The Sharp Decline of Mental Health during a Pandemic

One of the most talked about topics in today’s society is mental health. Many people wonder why the population’s mental health has declined so much over the years. Specifically, the last year has seen a drastic decrease in mental health, especially in the younger generation. Social isolation and seclusion has made many people feel alone and that there is no where to turn to. We know mental health diagnoses like depression and anxiety have had effects on all aspects of people’s lives. Symptoms can lead to poor work performance, decreased well being, and negatively affecting interpersonal relationships. COVID-19 has taken some of these symptoms and made them even worse. It is unknown how long it will take the population to bounce back mentally after living through a pandemic. 

In the study “Savoring the Moment: A Link Between Affectivity and Depression”, negative and positive affectivity was used to determine risk factors for depression. In order to help with depression treatments, we need to understand how temporal domains influence savoring. The savoring capacity of an individual is described as the capacity for one to attend, appreciate, and enhance the experience of one’s life. The study concluded that both positive and negative associativity were in fact associated both with depression and three savoring temporal domains. They specifically found that savoring could in fact reduce the symptoms of depression in people with low positive affectivity and high negative affectivity. Therefore, understanding how savoring is influential can help with future measures in terms of depression.

The statistics of the mental health decline are terrifying when it is put into perspective. The article “The Implications of COVID-19 for Mental Health and Substance Use” show a steep increase in individuals experiencing symptoms of anxiety disorder and/or depressive disorder. It is seen that from January-June 2019 there were 11.0% of people with symptoms while in January 2021 there were 41.1%. Many young adults have suffered the consequences of the pandemic, including school closures and loss of income. The younger generation was already at a high risk for poor mental health and now many are suffering from it as well. Specifically, 56% of young adults aged 18-24 reported symptoms of anxiety and depression during the pandemic and 26% endorsed suicidal thoughts. The article “Mental Health and Coping during Covid-19” displays ways that people can learn to combat negative symptoms and in turn come out with more resilience. They mention practices such as taking breaks, taking care of your body, making time for yourself, and connecting with others. 

People need help more than ever and after the loss we have all felt through the past year, every person deserves that. Life is so short and as seen in both articles, we need to live in the moment before poor mental health engulfs all of our lives. The importance of taking care of ourselves rings true now more than ever. Every person has had a different experience while in isolation, so checking in on your friends and family is so important. As stated, we need to savor the moment and engage in activities that make us happy. Learning how to deal with negative thoughts and seeking help is important in the lives of all young adults. No one should feel like they have no help when there are so many resources available. We need to educate our youth how to take care of themselves in their young adult years so that mental health does not continue to decline. 

Citations:

Kahrilas, I. J., Smith, J. L., Silton, R. L., & Bryant, F. B. (2020). Savoring the moment: A link between affectivity and depression. International Journal of Wellbeing,10(2), 19-36. doi:10.5502/ijw.v10i2.779

Mental health and coping during covid-19. (2021, January 2021). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

Nirmita Panchal, R., & 2021, F. (2021, April 14). The implications of Covid-19 for mental health and substance use. Retrieved from https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/ 

The Effects Circadian Rhythms on Behavioral Outputs

Circadian rhythms allow for the coordination between behavioral and physiological processes that synchronize themselves to their external environment, usually via the signaling of core clock neurons that travel downstream to other tissues. Such that circadian rhythms can be entrained by cues in the environment like light and temperature, but these daily rhythms also persist in the absence of cues. Though circadian rhythms are inherent and essential for proper function, the exact mechanisms behind this are still not quite yet well understood. Because of this, many researchers tend to utilize the model organism, Drosophila melanogaster, which has been essential in discovering novel regulators of circadian rhythms due to their low genetic redundancy and functional simplicity. In increasing the mechanistic understanding of circadian rhythms, its implications and impact on human health and daily functioning may also be better realized. 

Because it is still unclear as to how the central clock modulates certain circadian outputs, in the article, “A circadian output center controlling feeding: fasting rhythms in Drosophila,” by Dreyer et. al, the researchers specifically focused on the contributions of two neuronal populations in the pars intercerebralis (PI), a functional homolog to the mammalian hypothalamus, on circadian feeding times. Using a fly liquid-food interaction counter, the impact of DILP+ and SIPa+ cells on circadian feeding regulation was tested by continuously monitoring feeding behaviors while selectively activating or silencing each subset of PI cells. Thermogenetic manipulations of PI neurons expressing the neuropeptides, SIFamide and DILPs, were made, from which the rest: activity rhythms were monitored. These manipulations to the SIFa neuropeptide and mutations to the SIFa gene was found to cause a degradation of the feeding: fasting rhythms and also resulted in an elevated feeding amount. However, the manipulations to DILPs affected the amount of food consumption independently of feeding rhythms. Not only does this contribute to the current understandings of the PI’s control of circadian outputs, but also these findings also highlight how disruptions may cause circadian misalignment (Dreyer et al., 2019). 

This notion of circadian misalignment is particularly applicable when considering individuals who partake in shift work, which often is at odds with our endogenous circadian system. Understanding shift work and its effect on humans has become increasingly relevant due to the COVID-19 pandemic, in which healthcare workers worked around the clock caring for the large influx of patients. In the article, “Effects of circadian misalignment on cognition in chronic shift workers,” by Chellapa et. al., the cognitive performance of individuals was evaluated after being subjected to various sleep schedules that simulated either day or night shifts. In addition to completing multiple cognitive tasks including the Psychomotor Vigilance Task and the Digit Symbol Substitution Task, the researchers assessed subjective sleepiness and recorded participant sleep via polysomnography. From this, their results suggested that the cognitive performance of chronic shift workers was dramatically affected because of circadian misalignment, which can not only pose a safety risk but also may have serious consequences on overall health and wellbeing (Chellapa et al., 2019). 

Through the usage of animal models and human studies to uncover information regarding circadian rhythms, there is much potential in gaining an understanding of the mechanisms controlling circadian rhythms and their implications within various aspects, such as feeding and cognition. The research by Dr. Cavanaugh and Dr. Chellapa suggests that there is much more to be discovered regarding circadian outputs and the effects of disruptions on normal circadian-driven behaviors. Studying circadian rhythms not only aids in understanding the human body but also allows for treatments to be made for jetlag, sleep disorders, obesity, and mental health disorders, and improved methods for adjusting to nighttime shift work.

References 

Chellappa, S. L., Morris, C. J., & Scheer, F. (2019). Effects of circadian misalignment on cognition in chronic shift workers. Scientific reports, 9(1), 699. https://doi.org/10.1038/s41598-018-36762-w 

Dreyer AP, Martin MM, Fulgham CV, Jabr DA, Bai L, et al. (2019) A circadian output center controlling feeding:fasting rhythms in Drosophila. PLOS Genetics 15(11): e1008478. https://doi.org/10.1371/journal.pgen.1008478 

The Effects of Facial Changes on Facial Processing in Infants

Facial expressions and facial features are crucial to recognition and conversation in our day to day lives. Often times, we recall/identify an individual based on their facial characteristics and often times we may not even know their name; however, their face is stored in our brain so vividly. This ability to recognize faces and the mechanisms of facial processing has been studied in adults. Despite these extensive studies in adults, facial processing studies in infants has not been studied intensively. In both “Face-sensitive brain responses in the first year of life” written by Conte et. al and New York Time’s article “How Children Learn to Recognize Faces” by Dr. Perri Klass, researchers further knowledge about the development of face processing in children and the effects of disrupting facial development in infants.

In the article “Face-sensitive brain responses in the first year of life” researchers investigate face processing during infants with 132 infant participants. The main goal of the study is to determine if there is a region in the brain involved with facial processing and if this region is the same as the region of the brain responsible for face and facial processing in adults. Researchers examined ERP (event-related potential) responses of infants when presented stimuli of either an object or a face on the screen. The specific responses examined in this study including N290, P1, P400, and Nc. Through the trials and data collection, it was found that there was a significant N290 peak present for human faces. This means that there was greater N290 amplitude when the infant was presented an image of a human face (whether it be their mother’s face or a stranger’s face) than when presented an image of an object. This N290 response is localized in the middle/posterior fusiform gyri. Comparing infants aged 4.5 months to 12 months, it was discovered that the N290 amplitude increased with age as well. Lastly, researchers suggest that “by the end of the first year of life the N290 likely represents the electrophysiological marker of face-processing in infants” (Conte et al, 2020, p. 16). 

 

In the New York Times article, “How Children Learn to Recognize Faces,” Dr. Klass discusses the two different kinds of visual information used to recognize faces and the effect of disrupting facial development process in children. The two kinds of visual information are feature information and configural information. Young children tend to utilize feature information like “the size of the eyes, the size and shape of the nose, the presence and color of a beard” (Klass). These characteristics change over time, for example, one may shave their beard, which really impacts small children. The child may be depending on the characteristic of the beard on their father to recognize him and this change may put the child in a dilemma of where their father disappeared. As a child ages, however, they begin to utilize configural information which include “the distance between the features and their relations to the contour of the face” (Klass). These characteristics of a human’s face do not really change for which are characteristics that developed adults also use to recognize and remember a face. However, as a young infant, facial processing is often dependent on feature information. So, wearing Halloween costumes, fake accessories, and makeup may confuse the infant. In relation to the COVID-19 pandemic, face masks are a must everywhere we travel. The act of covering up one’s face from an infant may disrupt their facial recognition development. However, for safety of our own and infants, wearing masks is very important and the conflicts can be overcome with exposure with infant at home.

 

Both articles demonstrate the importance and development process of facial recognition in infants. Conte et. al focus on the activation of certain parts of the brain to locate the region responsible for facial recognition and why faces lead to a greater activation that objects. Dr. Klass furthers on the developmental process of facial recognition and focuses on the effects of changing one’s facial appearance in front of an infant still in the developmental process of facial recognition. Both studies depict the importance of facial expression and recognition in an infant’s life which may lead to numerous further studies on this developmental process. 

 

 

Works Cited:

Conte, S., Richards, J. E., Guy, M. W., Xie, W., & Roberts, J. E. (2020). Face-sensitive brain responses in the first year of life. NeuroImage, 211, 1. https://doi.org/10.1016/j.neuroimage.2020.116602 

Klass, P. (2018, October 29). How Children Learn to Recognize Faces. The New York Times. https://www.nytimes.com/2018/10/29/well/family/how-children-learn-to-recognize-faces.html. 

 

Facial Recognition Among Infants during COVID-19

In Conte et. al’s paper, “Face-sensitive brain responses in the first year of life,” they are interested in whether the same areas of the brain are involved with processing faces that are used in the adult stages of life. Even though infants do not have nearly the same mental capacity as adults do, they are still capable of recognizing faces just like adults can. It is known that the N170 ERP is involved with facial processing in adults (Conte et. al, p. 1). In their study they compared ERPs in infants for both faces and objects. They examined infants among four different age categories: 4.5, 6, 8, and 12 months. In their study they looked at four components of the facial processing system: P1, N290, P400 and Nc. Among these components, the face stimuli “selectively influenced the activity of the P1 ERP component by eliciting larger P1 peak responses than objects,” and the N290 had a similar result; however, the P400 and Nc had amplitudes increasing with age but there was no difference between that of objects and faces (Conte et. al, p. 7, 12, 14). So, with this study, one may begin to think about how mask wearing during the COVID-19 pandemic will affect these infants facial recognition capabilities.

The first year of life is a crucial development phase. As discussed in Conte et. al’s paper, infants are showing evidence of facial recognition by the age of three months (p. 2). In a recent article published in the Journal of Neonatal Nursing : JNN, they discuss the potential consequences that could come about from wearing face masks while caring for infants. They say that wearing a face mask “may affect the infant’s ability to develop facial processing and orientating to or focusing on another person’s face” (Green, et. al, p. 24). Infants must depend on others in their lives to take care of them. They should normally be able to “perceive, recognise and distinguish the familiar from the unfamiliar, and people from inanimate objects” as these are key development points in the infant (Green, et. al, p. 23). With the majority of a person’s face being hidden behind a mask, it could be detrimental to an infant’s development regarding facial recognition.

So, it’s not to say that face masks should not be worn around infants, but as mentioned in the neonatal journal there are a few ways to possibly minimize the potential effects of a face mask. Some of which include talking to the baby with the mask on, only wearing the mask when absolutely necessary, and being more expressive with your eyes and eyebrows when interacting with the baby (Green et. al, p. 24). With the ongoing occurrence of the pandemic, it would be interesting to see a future paper published regarding the effect that face masks have on facial recognition in babies. To relate to Conte et. al’s paper, one could possibly study the ERPs of those essential components and compare them to the babies who grew up in a normal environment without the face masks. Furthermore, it would even be fascinating to look at the long term effects these children may have regarding emotional processing or even building relationships with others.

Works Cited

Conte, Stefania, et al. “Face-Sensitive Brain Responses in the First Year of Life.” NeuroImage, Academic Press, 8 Feb. 2020, www.sciencedirect.com/science/article/pii/ S1053811920300896?via%3Dihub.

Green, Janet, et al. “The Implications of Face Masks for Babies and Families during the COVID-19 Pandemic: A Discussion Paper.” Journal of Neonatal Nursing : JNN, Neonatal Nurses Association. Published by Elsevier Ltd., 27 Feb. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC7598570/.

Facial Processing in Infancy

     The ability to detect and process faces is of paramount importance to human survival. Among all other social cues, faces are arguably the most important to humans as they convey critical information about age, sex, identity, and emotion. While the underlying mechanisms of facial processing are well documented in adult research, little is known about how these functions develop in infancy. Furthermore, little is known about the development of these mechanisms under circumstances where face processing is impaired such as in the neurodevelopmental condition, autism spectrum disorder. Research in both of these domains is necessary to provide insight into the underlying mechanisms of facial processing in infancy. 

    In the article, “Face-sensitive brain responses in the first year of life” by Conte et al., the researchers sought to discover the underlying brain regions responsible for facial processing during the first year of age. To do this, they analyzed changes in event-related potential (ERP) responses of infants aged 4.5 to 12 months as they viewed images of faces and objects. The researchers found that certain ERP components such as the P1 and N290 demonstrate specificity for human faces. These components elicited larger responses to faces than objects, and this response was primarily found in the lingual and middle/posterior fusiform gyri. The research findings by Conte et al. are particularly important because they open doors to building greater understandings of circumstances where facial processing is impaired. One significant example of this is in the neurodevelopmental condition, autism spectrum disorder. By comparing ERP responses of neurotypical infants with ERP responses of infants at high risk for developing autism, researchers can begin to find neurological markers for susceptibility to autism. 

    In the article, “Neural and behavioral indices of face processing in siblings of children with autism spectrum disorder (ASD): A longitudinal study from infancy to mid-childhood” by Shephard et al., the researchers investigated the development of facial processing in siblings at high and low familial risk for autism. They compared ERP responses of high and low-risk siblings at 7 months of age and again at 7 years of age. Interestingly, the researchers found that high-risk siblings for ASD demonstrated atypical P1 and N170 responses during facial processing in mid-childhood. Even more shockingly though, they discovered that atypical facial processing (as demonstrated by abnormal N170 amplitudes) and greater social-communication problems in mid-childhood were associated with atypical ERP responses during object processing, and not facial processing, in infancy. These findings suggest that compromised P1 and N170 functioning plays an important role in the development of ASD symptoms and that disruptions in object processing during infancy may influence facial processing and social functioning later in life. 

    Both of these studies look at the neurological mechanisms of facial processing during the developmental period. While Dr. Conte and her teammates studied the underlying mechanisms of facial processing in healthy infants, Dr. Shphard and her teammates studied the underlying mechanisms of facial processing in high and low-risk siblings for ASD. In both studies, the P1 and N170 (or the infant equivalent of N290) ERP components played a significant role in facial processing. As demonstrated in Dr. Shephard’s study, impaired functioning of these components acted as a significant marker for the development of ASD symptoms and diminished social functioning later in life. Taken together, these studies provide insight into the nature of face processing in infancy as well as in the developmental trajectory of face processing in ASD. 

Citations:

Conte, S., Richards, J. E., Guy, M. W., Xie, W., & Roberts, J. E. (2020). Face-sensitive brain responses in the first year of life. NeuroImage, 211, 116602. https://doi.org/10.1016/j.neuroimage.2020.116602 

Shephard, E., Milosavljevic, B., Mason, L., Elsabbagh, M., Tye, C., Gliga, T., ... & Volein, A. (2020). Neural and behavioural indices of face processing in siblings of children with autism spectrum disorder (ASD): A longitudinal study from infancy to mid-childhood. cortex, 127, 162-179.

Can Hysterectomy Be a Permanent Solution for Dysmenorrhea Subtypes?

The article Dysmenorrhea Subtypes Exhibit Differential Quantitative Sensory Assessment Profiles by Hellman et al. (2020) sought out to test the hypothesis if women with dysmenorrhea (DYS), dysmenorrhea with bladder hypersensitivity (DYSB), and bladder pain syndrome (BPS) have reduced level of bodily pain pressure pain threshold (PPT) and impaired conditioned pain modulation (CMP) which might indicate impairment of descending inhibition. In this study, patients experienced both dysmenorrhea and silent bladder pain (DYSB), comparing the results to healthy control groups (Hellman et al., 2020). In this study, the researchers did not conclude a valid solution to how women with severe bladder syndromes and pains can alleviate the pain they experience when they get their periods. The severity of the pain in women is severe; as a result, a new method of combating the challenge may need to be discovered in the long run.

One recent report by The Washington Post indicated that women's only choice at this stage in their life might be to go through a hysterectomy which is not an ideal solution for individuals who desire to have children in their life (Branigin, 2021). Though the only solution to the pain-relieving method of dysmenorrhea subtypes is hysterectomy, according to the report, some women are refused the treatment of hysterectomy based on the age of their healthcare providers. Furthermore, in the report, the women who experienced this reported that they felt motherhood was being pushed by their doctors more than their health (Branigin, 2021). Though doctor's responsibility is to their patient, the recent report and the women who experienced indicate otherwise in which the doctors refuse to perform hysterectomies to prioritize their reproductive health over their health. Counterintuitively, other research has indicated that doctors are more likely to give more hysterectomy to black patients even without the patients asking for it compared to white patients (Branigin, 2021). This could be debated in other cases, but the report shows that there may be race discrimination related to the white and black individuals undergoing hysterectomy.

Despite hysterectomy being the best option in pain relief for patients with dysmenorrhea, there are still some disagreements on its effectiveness from different scientific endometriosis communities. As a result, the surgical excision of a reproductive organ to alleviate one's pain is frowned upon by some doctors (Branigin, 2021). One reason for this is that some doctors still fear that endometriosis pain cannot guarantee that the pain will not show up in other organs after hysterectomy, which can be devastating not only for the doctors but also for the doctors also for the patient who risked their future life. Doctors' uncertainty toward the appearance of endometriosis pain in other organs stems from the fact that as long as a hormone stimulates the growth of the cells, the pain will appear. At this point, doctors in the OB/GYN field cannot identify (Branigin, 2021) precisely. In Hellman et al.'s 2020 research work and talk, this uncertainty and endometriosis pain dispersing in other parts of the female organ also exacerbate patients' pain.

Overall, the finding of this paper indicates the need for much more advanced procedure and treatment that works for all women without having them decide between their reproductive life and their pain management for their severe condition. The report further shows that there needs to be more research on pain dispersing on other organs of the women when and if they decide to undergo hysterectomy for their health. In addition, the report also sheds light on race discrimination in the medical field that needs to be addressed when treating women of all different backgrounds.

References

Branigin, A. B. (2021, April 20). Choosing between not having kids or pain: An endometriosis case is sparking outrage. The Washington Post. https://apple.news/ANE00QtxbRAmIRt8Le3EIWw

Hellman KM, Roth GE, Dillane KE, Garrison EF, Oladosu FA, Clauw DJ, Tu FF. Dysmenorrhea subtypes exhibit differential quantitative sensory assessment profiles. Pain. 2020 Jun;161(6):1227-1236. doi: 10.1097/j.pain.0000000000001826. PMID: 32168005; PMCID: PMC7230023.

Representation of the Diverse Autism Community in Research

The movie Music by Sia was just released in February of this year, and people are livid over its offensive portrayal of autism. The film's depiction of autistic traits comes off as mockery rather than an authentic attempt to do justice to the experiences of a large community of autistic people, and that may be in part due to the fact that no autistic actors were cast in the film. On top of that, the film was largely inaccessible to actually autistic individuals. The flashing lights and other sensory aspects of the film's musical numbers can be highly triggering to autistic people with sensory processing issues and epilepsy. On top of all this, the inclusion of restraint scenes after multiple people called for their omission in the final release, has a devastating impact on communities who have lost loved ones to this dangerous practice. While many people have responded to this film by taking the opportunity to educate themselves on the real experiences of autistic people, it is clear that much of the general public holds misconceptions about autism and how it affects those who have it. 

Unfortunately, misunderstandings about autism go beyond the general public to affect those directly involved with autism research and diagnosis too. Autism is diagnosed by certain criteria, two of which describe persistent deficits in social communication and interaction, as well as restricted, repetitive patterns of behavior, interest, or activities. As a developmental disorder, many are diagnosed as children; however, the social and behavioral aspects of these diagnostic criteria can make it difficult to understand the nuances of autism as it presents in complex social environments. 

Conte et al.'s (2020) research of the development of neural responses to faces in infants has profound implications for the early diagnosis of autism. Using cortical source localization methods in infants at risk for Autism Spectrum Disorder (ASD), the researchers identify neural regions implicated in face processing. Specifically, they found larger  P1 and N290 responses to faces than objects in the lingual and middle/posterior fusiform gyri. The Nc component had a significant difference between responding to faces as to objects,  it was influenced by the infant's attentional state, and it was found to be associated with the medial-anterior brain areas when responding to face stimuli. These results make sense since children with autism may process faces differently from neurotypical children. The team's research is critical to our understanding because it elucidates information about autism that does not rely on the subjective observation of social and behavioral traits. It also provides information that in the future may help with early diagnosis. 

This research is particularly powerful in light of ongoing criticisms of autism diagnosis and research for its lack of understanding of the phenotypic differences in presentation for women and gender diverse autistics. Historically, autism research has been focused on boys, specifically cisgender boys (Goldman, 2013). While many modern researchers understand that autism is not truly a male-dominant condition, aspects of this history have affected our understanding of autism today. Women are often under- or misdiagnosed before receiving a correct autism diagnosis because the criteria do not account for recent understandings of the differences in presentation across sex and gender. Goldman (2013) explains that "the potential effect of gendered social environment on the expression of symptoms may be quite different for a boy and a girl with autism, to the point where, despite the same social deficit, a girl may be perceived as shy and a boy as unresponsive." Other researchers have explained that autistic females may be better at camouflaging or "masking" their social difficulties, which could arise because of sex, gender, and/or socialization differences (Tillmann et al., 2020). This situation presents a sort of Catch-22 wherein more research into autistic women is needed to fully understand their experiences so that we can more accurately diagnose and help other autistic women. At the same time, more autistic women are needed to participate in samples as a part of such research (Tillmann et al., 2020), and the autistic women available for that sample whose presentation does not exactly follow our current understandings of autism may be difficult to achieve precisely because we lack the tools to diagnose them. 

While calls for further research into the so-called "female presentation of autism" are not profoundly new, recent research into the larger category of gender diversity among autistics has further emphasized the need to update our research and clinical conceptions of autism.  Warrier et al. (2020) explain that autistic people show greater diversity in gender and sexual orientation than the general population. Similarly, transgender and gender-diverse individuals are more likely to be autistic than cisgender people. The high prevalence of gender diversity among autistics suggests that there may be even more variability in terms of social and behavioral presentation of autistic traits. Gender diverse autistics need to be more deliberately included in research in order to fully represent the autistic community and our scientific understanding of it. At the same time, clinicians should work to understand presentations of autism that go beyond the typical cisgender male stereotypes so that people can receive the right diagnosis. 

Overall, the diversity of the autism community is not fully represented in research samples aimed at studying autism (Lai et al., 2015). In order to improve this, we need to recruit diverse participants, particularly gender diverse autistics, in our research studies and assist clinicians in diagnosing different presentations of autism. This is important, not only to our understanding of autism but also because a more robust understanding of the diversity among autistics, and a better capability to diagnose with this diversity in mind, will help more individuals receive the diagnoses and support that they need. Autistic people who have yet to receive the correct diagnosis may feel lost or as though something is wrong with them, and they may not have access to the support they need as a result. The significance of this research stands to help the autistic community by empowering more autistics with access to the supports they need and deserve. 

References:

Conte S, Richards JE, Guy MW, Xie W, Roberts JE. Face-sensitive brain responses in the first year of life. Neuroimage. 2020 May;211:116602. DOI:10.1016/j.neuroimage.2020.116602

Goldman S. (2013). Opinion: Sex, Gender and the Diagnosis of Autism - A Biosocial View of the Male Preponderance. Research in autism spectrum disorders, 7(6), 675–679. https://doi.org/10.1016/j.rasd.2013.02.006

Lai MC, Lombardo MV, Auyeung B, Chakrabarti B, Baron-Cohen S. Sex/gender differences and autism: setting the scene for future research. J Am Acad Child Adolesc Psychiatry. 2015 Jan;54(1):11-24. doi: 10.1016/j.jaac.2014.10.003. Epub 2014 Oct 16. PMID: 25524786;PMCID: PMC4284309.

J., Ashwood, K., Absoud, M. et al. Evaluating Sex and Age Differences in ADI-R and ADOS Scores in a Large European Multi-site Sample of Individuals with Autism Spectrum Disorder. J Autism Dev Disord 48, 2490–2505 (2018). https://doi.org/10.1007/s10803-018-3510-4

Warrier V, Greenberg DM, Weir E, Buckingham C, Smith P, Lai MC, Allison C, Baron-Cohen S. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nat Commun. 2020 Aug 7;11(1):3959. doi: 10.1038/s41467-020-17794-1. PMID: 32770077; PMCID:PMC7415151.