Journal of Bioethical Inquiry

, Volume 9, Issue 1, pp 93–103 | Cite as

The Extreme Male Brain Theory of Autism and the Potential Adverse Effects for Boys and Girls with Autism

  • Timothy M. KrahnEmail author
  • Andrew Fenton
Original Research


Autism, typically described as a spectrum neurodevelopmental disorder characterized by impairments in verbal ability and social reciprocity as well as obsessive or repetitious behaviours, is currently thought to markedly affect more males than females. Not surprisingly, this encourages a gendered understanding of the Autism Spectrum. Simon Baron-Cohen, a prominent authority in the field of autism research, characterizes the male brain type as biased toward systemizing. In contrast, the female brain type is understood to be biased toward empathizing. Since persons with autism are characterized as hyper-systemizers and hypo-empathizers, Baron-Cohen suggests that, whether they are male or female, most possess an “extreme male brain profile.” We argue that Baron-Cohen is misled by an unpersuasive gendering of certain capacities or aptitudes in the human population. Moreover, we suggest that this may inadvertently favour boys in diagnosing children with Autism Spectrum Disorders. If this is correct, it could also have rather serious consequences for treatment and services for girls (and women) on the Autism Spectrum.


Autism Gender Sex Brain Stereotyping Diagnosis Empathy 



Thanks to Susan Sherwin and the Novel Tech Ethics research team for feedback on previous drafts of this paper as well as audience members who attended an oral conference presentation on the topic at the American Society for Bioethics and Humanities annual conference in 2009. Funding for this project was provided by the Canadian Institutes of Health Research, NNF 80045, States of Mind: Emerging Issues in Neuroethics.

Statement of Competing Interests

The authors have no competing interests to declare.


  1. Abbeduto, L., and A. McDuffie. 2007. Language learning and use as embedded social activities: Evidence from autism and fragile X syndrome. In Language disorders from a developmental perspective: Essays in honor of Robin S. Chapman, ed. R. Paul and R.S. Chapman, 195–214. Mahwah: Lawrence Erlbaum Associates.Google Scholar
  2. American Psychiatric Association and Task Force on DSM-IV. 2000. Diagnostic and statistical manual of mental disorders, DSM-IV-TR. Washington, DC: American Psychiatric Association.Google Scholar
  3. Anonymous. 2005. Girls’ autism “under-diagnosed.” BBC News. Accessed August 18, 2010.
  4. Baron-Cohen, S. 1995. Mindblindness: An essay on autism and theory of mind. Cambridge: MIT Press.Google Scholar
  5. Baron-Cohen, S. 2002. The extreme male brain theory of autism. Trends in Cognitive Sciences 6(6): 248–254.PubMedCrossRefGoogle Scholar
  6. Baron-Cohen, S. 2003. The essential difference: Men, women and the extreme male brain. London: Penguin.Google Scholar
  7. Baron-Cohen, S. 2005a. Autism—“Autos”: Literally, a total focus on the self? In The lost self: Pathologies of the brain and identity, ed. T.E. Feinberg and J.P. Keenan, 166–180. Oxford: Oxford University Press.Google Scholar
  8. Baron-Cohen, S. 2005b. The empathizing system: A revision of the 1994 model of the mindreading system. In Origins of the social mind: Evolutionary psychology and child development, ed. B.J. Ellis and D.F. Bjorklund, 468–492. New York: Guilford Press.Google Scholar
  9. Baron-Cohen, S. 2005c. The male condition. The New York Times. Accessed August 15, 2010.
  10. Baron-Cohen, S. 2009. Coevolution of language and theory of mind. Do sex differences in empathy account for sex differences in language acquisition? Interdisciplines—European Science Foundation. Accessed August 18, 2010.
  11. Baron-Cohen, S., H. Tager-Flusberg, and D.J. Cohen. 1993. Understanding other minds: Perspectives from autism. Oxford: Oxford University Press.Google Scholar
  12. Brasic, J. R. 2011. Autism. Medscape Reference. Accessed August 13, 2011.
  13. Bryson, S.E., S.J. Rogers, and E. Fombonne. 2003. Autism Spectrum Disorders: Early detection, intervention, education, and psychopharmacological management. The Canadian Journal of Psychiatry 48(8): 506–516.Google Scholar
  14. Burman, D.D., T. Bitan, and J.R. Booth. 2008. Sex differences in neural processing of language among children. Neuropsychologia 46(5): 1349–1362.PubMedCrossRefGoogle Scholar
  15. Caplan, P.J., and J.B. Caplan. 1999. Thinking critically about research on sex and gender. New York: Addison-Wesley Longman.Google Scholar
  16. Carmen, E., N.F. Russo, and J.B. Miller. 1981. Inequality and women’s mental health: An overview. The American Journal of Psychiatry 138(10): 1319–1330.PubMedGoogle Scholar
  17. Connellan, J., S. Baron-Cohen, S. Wheelwright, A. Batki, and J. Ahluwalia. 2000. Sex differences in human neonatal social perception. Infant Behavior and Development 23(1): 113–118.CrossRefGoogle Scholar
  18. Cowley, G. 2003. Girls, boys and autism. Newsweek. Accessed August 18, 2010.
  19. Davidson, J. 2007. “In a world of her own …”: Re-presenting alienation and emotion in the lives and writings of women with autism. Gender, Place and Culture 14(6): 659–677.CrossRefGoogle Scholar
  20. de Villiers, J. 2000. Language and theory of mind: What are the developmental relationships. In Understanding other minds: Perspectives from developmental cognitive neuroscience, ed. S. Baron-Cohen, H. Tager-Flusberg, and D.J. Cohen, 83–123. Oxford: Oxford University Press.Google Scholar
  21. Donvan, J. 2008. “Underdiagnosed” girls with autism struggle to fit in. ABC News. Accessed August 18, 2010.
  22. Downs, E. 2008. Girls’ autism signs miss early diagnosis. The Journal Gazette. Accessed August 18, 2010.
  23. Dyck, M.J., K. Ferguson, and I.M. Shochet. 2001. Do autism spectrum disorders differ from each other and from non-spectrum disorders on emotion recognition tests? European Child and Adolescent Psychiatry 10(2): 105–116.PubMedCrossRefGoogle Scholar
  24. Ellefsen, A., H. Kampmann, E. Billstedt, I.C. Gillberg, and C. Gillberg. 2007. Autism in the Faroe Islands. An epidemiological study. Journal of Autism and Developmental Disorders 37(3): 437–444.PubMedCrossRefGoogle Scholar
  25. Faherty, C. 2002. Asperger’s syndrome in women: A different set of challenges? Autism Today. Accessed August 18, 2010.
  26. Farrant, B.M., J. Fletcher, and M.T. Maybery. 2006. Specific language impairment, theory of mind, and visual perspective taking: Evidence for simulation theory and the developmental role of language. Child Development 77(6): 1842–1853.PubMedCrossRefGoogle Scholar
  27. Fausto-Sterling, A. 1985. Myths of gender: Biological theories about women and men. New York: Basic Books.Google Scholar
  28. Fausto-Sterling, A. 2000. Sexing the body: Gender politics and the construction of sexuality. New York: Basic Books.Google Scholar
  29. Fenson, L., P. Dale, J. Reznick, E. Bates, D. Thal, and S. Pethick. 1994. Variability in early communicative development. Monographs of the Society for Research in Child Development 59(5): 1–173. discussion 174–185. Chicago: Chicago Press.PubMedCrossRefGoogle Scholar
  30. Fine, C. 2010a. Delusions of gender: How our minds, society, and neurosexism create difference. New York: W.W. Norton.Google Scholar
  31. Fine, C. 2010b. Response to Simon Baron-Cohen. Accessed August 10, 2011.
  32. Fisch, G.S. 2005. Syndromes and epistemology I: Autistic Spectrum Disorders. American Journal of Medical Genetics Part A 135(2): 117–119.PubMedCrossRefGoogle Scholar
  33. Flora, C. 2006. An Aspie in the city. Psychology Today, November/December. Accessed August 18, 2010.
  34. Fombonne, E. 2005. Epidemiology of autistic disorder and other pervasive developmental disorders. The Journal of Clinical Psychiatry 66(Supplement 10): 3–8.PubMedGoogle Scholar
  35. Frith, U. 1989. Autism and “theory of mind”. In Diagnosis and treatment of autism, ed. C. Gillberg, 29–52. New York: Plenum Press.Google Scholar
  36. Frith, U., and F. Happé. 1999. Theory of mind and self-consciousness: What is it like to be autistic? Mind and Language 14(1): 1–22.CrossRefGoogle Scholar
  37. Gillberg, C. 1991. Outcome in autism and autistic-like conditions. Journal of the American Academy of Child and Adolescent Psychiatry 30(3): 375–382.PubMedCrossRefGoogle Scholar
  38. Gillberg, C., M. Cederlund, K. Lamberg, and L. Zeijlon. 2006. Brief report: “The autism epidemic”. The registered prevalence of autism in a Swedish urban area. Journal of Autism and Developmental Disorders 36(3): 429–435.PubMedCrossRefGoogle Scholar
  39. Gillberg, C., and M. Coleman. 2000. The biology of the autistic syndromes. London: Mac Keith.Google Scholar
  40. Gillberg, C., and M. Rastam. 1992. Do some cases of anorexia nervosa reflect underlying autistic-like conditions? Behavioural Neurology 5(1): 27–32.Google Scholar
  41. Ginn, J., S. Arber, J. Brannen, et al. 1996. Feminist fallacies: A reply to Hakim on women’s employment. British Journal of Sociology 47(1): 167–174.PubMedCrossRefGoogle Scholar
  42. Hale, C.M., and H. Tager-Flusberg. 2003. The influence of language on theory of mind: A training study. Developmental Science 6(3): 346–359.PubMedCrossRefGoogle Scholar
  43. Happé, F. 1999. Autism: Cognitive deficit or cognitive style? Trends in Cognitive Sciences 3(6): 216–222.PubMedCrossRefGoogle Scholar
  44. Happé, F.G.E. 1995. The role of age and verbal ability in the theory of mind task performance of subjects with autism. Child Development 66(3): 843–855.PubMedCrossRefGoogle Scholar
  45. Happé, F., A. Ronald, and R. Plomin. 2006. Time to give up on a single explanation for autism. Nature Neuroscience 9(10): 1218–1220.PubMedCrossRefGoogle Scholar
  46. Hill, A. 2009. Doctors are “failing to spot Asperger's in girls.” The Guardian—The Observer. Accessed August 18, 2010.
  47. Howlin, P., L. Mawhood, and M. Rutter. 2000. Autism and developmental receptive language disorder—a follow-up comparison in early adult life. II: Social, behavioural, and psychiatric outcomes. Journal of Child Psychology and Psychiatry and Allied Disciplines 41(5): 561–578.CrossRefGoogle Scholar
  48. Jordan-Young, R.M. 2010. Brain storm: The flaws in the science of sex differences. Cambridge: Harvard University Press.Google Scholar
  49. Karrass, J., J.M. Braungart-Rieker, J. Mullins, and J.B. Lefever. 2002. Processes in language acquisition: The roles of gender, attention, and maternal encouragement of attention over time. Journal of Child Language 29(3): 519–543.PubMedCrossRefGoogle Scholar
  50. Kindlon, D.J., M. Thompson, and T. Barker. 1999. Raising Cain: Protecting the emotional life of boys. New York: Ballantine Books.Google Scholar
  51. Kitayama, S., and D. Cohen. 2010. Handbook of cultural psychology. New York: Guilford.Google Scholar
  52. Kopp, S., K.K. Berg, and C. Gillberg. 2010. Girls with social and/or attention deficits: A descriptive study of 100 clinic attenders. Journal of Attention Disorders 14(2): 167–181.PubMedCrossRefGoogle Scholar
  53. Kopp, S., and C. Gillberg. 1992. Girls with social deficits and learning problems: Autism, atypical Asperger syndrome or a variant of these conditions. European Child and Adolescent Psychiatry 1(2): 89–99.CrossRefGoogle Scholar
  54. Kopp, S., and C. Gillberg. 1997. Selective mutism: A population-based study: A research note. Journal of Child Psychology and Psychiatry and Allied Disciplines 38(2): 257–262.CrossRefGoogle Scholar
  55. Kraemer, S. 2000. The fragile male. British Medical Journal 321(7276): 1609–1612.PubMedCrossRefGoogle Scholar
  56. Levy, N. 2004. Understanding blindness. Review of The essential difference: Men, women and the extreme male brain by S. Baron-Cohen. Phenomenology and the Cognitive Sciences 3(3): 315–324.CrossRefGoogle Scholar
  57. Liss, M., B. Harel, D. Fein, et al. 2001. Predictors and correlates of adaptive functioning in children with developmental disorders. Journal of Autism and Developmental Disorders 31(2): 219–230.PubMedCrossRefGoogle Scholar
  58. Lloyd, G. 1984. The man of reason: “Male” and “female” in Western philosophy. London: Methuen.Google Scholar
  59. London, E. 2007. The role of the neurobiologist in redefining the diagnosis of autism. Brain Pathology 17(4): 408–411.PubMedCrossRefGoogle Scholar
  60. McLennan, J.D., C. Lord, and E. Schopler. 1993. Sex-differences in higher functioning people with autism. Journal of Autism and Developmental Disorders 23(2): 217–227.PubMedCrossRefGoogle Scholar
  61. Miller, C.A. 2001. False belief understanding in children with specific language impairment. Journal of Communication Disorders 34(1–2): 73–86.PubMedCrossRefGoogle Scholar
  62. Minshew, N.J., and G. Goldstein. 1998. Autism as a disorder of complex information processing. Mental Retardation and Developmental Disabilities Research Reviews 4(2): 129–136.CrossRefGoogle Scholar
  63. Minshew, N.J., and J.A. Meyer. 2006. Autism and related conditions. In Patient-based approaches to cognitive neuroscience, ed. M.J. Farah and T.E. Feinberg, 419–431. Cambridge: MIT Press.Google Scholar
  64. Minter, M., R.P. Hobson, and M. Bishop. 1998. Congenital visual impairment and “theory of mind”. British Journal of Developmental Psychology 16(2): 183–196.CrossRefGoogle Scholar
  65. Mwachofi, A.K. 2009. Gender difference in access and intervention outcomes: The case for women with disabilities. Disability and Rehabilitation 31(9): 693–700.PubMedCrossRefGoogle Scholar
  66. Nash, A., and G. Grossi. 2007. Picking Barbie’s brain: Inherent sex differences in scientific ability? Journal of Interdisciplinary Feminist Thought 2(1): 1–23.Google Scholar
  67. Nicholas, J.S., J.M. Charles, L.A. Carpenter, L.B. King, W. Jenner, and E.G. Spratt. 2008. Prevalence and characteristics of children with autism-spectrum disorders. Annals of Epidemiology 18(2): 130–136.PubMedCrossRefGoogle Scholar
  68. Nilsson, E.W., C. Gillberg, I.C. Gillberg, and M. Rastam. 1999. Ten-year follow-up of adolescent-onset anorexia nervosa: Personality disorders. Journal of the American Academy of Child and Adolescent Psychiatry 38(11): 1389–1395.PubMedCrossRefGoogle Scholar
  69. North, A. 2009. Asperger’s underdiagnosed in girls, says expert. Jezebel. Accessed September 3, 2011.
  70. Nyden, A., E. Hjelmquist, and C. Gillberg. 2000. Autism Spectrum and attention-deficit disorders in girls. Some neuropsychological aspects. European Child and Adolescent Psychiatry 9(3): 180–185.PubMedCrossRefGoogle Scholar
  71. Paechter, C.F. 2007. Being boys, being girls: Learning masculinities and femininities. Maidenhead: Open University Press.Google Scholar
  72. Pâerez Pereira, M., and G. Conti-Ramsden. 1999. Language development and social interaction in blind children. Hove: Psychology Press.Google Scholar
  73. Petersen, A.R. 2004. Engendering emotions. Houndmills: Palgrave Macmillan.CrossRefGoogle Scholar
  74. Peterson, C.C., and M. Siegal. 1995. Deafness, conversation and theory of mind. The Journal of Child Psychology and Psychiatry 36(3): 459–474.CrossRefGoogle Scholar
  75. Peterson, C.C., and M. Siegal. 2002. Representing inner worlds: Theory of mind in autistic, deaf and normal hearing children. Psychological Science 10(2): 126–129.CrossRefGoogle Scholar
  76. Powers, M., and R.R. Faden. 2006. Social justice: The moral foundations of public health and health policy. Oxford: Oxford University Press.Google Scholar
  77. Reddy, W.M. 2001. The navigation of feeling: A framework for the history of emotions. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  78. Rogers, L.J. 2010. Sexing the brain: The science and pseudoscience of sex differences. Kaohsiung Journal of Medical Sciences 26(6): S4–S9.PubMedCrossRefGoogle Scholar
  79. Rooney, P. 1994. Recent work in feminist discussions of reason. American Philosophical Quarterly 31(1): 1–21.Google Scholar
  80. Schick, B., J. de Villiers, P. de Villiers, and B. Hoffmeister. 2002. Theory of mind: Language and cognition in deaf children. The ASHA Leader, December 3. Accessed August 18, 2010.
  81. Sherwin, S. 1992. No longer patient: Feminist ethics and health care. Philadelphia: Temple University Press.Google Scholar
  82. Skuse, D.H., W. Mandy, C. Steer, et al. 2009. Social communication competence and functional adaptation in a general population of children: Preliminary evidence for sex-by-verbal IQ differential risk. Journal of the American Academy of Child and Adolescent Psychiatry 48(2): 128–137.PubMedCrossRefGoogle Scholar
  83. Smith, T. 2002. Sexual differences in Pervasive Developmental Disorders. Medscape Psychiatry & Mental Health eJournal. Accessed August 18, 2010.
  84. Smith, T., and O.I. Lovaas. 1998. Sex and bias: Reply to Boyd. Journal of Autism and Developmental Disorders 28(4): 343–344.PubMedCrossRefGoogle Scholar
  85. Spelke, E.S. 2005. Sex differences in intrinsic aptitude for mathematics and science? A critical review. American Psychologist 60(9): 950–958.PubMedCrossRefGoogle Scholar
  86. Steele, S., R.M. Joseph, and H. Tager-Flusberg. 2003. Brief report: Developmental change in theory of mind abilities in children with autism. Journal of Autism and Developmental Disorders 33(4): 461–467.PubMedCrossRefGoogle Scholar
  87. Stobbe, M. 2007. Autism “epidemic” may be all in the label—behaviors were as common years ago, but definition, diagnosis have shifted. Accessed August 18, 2010.
  88. Tager-Flusberg, H. 1993. What language reveals about the understanding of minds in children with autism. In Understanding other minds: Perspectives from autism, ed. S. Baron-Cohen, H. Tager-Flusberg, and D. Cohen, 138–157. Oxford: Oxford University Press.Google Scholar
  89. Tager-Flusberg, H. 2007. Evaluating the theory-of-mind hypothesis of autism. Current Directions in Psychological Science 16(6): 311–315.CrossRefGoogle Scholar
  90. Tavris, C. 1998. The science and politics of gender research: The meanings of difference. In Gender and motivation, ed. D. Bernstein, 1–24. Lincoln and London: University of Nebraska Press.Google Scholar
  91. Thompson, T., M. Caruso, and K. Ellerbeck. 2003. Sex matters in autism and other developmental disabilities. Journal of Learning Disabilities 7(4): 345–362.Google Scholar
  92. Traustadóttir, R., and K. Johnson. 2000. Women with intellectual disabilities: Finding a place in the world. London: Jessica Kingsley Publishers.Google Scholar
  93. Venter, A., C. Lord, and E. Schopler. 1992. A follow-up study of high-functioning autistic children. Journal of Child Psychology and Psychiatry and Allied Disciplines 33(3): 489–507.CrossRefGoogle Scholar
  94. Volkmar, F.R., P. Szatmari, and S.S. Sparrow. 1993. Sex differences in pervasive developmental disorders. Journal of Autism and Developmental Disorders 23(4): 579–591.PubMedCrossRefGoogle Scholar
  95. Wallentin, M. 2009. Putative sex differences in verbal abilities and language cortex: A critical review. Brain and Language 108(3): 175–183.PubMedCrossRefGoogle Scholar
  96. Walsh, P.N., and T. Heller. 2002. Health of women with intellectual disabilities. Oxford: Blackwell Science.CrossRefGoogle Scholar
  97. Wolff, S., and R.J. Mcguire. 1995. Schizoid personality in girls—a follow-up-study: What are the links with Asperger’s syndrome? Journal of Child Psychology and Psychiatry and Allied Disciplines 36(5): 793–817.CrossRefGoogle Scholar
  98. World Health Organization. 2009. Women and health: Today's evidence tomorrow’s agenda. WHO. Accessed September 23, 2011.
  99. Yoder, J.D., and A.S. Kahn. 2003. Making gender comparisons more meaningful: A call for more attention to social context. Psychology of Women Quarterly 27(4): 281–290.CrossRefGoogle Scholar
  100. Zahn-Waxler, C. 2006. The origins and development psychopathology in females and males. In Developmental psychopathology—vol. 1: Theory and method, ed. D. Cicchetti and D.J. Cohen, 76–138. Hoboken: Wiley.Google Scholar
  101. Zahn-Waxler, C., E.A. Shirtcliff, and K. Marceau. 2008. Disorders of childhood and adolescence: Gender and psychopathology. Annual Review of Clinical Psychology 4: 275–303.PubMedCrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Faculty of MedicineDalhousie UniversityHalifaxCanada
  2. 2.Department of PhilosophyCalifornia State University, FresnoFresnoUSA

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