Dottorato in ADVANCES IN INFECTIOUS DISEASES, MICROBIOLOGY, LEGAL
MEDICINE AND PUBLIC HEALTH SCIENCES

Titolo della tesi: Autism and gender differences. Psychological and social medicine reflections on the autism spectrum between gender and contemporary medicine

This thesis reflects an in-depth investigation of autism, fitting into a broad multidisciplinary landscape that spans medicine, psychiatry, psychology, and psychoanalysis, exploring gender differences and the theme of work throughout the history of autism and its diagnostic evolution. In Chapter One, we outline the main theories related to sex and gender, exploring how these have been treated and interpreted in different scientific disciplines. It will explore how psychiatry has influenced the understanding of gender differences in autism and how the gender medicine approach, over the years, has profoundly influenced the way people's health conditions are understood and treated. In particular, the approach of psychology and psychoanalysis will be explored, with a focus on Freudian theories and the fundamental concepts of psychosexual development, psychic determinism, and the unconscious, which is the beating heart of psychoanalytic theory. Chapter Two describes the characteristics of autism, starting from its historical evolution, expounding on the early definitions and meanings of the term, to the development of autism spectrum disorder within the DSM. Special attention will be paid to its implications from a gender perspective and to diagnostic processes, in which women are often underdiagnosed. In Chapter Three, special emphasis is placed on autism in women. The phenomenon of “camouflage” and the relationships between sex/gender differences and autism are described. These aspects have stimulated a wide range of research on sex differentiation of brain structures in autism, from clinical and neurobiological studies to etiological studies, such as the Male Brain theory and the Female Protective Model/Effect theory. In addition, this chapter explores the needs of autistic women, considering crucial aspects such as sexuality, menstrual cycle, and pregnancy, issues that are often neglected in research and clinical practice. Chapter Four is devoted to the research design, which makes use of data collected at two important Italian institutions specializing in the diagnosis, evaluation and treatment of autism: the Institute of Orthophonology in Rome and the Neapolisanit center in Ottaviano (NA). The main objective of the research is to investigate the gender differences observable at the time of the initial assessment for access to the aforementioned centers. The data, collected through specific standardized instruments, highlight gender differences in the manifestations of autism. Finally, Chapter Five addresses an often overlooked issue, that of employment of people with disabilities. The issue of employment is a significant element in people's lives, providing them with professional identity and opportunities for growth, as well as improved mental well-being. In this context, one of the most disadvantaged groups appears to be people with autism spectrum disorder, particularly women with autism. It is critical that employment research take into account sex and gender differences in order to help overcome obstacles and propose solutions and interventions to improve career opportunities and job retention.