, and governments do everything they can to communicate that women are as good as men at anything and better at many things, and that any disparity is necessarily caused by discrimination.

Sorry to go slightly OT here but just for my own sake... can someone tell me where the bottom figure appears in the top figure? Tried quickly googling for it but can't find this test anywhere other than on the OP blog.

No matter how long I stare at it, all I see is a flat yellow rectangle in the centre - it's driving me nuts!

Edit: scrub that! Finally figured it out by deduction i.e. move bottom figure up so front face aligns with central yellow square on top figure. Guess I was expecting something a bit more fun with a "magic eye" style ah ha! moment :D

Aye, it didn't appear instantly for me, but I broke the problem down like this: I decomposed the bottom figure into it's shapes, and the square stood out the most to me (it's composed of a square and 2 quadrilaterals). Then I looked for a square in the top figure, which happens to be in the middle.

Yep, similar here though didn't think to look for the quadrilaterals! Just broke the bottom figure in to it's component shapes/lines and then stared at the top figure to see where the front face and the top two diagonal lines coming off it would fit.

It doesn't seem like the same size though? Possible I'm misunderstanding what you're saying, but the diagonals appear to be disproportionately shorter in the top image. Even tried measuring the lines on my screen to make sure it wasn't an optical illusion.

The findings are beyond just diagnosis statistics and have been shown to correlate with other biologically male traits, like fetal testosterone.

https://molecularautism.biomedcentral.com/articles/10.1186/2...

Does this account for the fact that women tend to be underdiagnosed?

Loads of people go undiagnosed: https://m.medicalxpress.com/news/2016-11-undiagnosed-adults-...

I know people in tech have a tendency to try and break things. But I think everyone should give professionals in their respective fields just a little bit of benefit of the doubt.

Remember, these studies probably talk about averages and populations NOT individuals. And that test was just 1 example of the problems they give.

This post is by some guy who calls himself Donald Clark and I see zero credentials given.

I am not "in tech." Posting to HN says nothing about one's profession. At one time, I was Director of Community Life for The TAG Project. It was an unpaid position, I took it because I was homeschooling my 2xE kids, both of whom are likely somewhere on the spectrum. So, I know something about the issues of people on the spectrum and I know something about testing generally and my interest in this subject is not just some passing fancy because I am bored on a Sunday.

Tests are just tools. They sometimes get misused. My question should be taken literally, not inferred to be outright dismissive, as so many people here seem to be doing.

I wouldn't read too much into individual examples. However, in composite, these little tests do reveal how people think overall.

I often default to taking people literally. Because of that, people who don't like me sometimes suggest I am autistic as a faux polite way of publicly calling me a social retard.

Although ASD individuals are prone to being very literal, I have observed two other types of people who tend to do that.

The first are people from low context cultures, where you say what you mean and mean what you say. Except for certain aspects of military intelligence and information security, military culture is generally like this. My father and ex husband were both career military. So, I tend towards being blunt and direct. Some people find this refreshing. Others find it abhorrent.

The other group of people that I have observed as tending to be very literal and taking people at their word is people with PhDs. Less educated people routinely leap to conclusions that are rooted in personal bias. People with sufficient education tend to consider only the facts in evidence. They aren't stupid and they aren't unaware of the fact that there may be additional facts not currently in evidence. But they are less prone to shitty, prejudiced behaviors that are the lifeblood of sexism, racism, etc.

So, I am not at all confident that the way ASD individuals think is a) unique to them or b) evidence of mental defect.

I am highly skeptical of the degree to which all sorts of differences get labeled and medicalized and framed as a defect. They used to do this to homosexuals. IIRC, homosexuality is no longer officially listed as a mental disorder (aka form of insanity).

So, while I know that a battery of tests can cast light on certain things, I still fail to see why this specific test is seen as indicative of being on the spectrum.

I was under the impression that the primary characteristic is social; that is, you need to have some sort of difficulty in social situations to qualify at all for "autism". I would not imagine that these tests would be the line between "autistic" and "socionormal" (probably not the right term) but between "autism" and some other diagnosis.

So perhaps the problem here is either a) I'm missing something with respect to autism diagnosis or b) they shouldn't be portraying this as crucial evidence in public discourse, which is what i think you've been arguing for. Is this a good understanding?

I might add i agree; I think certain fields attractive a different way of thinking that overlaps heavily with the autistic spectrum.

A tldr of what I think is that the world has radically changed in the last 100 years and society has become openly hostile to people in ways that are more problematic for some people than others. Rather than wondering what the hell has happened at scale that the world is so problematic for so many people to navigate, we hand out diagnoses to those having the most trouble. It is a form of washing our hands of responsibility for shitting on people (at the societal level).

There is an autism "epidemic." So, either something has happened at scale to cause a sudden and dramatic increase in basically birth defects (which appears to be true, actually) or society is less people friendly in critical ways or both. Yet, we don't say "Shit! We have poisoned the environment and it is causing our babies to be defective! We need to fix this!" And we also don't say "Shit! What the fuck is wrong with the world that so many perfectly normal people cannot function in it?" No, we say "You, as an individual, are defective and you, as an individual, needs to try harder to fit in. Don't expect the world to be too accommodating."

Which must be some new record for politely telling people "Fuck you and the horse you road in on" with plausible deniability.

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