Paul F. Lazarsfeld Center for the Social Sciences, Columbia University, 420 W, 118th Street, Mail Code 3355, New York, NY 10027, USA.
Soc Sci Med. 2012 Jun;74(11):1667-74. doi: 10.1016/j.socscimed.2011.06.013. Epub 2011 Jul 12.
One of the most consistent observations in the epidemiology of autism spectrum disorders (ASD) is the preponderance of male cases. A few hypotheses have been put forth which attempt to explain this divergence in terms of sex-linked biology, with limited success. Feminist epidemiologists suggest the importance of investigating specific mechanisms for male-female differences in health outcomes, which may include sex-linked biology and/or gender relations, as well as complex biosocial interactions. Neither domain has been systematically investigated for autism, and the possible role of gender has been particularly neglected. In this article, we posit hypotheses about how social processes based on perception of persons as male or female, particularly patterns of social and physical interaction in early development, may affect the observed occurrence and diagnosis of ASD. We gesture toward an embodiment model, incorporating hypotheses about initial biological vulnerabilities to autism--which may or may not be differentially distributed in relation to sex biology--and their interactions with gender relations, which are demonstrably different for male and female infants. Toward building such a model, we first review the epidemiology of ASD with an eye toward male-female differences, then present a theory of gender as a "pervasive developmental environment" with relevance for the excess burden of autism among males. Finally, we suggest research strategies to further investigate this issue.
自闭症谱系障碍（ASD）流行病学中最一致的观察结果之一是男性病例居多。已经提出了一些假设，试图从性连锁生物学的角度来解释这种差异，但收效甚微。女性主义流行病学家建议，有必要研究特定的机制，以了解男女在健康结果方面的差异，这些机制可能包括性连锁生物学和/或性别关系，以及复杂的生物社会相互作用。这两个领域都没有系统地研究自闭症，而性别可能发挥的作用尤其被忽视。在本文中，我们提出了一些假设，探讨了基于对男性或女性的感知的社会过程，特别是在早期发展中社会和身体互动的模式，如何影响自闭症的观察到的发生和诊断。我们提出了一个体现模型，纳入了关于自闭症初始生物学脆弱性的假设——这些脆弱性可能与性别生物学有关，也可能无关——以及它们与性别关系的相互作用，这些关系对男性和女性婴儿是明显不同的。为了建立这样一个模型，我们首先回顾了自闭症的流行病学，着眼于男女差异，然后提出了一种性别理论，即性别是一种“普遍的发展环境”，与男性自闭症发病率偏高有关。最后，我们建议了研究策略，以进一步调查这个问题。
