The extreme male brain revisited: gender coherence in adults with autism spectrum disorder.

BACKGROUND: The 'extreme male brain' theory suggests that autism spectrum disorder (ASD) is an extreme variant of male intelligence. However, somewhat paradoxically, many individuals with ASD display androgynous physical features regardless of gender. AIMS: To assess physical measures, supposedly related to androgen influence, in adults with and without ASD. METHOD: Serum hormone levels, anthropometry, the ratio of 2nd to 4th digit length (2D:4D) and psychiatric symptomatology were measured in 50 adults with high-functioning ASD and age- and gender-matched neurotypical controls. Photographs of face and body, as well as voice recordings, were obtained and assessed with respect to gender coherence, blindly and independently, by eight assessors. RESULTS: Women with ASD had higher total and bioactive testosterone levels, less feminine facial features and a larger head circumference than female controls. Men in the ASD group were assessed as having less masculine body characteristics and voice quality, and displayed higher (i.e. less masculine) 2D:4D ratios, but similar testosterone levels to controls. Androgynous facial features correlated strongly and positively with autistic traits measured with the Autism-Spectrum Quotient in the total sample. In males and females with ASD dehydroepiandrosterone sulfate did not decrease with age, in contrast to the control group. CONCLUSIONS: Women with ASD had elevated testosterone levels and several masculinised characteristics compared with controls, whereas men with ASD displayed several feminised characteristics. Our findings suggest that ASD, rather than being characterised by masculinisation in both genders, may constitute a gender defiant disorder.

Do patients with hoarding disorder have autistic traits?

BACKGROUND: Hoarding symptoms have been described in individuals with autism spectrum disorders (ASD). Furthermore, individuals with hoarding disorder (HD) may display some ASD-like features. In order to further refine the diagnostic boundaries of HD, we examined the presence of autistic traits and theory of mind deficits in individuals with HD and of hoarding behavior in patients with ASD. METHODS: Two hundred and twenty-one participants in five groups (HD, ASD, obsessive-compulsive disorder (OCD), anxiety disorders (AD), and healthy controls (HC)) were administered measures of autistic traits (Autism-Spectrum Quotient), theory of mind (eyes test-revised), and hoarding severity (saving inventory-revised; SI-R (add acronym)). RESULTS: Hoarders displayed more autistic traits compared to healthy individuals but not to psychiatric controls. Participants with ASD had significantly higher scores on the SI-R than both psychiatric (OCD or AD) and HC groups, indicating more severe hoarding behavior, but had lower scores than participants with HD. The presence of autistic traits in individuals with HD was related to the presence of comorbid OCD, but the presence of hoarding symptoms in individuals with ASD was unrelated to comorbid OCD. CONCLUSIONS: We conclude that individuals with HD do not display more autistic traits than psychiatric controls, thus supporting its status as an independent diagnostic entity. More research is needed to further understand the phenomenology and clinical relevance of hoarding symptoms in ASD.