ORCID Profile
0000-0002-6394-8435
Current Organisations
Macquarie University
,
University of Western Australia
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Publisher: SAGE Publications
Date: 10-06-2023
DOI: 10.1177/13623613231180075
Abstract: Camouflaging (or otherwise referred to as masking or passing) involves hiding one’s autistic-related characteristics and differences to get by in social situations in predominantly non-autistic societies. Very little is known to date about the course of camouflaging motivations and strategies over time or the psychosocial factors that may influence autistic people’s camouflaging choices and trajectories. In an exploratory qualitative study within an Asian sociocultural context, we interviewed 11 Singaporean autistic adults (9 males, 2 females, aged 22–45 years) about their camouflaging experiences to better understand (1) their camouflaging motivations and strategies over time, and (2) related psychosocial influences. Organised across four phases (pre-camouflaging, beginnings, continuity and change over time), 17 themes relating to camouflaging motivations and 8 themes relating to strategies were identified. The earliest camouflaging motivations were predominantly relational, linked to a negative self-identity that had been shaped by adverse social experiences. Camouflaging strategies became increasingly complex and integrated into one’s sense of self over time. Our findings highlight the role of psychosocial pressures precipitating camouflaging and emphasise the need for in idual and societal changes, including moving towards enhanced acceptance and inclusion to reduce psychosocial pressures on autistic people to camouflage. Over their lifetimes, many autistic people learn to camouflage (hide or mask) their autism-related differences to forge relationships, find work and live independently in largely non-autistic societies. Autistic adults have described camouflaging as a ‘lifetime of conditioning . . . to act normal’ involving ‘years of effort’, suggesting that camouflaging develops over an autistic person’s lifetime and may start early on, in childhood or adolescence. Yet, we know very little about why and how autistic people start to camouflage, or why and how their camouflaging behaviours continue or change over time. We interviewed 11 Singaporean autistic adults (9 male, 2 female, 22–45 years old) who shared their camouflaging experiences. We found that autistic adults’ earliest motivations to camouflage were largely related to the desire to fit in and connect with others. They also camouflaged to avoid difficult social experiences (such as being teased or bullied). Autistic adults shared that their camouflaging behaviours became more complex and that, for some, camouflaging became a part of their self-identity over time. Our findings suggest that society should not pathologise autistic differences, but instead accept and include autistic people, to reduce the pressure on autistic people to hide who they truly are.
Publisher: Springer Science and Business Media LLC
Date: 26-08-2021
Publisher: Springer Science and Business Media LLC
Date: 16-01-2020
DOI: 10.1038/S41398-020-0695-Z
Abstract: Autism spectrum disorder is a heritable neurodevelopmental condition diagnosed based on social and communication differences. There is strong evidence that cognitive and behavioural changes associated with clinical autism aggregate with biological relatives but in milder form, commonly referred to as the ‘broad autism phenotype’. The present study builds on our previous findings of increased facial masculinity in autistic children (Sci. Rep., 7:9348, 2017) by examining whether facial masculinity represents as a broad autism phenotype in 55 non-autistic siblings (25 girls) of autistic children. Using 3D facial photogrammetry and age-matched control groups of children without a family history of ASD, we found that facial features of male siblings were more masculine than those of male controls ( n = 69 p 0.001, d = 0.81 [0.36, 1.26]). Facial features of female siblings were also more masculine than the features of female controls ( n = 60 p = 0.005, d = 0.63 [0.16, 1.10]). Overall, we demonstrated for males and females that facial masculinity in non-autistic siblings is increased compared to same-sex comparison groups. These data provide the first evidence for a broad autism phenotype expressed in a physical characteristic, which has wider implications for our understanding of the interplay between physical and cognitive development in humans.
Publisher: Springer Science and Business Media LLC
Date: 15-04-2015
Publisher: ACM
Date: 08-03-2021
Publisher: ISCA
Date: 25-10-2020
Publisher: The Royal Society
Date: 07-10-2015
Abstract: Prenatal testosterone may have a powerful masculinizing effect on postnatal physical characteristics. However, no study has directly tested this hypothesis. Here, we report a 20-year follow-up study that measured testosterone concentrations from the umbilical cord blood of 97 male and 86 female newborns, and procured three-dimensional facial images on these participants in adulthood (range: 21–24 years). Twenty-three Euclidean and geodesic distances were measured from the facial images and an algorithm identified a set of six distances that most effectively distinguished adult males from females. From these distances, a ‘gender score’ was calculated for each face, indicating the degree of masculinity or femininity. Higher cord testosterone levels were associated with masculinized facial features when males and females were analysed together ( n = 183 r = −0.59), as well as when males ( n = 86 r = −0.55) and females ( n = 97 r = −0.48) were examined separately ( p -values 0.001). The relationships remained significant and substantial after adjusting for potentially confounding variables. Adult circulating testosterone concentrations were available for males but showed no statistically significant relationship with gendered facial morphology ( n = 85, r = 0.01, p = 0.93). This study provides the first direct evidence of a link between prenatal testosterone exposure and human facial structure.
Publisher: The Royal Society
Date: 23-03-2022
Abstract: The broad autism phenotype commonly refers to sub-clinical levels of autistic-like behaviour and cognition presented in biological relatives of autistic people. In a recent study, we reported findings suggesting that the broad autism phenotype may also be expressed in facial morphology, specifically increased facial masculinity. Increased facial masculinity has been reported among autistic children, as well as their non-autistic siblings. The present study builds on our previous findings by investigating the presence of increased facial masculinity among non-autistic parents of autistic children. Using a previously established method, a ‘facial masculinity score’ and several facial distances were calculated for each three-dimensional facial image of 192 parents of autistic children (58 males, 134 females) and 163 age-matched parents of non-autistic children (50 males, 113 females). While controlling for facial area and age, significantly higher masculinity scores and larger (more masculine) facial distances were observed in parents of autistic children relative to the comparison group, with effect sizes ranging from small to medium (0.16 ≤ d ≤ .41), regardless of sex. These findings add to an accumulating evidence base that the broad autism phenotype is expressed in physical characteristics and suggest that both maternal and paternal pathways are implicated in masculinized facial morphology.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Center for Open Science
Date: 12-04-2023
Abstract: Camouflaging involves hiding one’s autistic characteristics in social situations and is associated with poorer mental health in autistic people. Various psychosocial factors are likely implicated in camouflaging and its impact on well-being. This mixed methods systematic review aimed to synthesize qualitative and quantitative research on psychosocial factors associated with camouflaging and its relationship with mental well-being in autistic and non-autistic people. Six electronic databases were searched. Following a convergent integrated approach, quantitative data were transformed and synthesized with qualitative data to perform thematic synthesis. Fifty-eight studies (40 qualitative, 13 quantitative, and five mixed methods) were included. We identified three themes on psychosocial correlates of camouflaging: (1) social norms and pressures of a largely non-autistic world, (2) social acceptance and rejection, and (3) self-esteem and identity and four themes on psychosocial consequences of camouflaging for mental well-being: (1) a pragmatic way of exerting in idual agency and control (2) overlooked, under-supported, and burnt out (3) impact on social relationships and (4) low self-esteem and identity confusion. Camouflaging is a largely socially driven response associated with negative psychological and social consequences. A whole society approach is needed to promote a culture of acceptance and support autistic in iduals to express their authentically autistic selves.
Publisher: Elsevier BV
Date: 11-2023
Publisher: MIT Press - Journals
Date: 2022
DOI: 10.1162/LEON_A_02099
Abstract: Theory of Mind (ToM)—a social cognitive ability commonly underdeveloped in in iduals with autism—is necessary to attribute mental states to oneself and others. Research into robot-assisted interventions to improve ToM ability in children with autism has become increasingly popular. However, no appropriate task currently exists to measure the degree of efficacy of robot-assisted interventions targeting ToM ability. The authors demonstrate how animation techniques and principles can be leveraged to develop and produce videos of humanoid robots interacting, which could selectively measure ToM.
Publisher: Wiley
Date: 16-09-2021
DOI: 10.1002/AUR.2612
Abstract: Greater facial asymmetry has been consistently found in children with autism spectrum disorder (ASD) relative to children without ASD. There is substantial evidence that both facial structure and the recurrence of ASD diagnosis are highly heritable within a nuclear family. Furthermore, sub‐clinical levels of autistic‐like behavioural characteristics have also been reported in first‐degree relatives of in iduals with ASD, commonly known as the ‘broad autism phenotype’. Therefore, the aim of the current study was to examine whether a broad autism phenotype expresses as facial asymmetry among 192 biological parents of autistic in iduals (134 mothers) compared to those of 163 age‐matched adults without a family history of ASD (113 females). Using dense surface‐modelling techniques on three dimensional facial images, we found evidence for greater facial asymmetry in parents of autistic in iduals compared to age‐matched adults in the comparison group ( p = 0.046, d = 0.21 [0.002, 0.42]). Considering previous findings and the current results, we conclude that facial asymmetry expressed in the facial morphology of autistic children may be related to heritability factors. In a previous study, we showed that autistic children presented with greater facial asymmetry than non‐autistic children. In the current study, we examined the amount of facial asymmetry shown on three‐dimensional facial images of 192 parents of autistic children compared to a control group consisting of 163 similarly aged adults with no known history of autism. Although parents did show greater levels of facial asymmetry than those in the control group, this effect is statistically small. We concluded that the facial asymmetry previously found in autistic children may be related to genetic factors.
Publisher: Public Library of Science (PLoS)
Date: 14-06-2018
Publisher: Wiley
Date: 17-08-2017
DOI: 10.1002/AUR.1824
Abstract: Atypical facial characteristics have been observed in many disorders associated with developmental disability. While autism spectrum conditions (ASC) have not previously been thought to be associated with a distinct facial phenotype, an emerging research literature is casting doubt on this assumption. The identification of differences in the facial phenotype of in iduals with ASC may contribute to efforts to promote early identification of the condition and help elucidate etiological pathways. With the aim of identifying facial phenotypes associated with ASC, this commentary evaluated facial features purported to distinguish ASC from typical development. Although there is little consensus across the reviewed studies for the majority of facial characteristics described, preliminary evidence suggests increased facial asymmetry may be more common in ASC. There is also evidence to suggest that there are morphologically distinct subgroups within ASC that correspond with different cognitive and behavioral symptomatology. However, in light of the various inconsistencies in the reported literature, and based on an accumulating understanding of etiological pathways proposed to be associated with ASC, we propose an alternative paradigm for investigating facial phenotypes in ASC. A series of studies are outlined to demonstrate the promise of a research program that has taken a hypothesis-driven approach to examine facial phenotypes associated with increased exposure to prenatal testosterone and to ASC. Autism Res 2017, 10: 1910-1918. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. This commentary reviewed studies that found differences in the facial features of in iduals with autism spectrum conditions (ASC) compared to typically developing in iduals. While there is little agreement between studies, there is some support for asymmetrical facial features associated with ASC, and preliminary evidence that particular facial features relate to specific patterns of cognitive and behavioral symptoms. However, in light of inconsistencies between studies and based on accumulating understanding of etiological pathways, we propose an alternative approach to investigating facial differences in ASC.
Publisher: Wiley
Date: 05-12-2020
DOI: 10.1111/BJOP.12436
Abstract: Reports linking prenatal testosterone exposure to autistic traits and to a masculinized face structure have motivated research investigating whether autism is associated with facial masculinization. This association has been reported with greater consistency for females than for males, in studies comparing groups with high and low levels of autistic traits. In the present study, we conducted two experiments to examine facial masculinity/femininity in 151 neurotypical adults selected for either low, mid-range, or high levels of autistic traits. In the first experiment, their three-dimensional facial photographs were subjectively rated by 41 raters for masculinity/femininity and were objectively analysed. In the second experiment, we generated 6-face composite images, which were rated by another 36 raters. Across both experiments, findings were consistent for ratings of photographs and composite images. For females, a linear relationship was observed where femininity ratings decreased as a function of higher levels of autistic traits. For males, we found a U-shaped function where males with mid-range levels of traits were rated lowest on masculinity. Objective facial analyses revealed that higher levels of autistic traits were associated with less feminine facial structures in females and less masculine structures in males. These results suggest sex-specific relationships between autistic traits and facial masculinity/femininity.
Publisher: Center for Open Science
Date: 16-12-2021
Abstract: Many autistic people develop camouflaging strategies to mask or compensate for their underlying autism-related differences in order to get by in predominantly non-autistic societies. Autistic adults have described camouflaging as a “lifetime of conditioning to act normal”, suggesting that camouflaging develops over the autistic person’s lifespan. Yet, very little is so far known about the course of camouflaging motivations and behaviours over time or the psychosocial factors that may influence autistic people’s camouflaging trajectories. In an exploratory qualitative study within an Asian sociocultural context, we interviewed 11 Singaporean autistic adults in depth about their camouflaging experiences throughout their lives. We aimed to better understand the beginnings, continuity and changes in their camouflaging motivations and strategies over time, and related psychosocial influences. Interviews were transcribed verbatim and thematically analysed. Twenty-six themes were identified, and were organised across four phases - pre-camouflaging, beginnings, continuity, and change over time. The earliest camouflaging motivations were predominantly relational, linked to a negative self-identity shaped by adverse social experiences. Strategies were increasingly complex and better integrated into one’s sense of self over time, or more selectively engaged in. Our findings highlight the role of psychosocial pressures precipitating camouflaging. They also emphasise the need for both in idual psychological and societal-level changes to move from pathologizing autistic differences to acceptance, understanding, and inclusion, so as to reduce psychosocial pressures on autistic people of all ages to camouflage.
Publisher: Public Library of Science (PLoS)
Date: 17-07-2015
Publisher: Elsevier BV
Date: 02-2023
Publisher: Springer Science and Business Media LLC
Date: 24-08-2017
DOI: 10.1038/S41598-017-09939-Y
Abstract: Elevated prenatal testosterone exposure has been associated with Autism Spectrum Disorder (ASD) and facial masculinity. By employing three-dimensional (3D) photogrammetry, the current study investigated whether prepubescent boys and girls with ASD present increased facial masculinity compared to typically-developing controls. There were two phases to this research. 3D facial images were obtained from a normative s le of 48 boys and 53 girls (3.01–12.44 years old) to determine typical facial masculinity/femininity. The sexually dimorphic features were used to create a continuous ‘gender score’, indexing degree of facial masculinity. Gender scores based on 3D facial images were then compared for 54 autistic and 54 control boys (3.01–12.52 years old), and also for 20 autistic and 60 control girls (4.24–11.78 years). For each sex, increased facial masculinity was observed in the ASD group relative to control group. Further analyses revealed that increased facial masculinity in the ASD group correlated with more social-communication difficulties based on the Social Affect score derived from the Autism Diagnostic Observation Scale-Generic (ADOS-G). There was no association between facial masculinity and the derived Restricted and Repetitive Behaviours score. This is the first study demonstrating facial hypermasculinisation in ASD and its relationship to social-communication difficulties in prepubescent children.
Publisher: Center for Open Science
Date: 05-07-2019
Abstract: Alcohol exposure during pregnancy has been associated with altered brain development and facial dysmorphology. While autism spectrum disorder (ASD) is not specifically related to distinct facial phenotypes, recent studies have suggested certain facial characteristics—increased facial masculinity and asymmetry—may be associated with ASD and its clinical presentations. In the present study, we conducted a preliminary investigation to examine the effects of prenatal alcohol exposure on facial morphology in autistic children with (n = 37 mean age = 8.21 years, SD = 2.72) and without (n = 100 mean age = 8.37 years, SD = 2.47) prenatal alcohol exposure. Using three-dimensional facial scans and principal component analysis, we identified a facial shape associated with prenatal alcohol exposure in autistic children. However, variations in the alcohol-related facial shape were generally not associated with behavioural and cognitive measures. These findings suggest that while early exposure to alcohol may influence the development of facial structures, it is does not appear to be associated with ASD phenotypic variability. Importantly, although these findings do not implicate a role for prenatal alcohol exposure in the etiology of ASD, further research is warranted to investigate the link between prenatal alcohol exposure and facial morphology differences among neurodevelopmental conditions.
Publisher: Informa UK Limited
Date: 06-08-2022
Publisher: Wiley
Date: 21-06-2019
DOI: 10.1002/AUR.2161
Abstract: A key research priority in the study of autism spectrum conditions (ASC) is the discovery of biological markers that may help to identify and elucidate etiologically distinct subgroups. One physical marker that has received increasing research attention is facial structure. Although there remains little consensus in the field, findings relating to greater facial asymmetry (FA) in ASC exhibit some consistency. As there is growing recognition of the importance of replicatory studies in ASC research, the aim of this study was to investigate the replicability of increased FA in autistic children compared to nonautistic peers. Using three-dimensional photogrammetry, this study examined FA in 84 autistic children, 110 typically developing children with no family history of the condition, and 49 full siblings of autistic children. In support of previous literature, significantly greater depth-wise FA was identified in autistic children relative to the two comparison groups. As a further investigation, increased lateral FA in autistic children was found to be associated with greater severity of ASC symptoms on the Autism Diagnostic Observation Schedule, second edition, specifically related to repetitive and restrictive behaviors. These outcomes provide an important and independent replication of increased FA in ASC, as well as a novel contribution to the field. Having confirmed the direction and areas of increased FA in ASC, these findings could motivate a search for potential underlying brain dysmorphogenesis. Autism Res 2019, 12: 1774-1783. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study looked at the amount of facial asymmetry (FA) in autistic children compared to typically developing children and children who have siblings with autism. The study found that autistic children, compared to the other two groups, had greater FA, and that increased FA was related to greater severity of autistic symptoms. The face and brain grow together during the earliest stages of development, and so findings of facial differences in autism might inform future studies of early brain differences associated with the condition.
Publisher: Mary Ann Liebert Inc
Date: 09-2023
Publisher: Wiley
Date: 08-11-2020
DOI: 10.1111/JCPP.13349
Abstract: Birth order effects have been linked to variability in intelligence, educational attainment and sexual orientation. First‐ and later‐born children have been linked to an increased likelihood of an Autism Spectrum Disorder (ASD) diagnosis, with a smaller body of evidence implicating decreases in cognitive functioning with increased birth order. The present study investigated the potential association between birth order and ASD diagnostic phenotypes in a large and representative population s le. Data were obtained from an ongoing prospective diagnostic registry, collected between 1999 and 2017, including children (1–18 years of age, n = 5,404) diagnosed with ASD in the state of Western Australia. Children with ASD were ranked relative to sibling’s birth to establish birth order within families at time of ASD diagnosis. Information reported to the registry by health professionals at the time of diagnostic evaluation included demographic and family characteristics, functional abilities and intellectual capacity. Adaptive functioning and intelligence scores decreased with increasing birth order, with later‐born children more likely to have an intellectual disability. Compared to first‐born children with siblings, first‐born children without siblings at the time of diagnosis also exhibited decreased cognitive functioning. These findings demonstrate for the first time an association between increasing birth order and variability in ASD clinical phenotypes at diagnosis, with potential evidence of reproductive curtailment in children without siblings. Taken together, these findings have significant implications for advancing understanding about the potential mechanisms that contribute to heterogeneity in ASD clinical presentations as a function of birth order and family size.
No related grants have been discovered for Diana Tan.