Simon Baron-Cohen

Baron-Cohen's work in E-S theory led him to investigate whether higher levels of prenatal testosterone explain the increased rate of autism among males.[11] His prenatal sex steroid theory of autism gained additional support in 2015 and 2019 in finding elevated prenatal androgens and estrogens are associated with autism.[16][17]

In his 2004 book Prenatal Testosterone in Mind (MIT Press), Baron-Cohen put forward the prenatal sex steroid theory of autism.[18] He proposed this theory to understand why autism is more common in males. Using the Cambridge Child Development Project that he established in 1997, a longitudinal study studying children of 600 women who had undergone amniocentesis in pregnancy, he followed these children postnatally. This study demonstrated, for the first time in humans, how normative variation in amniotic prenatal testosterone levels correlates with individual differences in typical postnatal brain and behavioral development. His team discovered that in typical children, amount of eye contact, rate of vocabulary development, quality of social relationships, theory of mind performance, and scores on the empathy quotient are all inversely correlated with prenatal testosterone levels. In contrast, he found that scores on the embedded figures test (of attention to detail), on the systemizing quotient (SQ), measures of narrow interests, and number of autistic traits are positively correlated with prenatal testosterone levels.[19] Within this study his team conducted the first human neuroimaging studies of brain grey matter regional volumes and brain activity associated with prenatal testosterone.[20] Other clues for the theory came from Baron-Cohen's postnatal hormonal studies which found that autistic adults have elevated circulating androgens in serum[21] and that the autistic brain in women is ‘masculinized’ in both grey and white matter brain volume.[22] An independent animal model by Xu et al. (2015, Physiology and Behavior, 138, 13–20) showed that elevated prenatal testosterone during pregnancy leads to reduced social interest in the offspring. Baron-Cohen's group also studied the rate of autism in offspring of mothers with polycystic ovary syndrome (PCOS), a medical condition caused by elevated prenatal testosterone. He found that in women with PCOS, the odds of having a child with autism are significantly increased.[23] This has been replicated in three other countries (Sweden, Finland, and Israel) and is in line with the finding that mothers of autistic children themselves have elevated sex steroid hormones.[24][25] But to really test the theory, Baron-Cohen needed a much larger sample than his Cambridge Child Development Project, since autism only occurs in 1% of the population. So, in 2015, he set up a collaboration with the Danish Biobank which has stored over 20 thousand amniotic fluid samples which he linked to later diagnosis of autism via the Danish Psychiatric Register. He tested the prenatal androgens and found that children later diagnosed as autistic were exposed to elevated levels of prenatal testosterone, and the Δ4 sex steroid precursors to prenatal testosterone.[17] In 2019 he tested the same cohort's levels of exposure to prenatal estrogens and again found these were elevated in pregnancies that resulted in autism.[16] These novel studies provide evidence of the role of prenatal hormones, interacting with genetic predisposition, in the cause of autism.

While a member of the Cognitive Development Unit (CDU) in London in 1985, to explain the social-communication deficits in autism, Baron-Cohen and his colleagues Frith and Alan Leslie formulated the "theory of mind" (ToM) hypothesis. ToM (also known as "cognitive empathy") is the brain's partially innate mechanism for rapidly making sense of social behavior by effortlessly attributing mental states to others, enabling behavioral prediction and social communication skills.[26][27] They confirmed this using the false belief test, showing that a typical four-year-old child can infer another person's belief that is different to their own, while autistic children on average are impaired in this ability.[27] Baron-Cohen's 1995 book Mindblindness summarized his subsequent experiments in ToM and its impairment in autism. He went on to show that children with autism are blind to the mentalistic significance of the eyes and show deficits in advanced ToM, measured by the "reading the mind in the eyes test" (or "eyes test") that he designed.[28] He conducted the first neuroimaging study of ToM in typical and autistic adults, and studied patients demonstrating lesions in the orbito- and medial-prefrontal cortex and amygdala can impair ToM.[29] He also reported the first evidence of atypical amygdala function in autism during ToM.[30] In 2017, his team studied 80K genotyped individuals who took the eyes test. He found Single Nucleotide Polymorphisms (SNPs) partly contribute to individual differences on this dimensional trait measure on which autistic people are impaired.[31] This is evidence that cognitive empathy/ToM is partly heritable. This also illustrates Baron-Cohen's approach to autism genetics that relates autism to individual differences in traits such as empathy and systemizing in the general population.[32] The National Institutes of Health recommended Baron-Cohen's eyes test as a core measure that should be used as part of the Research Domain Criteria (RDOC) for assessing social cognition.

Baron-Cohen developed the Mindreading software for special education,[33] which was nominated for an award from the British Academy of Film and Television Arts (BAFTA) interactive award in 2002.[34] His lab developed The Transporters, an animation series designed to teach children with autism to recognize and understand emotions. The series was also nominated for a BAFTA award.[12][35]

Baron-Cohen has faced criticism by some for his "empathizing-systemizing theory", which states that humans may be classified on the basis of their scores along two dimensions (empathizing and systemizing); and that females tend to score higher on the empathizing dimension and males tend to score higher on the systemizing dimension. Feminist scientists, including Cordelia Fine, neuroscientist Gina Rippon, and Lise Eliot have opposed his extreme male brain theory of autism, calling it "neurotrash" and neurosexism.[36][37][38][39] Rippon also argues against using "male" and "female" for describing different types of brains, and that brain types do not correspond to genders.[37][40] Baron-Cohen has defended the neuroscience of sex differences against charges of neurosexism, arguing that "Fine's neurosexism allegation is the mistaken blurring of science with politics", adding that "You can be a scientist interested in the nature of sex differences while being a clear supporter of equal opportunities and a firm opponent of all forms of discrimination in society."[41]

A book review published in Phenomenology and the Cognitive Sciences characterized The Essential Difference as "very disappointing" with a "superficial notion of intelligence", concluding that Baron-Cohen's major claims about mindblindness and systemizing–empathizing are "at best, dubious".[42] According to Time magazine, his views on systemizing traits had "earned him the ire of some parents of autistic children, who complain that he underestimates their families' suffering".[12] Time said that while research from Washington University in St. Louis did not support the assortative mating theory, a survey finding that autism was twice as high in Eindhoven had "breathed new life" into Baron-Cohen's theory.[12] Time magazine has also criticized the assortative mating theory proposed by Baron-Cohen, claiming that it is largely speculative and based on anecdotal evidence. The theory claims that autism rates are increasing because "systemizers", individuals with more autistic traits, are more likely to marry each other and are more likely to have autistic offspring due to relatively recent societal changes.[43] James McGrath has criticized the autism-spectrum quotient, writing that the score increases if one indicates interest in mathematics, and decreases if one indicates interest in literature or art. He claims that this leads to the false notion that most autistic people are strong in math.[44]

The developers of the software Baron-Cohen used for a 2009 study which reported that autistic individuals possessed superior visual acuity said that his results were impossible based on the technology used in the study. Baron-Cohen's team responded to this criticism by re-running the study and retracting the claim.[45][46][47]

Baron-Cohen's supposition that Isaac Newton and Albert Einstein displayed autistic traits has been met with scepticism by UCSF psychiatrist Glenn Elliot, who writes that attempting to diagnose on the basis of biographical information is extremely unreliable, and that any behavior can have various causes.[48]

Critics also say that because his work has focused on higher-functioning individuals with autism spectrum disorders, it requires independent replication with broader samples[49] and that his theories are based on subjective perceptions.[40] In response to some of these criticisms, Baron-Cohen agrees that many of his results have not been replicated, and says that he remains "open minded about these hypotheses until there are sufficient data to evaluate them". Still, he says he does not see a problem with introducing theories before definitive evidence has been collected.[49]

Furthermore, the mindblindness hypothesis, in addition to being questioned shortly after its publication,[50] has faced criticism from the scientific community,[51][52][53] in response to the many failed replications of classic ToM studies and the growing body of evidence for the heterogeneity of autism.[54] The theory of the double empathy problem and subsequent findings challenge the notion that autistic people exhibit inherent deficits in empathy and argued that difficulties of autistic people in social interactions with non-autistic people are due to differences in social-cognition and experiences between autistic people and non-autistic people, leading to two-way misunderstanding,[55] some aspects of which have been positively acknowledged by Baron-Cohen.[56]

Baron-Cohen's theories about mindblindness are also questioned by academic philosophers, particularly Autistic academic philosophers, in part on the basis that non-Autistic people are as blind to the internal states of Autistic people as Autistic people are to those of non-Autistics. [57] There is also criticism of Baron-Cohen's application of Theory of Mind to Autism on the grounds that he is not behaving scientifically, and that he is doing real harm to Autistic people.[58] Some also say that Baron-Cohen's work is easy to interpret as classifying Autistic people as not fully human. [58][59]

• Mindblindness: An Essay on Autism and Theory of Mind. MIT Press/Bradford Books. 1995. ISBN 978-0-262-02384-9.
• The Essential Difference: Men, Women and the Extreme Male Brain. Penguin/Basic Books. 2003. ISBN 978-0-7139-9671-5.
• Autism and Asperger Syndrome. Facts. Oxford University Press. 2008. ISBN 978-0-19-850490-0.
• Zero Degrees of Empathy: A New Theory of Human Cruelty. Penguin/Allen Lane. 2011. ISBN 978-0-7139-9791-0. (published in the US as The Science of Evil: On Empathy and the Origins of Human Cruelty, ISBN 978-0-465-02353-0)
• The Pattern Seekers: A New Theory of Human Invention. Allen Lane. 2020. ISBN 978-0241242186. (published in the US as The Pattern Seekers: How Autism Drives Human Invention. Basic Books. 2020. ISBN 978-1541647145.)

• Baron-Cohen S, Tager-Flusberg H, Lombardo MV, eds. (2013). Understanding Other Minds: Perspectives From Social Cognitive Neuroscience (3rd ed.). Oxford University Press. ISBN 978-0-19-852446-5.
• Hadwin J, Howlin P, Baron-Cohen S (2008). Teaching Children with Autism to Mindread: A Practical Guide for Teachers and Parents. Wiley. ISBN 978-0-471-97623-3.
• Baron-Cohen S, Lutchmaya S, Knickmeyer R (2005). Prenatal Testosterone in Mind: Amniotic Fluid Studies. MIT Press/Bradford Books. ISBN 978-0-262-26774-8.
• Baron-Cohen S, Wheelwright S (2004). An Exact Mind: An Artist with Asperger Syndrome. Jessica Kingsley. ISBN 978-1-84310-032-4.
• Baron-Cohen S; Tager-Flusberg H; Cohen DJ, eds. (2000). Understanding Other Minds: Perspectives from Developmental Cognitive Neuroscience (2nd ed.). Oxford University Press. ISBN 978-0-19-852445-8.
• Baron-Cohen S, Harrison J, eds. (1997). Synaesthesia: Classic and Contemporary Readings. Blackwells. ISBN 978-0-631-19763-8.
• Baron-Cohen S, ed. (1997). The Maladapted Mind: Classic Readings in Evolutionary Psychopathology. East Sussex, UK: Psychology Press/Taylor Francis Group. ISBN 978-0-86377-460-7.

• Baron-Cohen S, Leslie AM, Frith U (October 1985). "Does the autistic child have a "theory of mind"?". Cognition. 21 (1): 37–46. doi:10.1016/0010-0277(85)90022-8. PMID 2934210. S2CID 14955234.
• Baron-Cohen S, Knickmeyer RC, Belmonte MK (November 2005). "Sex differences in the brain: implications for explaining autism" (PDF). Science. 310 (5749): 819–23. Bibcode:2005Sci...310..819B. doi:10.1126/science.1115455. PMID 16272115. S2CID 44330420.