Prior to the development of E-S theory, Baron-Cohen had previously proposed and studied the mind-blindness theory in 1990, which proposed a homogenous (single-cause) explanation of autism as due to either a lack of theory of mind, or developmental delay in theory of mind during childhood. Theory of mind is the ability to attribute mental states to themselves or others. The mind-blindness theory could explain social and communication difficulties, but could not explain other key traits of autism including unusually narrow interests and highly repetitive behaviors. Mind-blindness was later largely rejected by academia in response to strong evidence for the heterogeneity of autism, although some proponents in academia including Baron-Cohen existed as of March 2011.
Baron-Cohen and associates say that similar sex differences on average have been found using performance tests of empathy such as facial emotion recognition tasks and on performance tests of systemising such as measures of mechanical reasoning or 'intuitive physics'. He has also argued that these sex differences are not only due to socialization. In a 2018 article published in the Proceedings of the National Academy of Sciences (PNAS), Baron-Cohen's team demonstrated the robustness of the theory on sample of half a million individuals.
While experience and socialization contribute to the observed sex differences in empathy and systemising, Baron-Cohen and colleagues suggest that biology also plays a role. A candidate biological factor influencing E and S is fetal testosterone (FT). FT levels are positively correlated with scores on the Systemising Quotient and are negatively correlated with scores on the Empathy Quotient A new field of research has emerged to investigate the role of testosterone levels in autism. Correlational research demonstrated that elevated rates of testosterone were associated with higher rates of autistic traits, lower rates of eye contact, and higher rates of other medical conditions. Furthermore, experimental studies showed that altering testosterone levels influences the maze performance in rats, having implications for human studies. The fetal testosterone theories posit that the level of testosterone in the womb influences the development of sexually dimorphic brain structures, resulting in sex differences and autistic traits in individuals.
Baron-Cohen and colleagues performed a study in 2014 using 19,677 samples of amniotic fluid to show that people who would later develop autism had elevated fetal steroidogenic levels, including testosterone.
Baron-Cohen's work in systemising-empathising led him to investigate whether higher levels of fetal testosterone explain the increased prevalence of autism spectrum disorders among males in his theory known as the "extreme male brain" theory of autism. A review of his book The Essential Difference published in Nature in 2003 summarises his proposals as: "the male brain is programmed to systemize and the female brain to empathize ... Asperger's syndrome represents the extreme male brain".
Baron-Cohen and colleagues extended the E–S theory into the extreme male brain theory of autism, which hypothesises that autism shows an extreme of the typical male profile. This theory divides people into five groups:
Baron-Cohen says that tests of the E–S model show that twice as many females than males are Type E and twice as many males than females are Type S. 65% of people with autism spectrum conditions are Extreme Type S. The concept of the Extreme Type E brain has been proposed; however, little research has been conducted on this brain profile.
Apart from the research using EQ and SQ, several other similar tests also have found female and male differences and that people with autism or Asperger syndrome on average score similarly to but more extremely than the average male. For example, the brain differences model provides a broad overview of sex differences that are represented in individuals with autism, including brain structures and hormone levels.
Some, but not all, studies have found that brain regions that differ in average size between males and females also differ similarly between people who have autism and those who do not have autism.
Baron-Cohen's research on relatives of people with Asperger syndrome and autism found that their fathers and grandfathers are twice as likely to be engineers as the general population. A follow-up study by David A. Routh and Christopher Jarrold found disproportionate numbers of doctors, scientists, and accountants were fathers of autists, while "skilled and unskilled manual workers are less common as fathers than would be predicted". They hypothesised that this observed overrepresentation of science and accounting among autism fathers could be due to a sampling bias. Another similar finding by Baron-Cohen in California has been referred to as the Silicon Valley phenomenon, where a large portion of the population works in technical fields, and he says autism prevalence rates are ten times higher than the average of the US population. These data suggest that genetics and the environment play a role in autism prevalence, and children with technically minded parents are therefore more likely to be diagnosed with autism.
Another possibility has been proposed that spins the perspective of the extreme male brain. Social theorists have been investigating the concept that females have protective factors against autism by having a more developed language repertoire and more empathy skills. Female children speak earlier and use language more than their male counterparts, and the lack of this skill translates into many symptoms of autism, offering another explanation for the discrepancy in prevalence.
The extreme male brain theory (EMB), put forward by Baron-Cohen suggests that autistic brains show an exaggeration of the features associated with male brains. These are mainly size and connectivity with males generally having a larger brain with more white matter, leading to increased connectivity in each hemisphere. This is seen in an exaggerated form in the brains of those with ASD. There is a decrease in the Corpus Callosum in people with ASD.. Individuals with ASD were found to have widespread interconnectivity abnormalities in specific brain regions. This could explain the different results on empathy tests between men and women as well as the deficiencies in empathy seen in ASD as empathy requires several brain regions to be activated which need information from many different areas of the brain. A further example of how brain structure can influence ASD is looking at cases where the corpus callosum does not fully develop (agenesis of corpus callosum). It was found that autism is commonly diagnosed in children where the corpus callosum does not fully develop (45% of children with agenesis of the corpus callosum). A further example of brain structures relating to ASD is that children with ASD tend to have a larger amygdala, this is another example of being an extreme version of the male brain which generally has a larger amygdala.
These brain differences have all been shown to have an influence on social cognition and communication. High levels of fetal testosterone have also been shown to be related to behavior associated with autism, such as eye contact. Studies examining the relationship between prenatal testosterone levels and autistic traits found that high levels correlated with traits such as decreased eye contact. These were present in both sexes. This suggests that fetal testosterone (fT) is the cause of sex differences in the brain and that there is a link between fT levels and ASD. In general females with autism have a higher rate of medical conditions which are related to high androgen levels and both males and females with autism have higher than average androgen levels. Males have higher fT levels naturally meaning that there is less of a change required in the hormone levels to reach a point high enough to cause the developmental changes seen in autism. This is a possible cause for the male prevalence seen in autism.
Studies found that individuals with autism spectrum disorder (ASD) self-report lower levels of empathic concern, show less or absent comforting responses toward someone who is suffering, and report equal or higher levels of personal distress compared to controls. The combination of reduced empathic concern and increased personal distress may lead to the overall reduction of empathy in ASD.
Studies also suggest that individuals with ASD may have impaired theory of mind, involving the ability to understand the perspectives of others. The terms cognitive empathy and theory of mind are often used synonymously, but due to a lack of studies comparing theory of mind with types of empathy, it is unclear whether these are equivalent. Notably, many reports on the empathic deficits of individuals with Asperger syndrome are actually based on impairments in theory of mind.
Baron-Cohen argued that psychopathy is associated with intact cognitive empathy but reduced affective empathy while ASD is associated with both reduced cognitive and affective empathy.
Empathising-Systemising theory has also been criticised, from various points of view.
Others have criticised the original EQ and SQ, which form most of the research basis behind the notions of empathising and systemising. Both measure more than one factor, and sex differences exist on only some of the factors. In a 2003 Wall Street Journal article, Robert McGough wrote about responses to the theory by neurologist and pediatrician Isabelle Rapin and psychologist Helen Tager-Flusberg:
Some research in systemising and empathising in early life indicates that boys and girls develop in similar ways, casting doubt on the theory of sex differences in these areas. A cognitive style that more naturally opposes empathising, which has been given the name Machiavellianism, emphasises self-interest and has been shown to be strongly correlated with competitiveness. Evolutionary theory predicts that typical males will be more competitive than typical females. In contrast, research has generally shown a weak negative correlation between empathising and systemising. (It is worth noting that weak correlation between empathising and systemising would support treating them as independent variables, i.e., as distinct dimensions of personality, each of which may or may not correlate with an individual's biological sex or preferred gender.)
The 'extreme male brain' theory has also been criticised, with critics saying that the tests behind this theory are based on gender stereotypes, and not on hard science. Psychologist and leading autism researcher Catherine Lord says the theory is based on "gross misinterpretations" of developmental data. Psychiatrist David Skuse has claimed that communication differences between genders are likely to be small. Psychiatrist Meng-Chuan Lai says the study results have not been replicated.
Lizzie Buchen, a science journalist for Nature's news feature section, wrote in 2011 that because Baron-Cohen's work has focused on higher-functioning individuals with autism spectrum disorders, his work requires independent replication with broader samples. Mirroring Helen Tager-Flusberg's 2003 warnings, Buchen added that it could lead to hurtful discriminatory views of autistic children "Some critics are also rankled by Baron-Cohen's history of headline-grabbing theories—particularly one that autism is an 'extreme male' brain state. They worry that his theory about technically minded parents may be giving the public wrong ideas, including the impression that autism is linked to being a 'geek'." In a 2003 article in The Spectator, philosopher Hugh Lawson-Tancred wrote "The emphasis on the ultra-maleness approach is no doubt attributable to the fact that Baron-Cohen works mainly with higher functioning autism and Asperger's syndrome."
As a basis for his theory, Baron-Cohen cited a study done on newborn infants in which baby boys looked longer at an object and baby girls looked longer at a person. However, Elizabeth Spelke's 2005 review of studies done with very young children found no consistent differences between boys and girls. Subsequent research showed that there could indeed be a sex difference between males and females, but that males actually looked more at human faces than females on average. A European Union Horizon 2020 backed research program in brain and autism research pointed at genetic factors, confirming individual differences in object or human proclivities in babies but did not confirm the sex difference.
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See also:
Ellis, Hayden D. (2005). "Book review: Baron-Cohen, Simon (2003): The essential difference: Men, women and the extreme male brain". Cognitive Neuropsychiatry. 10 (1): 73–75. doi:10.1080/13546800344000273. S2CID 218577642.
http://docs.autismresearchcentre.com/papers/2005_BC_ReplyToHadynEllis.pdf
Baron-Cohen S, Auyeung B, Nørgaard-Pedersen B, Hougaard DM, Abdallah MW, Melgaard L, et al. (March 2015). "Elevated fetal steroidogenic activity in autism". Molecular Psychiatry. 20 (3): 369–76. doi:10.1038/mp.2014.48. PMC 4184868. PMID 24888361. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184868
Baron-Cohen, Simon (2007), "Chapter 16 The evolution of empathizing and systemizing: assortative mating of two strong systemizers and the cause of autism", in Dunbar, Robin I. M.; Barret, Louise (eds.), The Oxford handbook of evolutionary psychology, Oxford: Oxford University Press, pp. 213–226, ISBN 9780198568308 9780198568308
Baron-Cohen, Simon (9 November 2012). "Are geeky couples more likely to have kids with autism?". Scientific American. Retrieved 28 December 2013. http://www.scientificamerican.com/article.cfm?id=are-geeky-couples-more-likely-to-have-kids-with-autism
Benenson, Joyce F. (10 July 2003). "Sex on the brain". Nature. 424 (6945): 132–133. Bibcode:2003Natur.424..132B. doi:10.1038/424132b. https://doi.org/10.1038%2F424132b
Baron-Cohen, Simon; Knickmeyer, Rebecca C.; Belmonte, Matthew K. (4 November 2005). "Sex differences in the brain: implications for explaining autism" (PDF). Science. 310 (5749): 819–823. Bibcode:2005Sci...310..819B. doi:10.1126/science.1115455. PMID 16272115. S2CID 44330420.
Extracted in:
Kessel, Cathy (15 November 2011). "Half of Women Do Not Have "Female Brains" (blog)". mathedck.wordpress.com. Mathematics and Education via WordPress.
/wiki/Simon_Baron-Cohen
Baron-Cohen, Simon (2009). "Autism: The Empathizing–Systemizing (E-S) Theory". Annals of the New York Academy of Sciences. 1156 (The Year in Cognitive Neuroscience 2009): 68–80. Bibcode:2009NYASA1156...68B. doi:10.1111/j.1749-6632.2009.04467.x. PMID 19338503. S2CID 1440395. /wiki/Annals_of_the_New_York_Academy_of_Sciences
Krieser, Nicole L.; White, Susan W. (March 2014). "ASD in females: are we overstating the gender difference in diagnosis?". Clinical Child and Family Psychology Review. 17 (1): 67–84. doi:10.1007/s10567-013-0148-9. PMID 23836119. S2CID 23881206. /wiki/Doi_(identifier)
Baron-Cohen, Simon (2010), "Empathizing, systemizing, and the extreme male brain theory of autism", Savic, Ivanka, ed. (2010). Sex differences in the human brain, their underpinnings and implications. Progress in Brain Research. Vol. 186. Amsterdam: Elsevier. pp. 167–175. ISBN 9780444536303. 9780444536303
Krieser, Nicole L.; White, Susan W. (March 2014). "ASD in females: are we overstating the gender difference in diagnosis?". Clinical Child and Family Psychology Review. 17 (1): 67–84. doi:10.1007/s10567-013-0148-9. PMID 23836119. S2CID 23881206. /wiki/Doi_(identifier)
Baron-Cohen, Simon (2010), "Empathizing, systemizing, and the extreme male brain theory of autism", Savic, Ivanka, ed. (2010). Sex differences in the human brain, their underpinnings and implications. Progress in Brain Research. Vol. 186. Amsterdam: Elsevier. pp. 167–175. ISBN 9780444536303. 9780444536303
Baron-Cohen, Simon; Wheelwright, Sally; Stott, Carol; Bolton, Patrick; Goodyer, Ian (July 1997). "Is there a link between engineering and autism?". Autism. 1 (1): 101–109. doi:10.1177/1362361397011010. S2CID 145375886. /wiki/Autism_(journal)
Jarrold, Christopher; Routh, David A. (September 1998). "Is there really a link between engineering and autism?". Autism. 2 (3): 281–289. doi:10.1177/1362361398023006. S2CID 145486904. /wiki/Autism_(journal)
Baron-Cohen, Simon (November 2012). "Autism and the technical mind: live chat with Simon Baron-Cohen, November 9, 10 A.M. EST". Scientific American. Vol. 307, no. 5. pp. 72–75. https://www.scientificamerican.com/article/baron-cohen-autism-and-technical-mind-live-chat/
Krieser, Nicole L.; White, Susan W. (March 2014). "ASD in females: are we overstating the gender difference in diagnosis?". Clinical Child and Family Psychology Review. 17 (1): 67–84. doi:10.1007/s10567-013-0148-9. PMID 23836119. S2CID 23881206. /wiki/Doi_(identifier)
Luders, Eileen; Toga, Arthur W.; Thompson, Paul M. (1 January 2014). "Why size matters: Differences in brain volume account for apparent sex differences in callosal anatomy: The sexual dimorphism of the corpus callosum". NeuroImage. 84: 820–824. doi:10.1016/j.neuroimage.2013.09.040. PMC 3867125. PMID 24064068. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867125
Bruner, Emiliano; de la Cuétara, José Manuel; Colom, Roberto; Martin-Loeches, Manuel (April 2012). "Gender-based differences in the shape of the human corpus callosum are associated with allometric variations". Journal of Anatomy. 220 (4): 417–421. doi:10.1111/j.1469-7580.2012.01476.x. PMC 3375777. PMID 22296183. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375777
Baron-Cohen, Simon; Knickmeyer, Rebecca C.; Belmonte, Matthew K. (4 November 2005). "Sex differences in the brain: implications for explaining autism" (PDF). Science. 310 (5749): 819–823. Bibcode:2005Sci...310..819B. doi:10.1126/science.1115455. PMID 16272115. S2CID 44330420.
Extracted in:
Kessel, Cathy (15 November 2011). "Half of Women Do Not Have "Female Brains" (blog)". mathedck.wordpress.com. Mathematics and Education via WordPress.
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Extracted in:
Kessel, Cathy (15 November 2011). "Half of Women Do Not Have "Female Brains" (blog)". mathedck.wordpress.com. Mathematics and Education via WordPress.
/wiki/Simon_Baron-Cohen
Frazier, Thomas W.; Hardan, Antonio Y. (15 November 2009). "A meta-analysis of the corpus callosum in autism". Biological Psychiatry. 66 (10): 935–941. doi:10.1016/j.biopsych.2009.07.022. PMC 2783565. PMID 19748080. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2783565
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Baron-Cohen, Simon; Knickmeyer, Rebecca C.; Belmonte, Matthew K. (4 November 2005). "Sex differences in the brain: implications for explaining autism" (PDF). Science. 310 (5749): 819–823. Bibcode:2005Sci...310..819B. doi:10.1126/science.1115455. PMID 16272115. S2CID 44330420.
Extracted in:
Kessel, Cathy (15 November 2011). "Half of Women Do Not Have "Female Brains" (blog)". mathedck.wordpress.com. Mathematics and Education via WordPress.
/wiki/Simon_Baron-Cohen
Baron-Cohen, Simon; et al. (May 2013). "Autism traits in individuals with agenesis of the corpus callosum". Journal of Autism and Developmental Disorders. 43 (5): 1106–1118. doi:10.1007/s10803-012-1653-2. PMC 3625480. PMID 23054201.
See also:
Frazier, Thomas W.; Keshavan, Matcheri S.; Minshew, Nancy J.; Hardan, Antonio Y. (November 2012). "A two-year longitudinal MRI study of the corpus callosum in autism". Journal of Autism and Developmental Disorders. 42 (11): 2312–2322. doi:10.1007/s10803-012-1478-z. PMC 4384817. PMID 22350341.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625480
Barnea-Goraly, Naama; Frazier, Thomas W.; Piacenza, Lucia; Minshew, Nancy J.; Keshavan, Matcheri S.; Reiss, Allan L.; Hardan, Antonio Y. (3 January 2014). "A preliminary longitudinal volumetric MRI study of amygdala and hippocampal volumes in autism". Progress in Neuro-Psychopharmacology & Biological Psychiatry. 48: 124–128. doi:10.1016/j.pnpbp.2013.09.010. PMC 8655120. PMID 24075822. S2CID 35129120. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655120
Baron-Cohen, Simon; Knickmeyer, Rebecca C.; Belmonte, Matthew K. (4 November 2005). "Sex differences in the brain: implications for explaining autism" (PDF). Science. 310 (5749): 819–823. Bibcode:2005Sci...310..819B. doi:10.1126/science.1115455. PMID 16272115. S2CID 44330420.
Extracted in:
Kessel, Cathy (15 November 2011). "Half of Women Do Not Have "Female Brains" (blog)". mathedck.wordpress.com. Mathematics and Education via WordPress.
/wiki/Simon_Baron-Cohen
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Minio-Paluello, Ilaria; Lombardo, Michael V.; Chakrabarti, Bhismadev; Wheelwright, Sally; Baron-Cohen, Simon (December 2009). "Response to Smith's Letter to the Editor "Emotional Empathy in Autism Spectrum Conditions: Weak, Intact, or Heightened?"" (PDF). Journal of Autism and Developmental Disorders. 39 (12): 1749–1754. doi:10.1007/s10803-009-0800-x. S2CID 42834991.
See also:
Smith, Adam (December 2009). "Emotional Empathy in Autism Spectrum Conditions: Weak, Intact, or Heightened?". Journal of Autism and Developmental Disorders. 39 (12): 1747–1748. doi:10.1007/s10803-009-0799-z. PMID 19572192. S2CID 13290717.
http://people.ds.cam.ac.uk/bc249/papers/minio-paluello_2009_jadd.pdf
Minio-Paluello, Ilaria; Lombardo, Michael V.; Chakrabarti, Bhismadev; Wheelwright, Sally; Baron-Cohen, Simon (December 2009). "Response to Smith's Letter to the Editor "Emotional Empathy in Autism Spectrum Conditions: Weak, Intact, or Heightened?"" (PDF). Journal of Autism and Developmental Disorders. 39 (12): 1749–1754. doi:10.1007/s10803-009-0800-x. S2CID 42834991.
See also:
Smith, Adam (December 2009). "Emotional Empathy in Autism Spectrum Conditions: Weak, Intact, or Heightened?". Journal of Autism and Developmental Disorders. 39 (12): 1747–1748. doi:10.1007/s10803-009-0799-z. PMID 19572192. S2CID 13290717.
http://people.ds.cam.ac.uk/bc249/papers/minio-paluello_2009_jadd.pdf
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