Save Money with Generic Epinephrine


Have you seen the price of EpiPens lately? They are between $600-$700 for a two-pack. If you have high deductible insurance or high co-pays, you will be paying a large part of this cost. Here are some strategies you can use to find cheaper auto-injectors.

Buy Generic

Generics cost between $150-$450, and often have a lower co-pay. The generic epinephrine auto-injectors contain the same medication in a slightly different device. They are available in both 0.15 mg and 0.30 mg dosages, just like EpiPens. Pharmacies often do not tell customers about the generic option because they do not consider it equivalent based on differences in the device, but the generic auto-injector has a tried and true delivery system used by brands such as Adrenaclick and TwinJect. Generic auto-injectors are also smaller and lighter weight than EpiPen brand auto-injectors.


Here’s how to get generic epinephrine auto-injectors:

1. Check with your insurance to make sure that “epinephrine injection, USP” is covered and find out what your cost will be. You may save a significant amount! Also find out how many you can buy at once and how often you can refill your prescription.

2. Call around to pharmacies in your area and find out if they carry the generic epinephrine auto-injectors. If a pharmacy doesn’t carry them, they may be able to order some for you. Compare prices between pharmacies. Try using

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3. Get a prescription from your doctor that is specifically for generic epinephrine auto-injectors. Make sure you are not getting a prescription for EpiPen! Many doctors are not aware that generic epinephrine auto-injectors are available since these are not aggressively marketed like EpiPens.

4. Use $0 co-pay coupons.

5. Make sure you are getting a device that does not expire in less than 12 months. Before you leave the pharmacy counter, check the expiration dates on your devices. Epinephrine auto-injectors should last about a year (unless you use them.) You should not have to buy new ones before that.

6. If this is your first time using the generic auto-injectors, order a free training device and watch the training video on the website.

I hope this helps! Please share more tips in the comments.

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Hostility Toward Gifted Children

Bullying has been in the news lately, so I’ve decided to share my family’s experience with bullying in 2007.  Here’s  a little background on the situation:

Our son M is highly gifted.  He had been attending Kindercare since he was two-and-a-half. During the 2006-2007 school year, he began the year in the PreK classroom. After Winter break, the school decided to eliminate the PreK class, and place those students together with the three and four-year-olds.  The director decided to place M (who had been reading and doing basic arithmetic since before he was three) in the Kindergarten class instead. M had turned four just a few months before he was accelerated to Kindergarten.

M seemed to be doing fine in the Kindergarten class which he attended every morning for three hours.  Keep in mind that Kindergarten is not required in California, and there were no “graduation requirements” to be met in this class. Even if there had been, M would have met them. We paid for him to be in that class, and he did the work he was given in that class.  He participated with the rest of the kindergarteners learning a song for their end-of-year party and graduation. The teacher ordered cute little caps and gowns for the kids to wear for their ceremony, and M was excited to wear his.


About a week before the party, I found this note in M’s cubby (names have been changed to protect the kids.)

Dear “M’s Parents”,

My name is Jack Hill. I’m Greg Hill’s father. I’m not sure if you know Greg. I know I’ve never met M.

Greg and Karl have been attending Kindercare since 2001, starting as babies just after the school opened. They’ve been here longer than any Kindercare employee. Brian and Nate started just a year or so later.

This Friday marks a completion for them—for Greg and Karl more so than the others. Greg and Karl will be the first children to complete a full course at this school. As tradition dictates, we mark that completion with a ceremony, including ceremonial garb and a certificate.

We do that to indicate and savor the accomplishment. We give the children a sense of achievement to carry with them in their new beginning as First Graders. We in turn are rewarded with a pride different from all the other feelings of pride we’ve felt for our child. This completion marks the beginning of our pride in watching our child become an adult.

My son tells me M will participate in the ceremony, but will not really graduate because he’s really just visiting Kindergarten. He wonders if that is right—and so do I.

Several of the kindergarten parents have asked themselves and each other the same question.

The children know that M is not really in their class. They know he won’t really be in kindergarten until next year. They know he hasn’t accomplished everything that they have. They know that when he participates in their graduation it will be pretend.

I would like you to know that your charade trivializes not only my child’s accomplishment or the other kindergartener’s, but yours as well—next year, when the accomplishment will be real. I began this letter with the intent to threaten and coerce you into doing what I think is right, but now I realize that perhaps you just didn’t know there’s really more to this ceremony than just dressing up. Perhaps you didn’t know that it had meaning for all of us.

I respectfully ask you to consider what this moment really means to you and your son. I ask you to weigh that value against tainting our children’s graduation.

I ask you simply to understand that you will be demonstrating reward for cheating to the entire 2007 kindergarten class by having your child participate in this graduation ceremony without basis.

I am asking you not to do that.


Jack Hill

Now you might say that the author of this letter is obviously crazy, and should simply be ignored. However, I was concerned by the “threaten and coerce” line.  The idea that another parent (whom I had never met!) could harbor so much hostility toward my family was frightening.  My husband and I brought the letter to the director of the school who said she would talk to this parent.  Unfortunately, after talking to him she was so intimidated that she asked us not to attend the party!  We were frightened enough that we decided it wasn’t worth it to insist.  Four years later, I still feel a twinge of fear when I encounter the families named in the letter in the community.

School administrators need to be aware of hostility toward gifted students, and stand up to parents who bully other families.

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Social Consequences of Food Allergy

recent study published in Pediatrics reported that over 30% of children with food allergies say they have been bullied about their allergies.  Previous studies have also found that having a food allergy puts a child at risk for bullying.  I’d like to share my experience with raising two children with food allergies and examine why bullying is such a problem for this group.

Food sharing is one of the most basic social constants in human culture.  We use food as our social glue.  When a group shares food, we are saying we are a family, a team, a tribe.  Many cultural traditions and religious rituals involve the sharing of food.  We use it both as an offering and as a way of increasing our status within the group.  We use it as a way of connecting with one another.1  So what are the consequences when an individual cannot participate in these most basic of social interactions?  Asking this question can help us understand the social stigma of food allergies.

I have two children with anaphylactic food allergies who experienced this stigma during the time they were in public school.  When I was new to the world of food allergies, I didn’t understand why many people seemed so resistant to accommodating the needs of my children.  Why did they feel so angry about restrictions placed on bringing treats to class for holidays and birthdays?  To me, it seemed obvious that a child’s safety should be placed above custom, and yet there were a few parents and teachers who intentionally circumvented the rules, and others who obeyed, but grudgingly.  I learned that they viewed the safety rules as arbitrary barriers preventing them and their children from participating in the food sharing traditions they felt were vital for their own and their children’s social connections and standing.2

Now let’s look at the same situation from the perspective of a child with food allergies.  Whenever cupcakes were brought to class, my son was not able to eat one.  Yes, we did provide him with some other treat, but the deeper message was that he could not share what the others were eating, and was not part of the group.  Every event based on food sharing was a reminder of his separateness.  It was also a reminder that the adults in charge did not think he was important enough to be included.

An example of the kind of food sharing interaction we all take for granted:
A parent comes to the class bringing cupcakes.  Each student is offered a cupcake and enjoys the sweet treat.  The students’ trust and liking for this parent is increased.  The birthday student is a celebrity for a day, and when the other kids have their birthdays, they ask their parents to bring cupcakes.

What happens when there is a student with a food allergy in the class:
A parent brings cupcakes to class.  My son is offered a cupcake, but he must say, “No thank you, I have food allergies.”  He is allergic to egg, and these cupcakes almost certainly contain egg.  This is the first moment where the food sharing ritual breaks down.  The food allergic person is forced to refuse the offer of food.  In many cultures, refusing an offer of food is considered rude.  Even though he gives the reason (food allergies) this is often not accepted.  People become defensive, and don’t believe that the allergy is real or serious.  They offer objections: Their friend’s child is allergic to egg but can tolerate baked goods, so this cupcake is okay.   A little bit won’t hurt.  They are pretty sure the item doesn’t contain eggs, and so on. To them, his rejection of the food feels like a rejection of the person offering it.

Children with food allergies are put in the difficult social position of having to stand up to adults who are determined to give them unsafe food.  My son tries to mollify them by saying, “It’s okay, I have my own treat.”  Or he will take it and “save it for later,” but trying to avoid the stigma of the food allergy by saying that he is not hungry is not very effective because this is also seen as a rejection of the person offering the food.  Eating his own treat does not serve the same symbolic social function as sharing what everyone else is eating.  In fact, it carries the opposite meaning: he is separate, and not part of the group.  Having to refuse the offered food sends the message, “I don’t trust you, and I don’t want to be part of your group.”

Even if the food allergic student’s parents try to compensate by bringing safe food to share with the whole group, the inability to reciprocate by accepting food from others creates stigma.  When the parent of a food allergic child overcompensates by bringing multiple offers of food to the group, that is often met with resentment from the other parents who feel they are not given equal opportunities to share.  This is a no-win situation, and the resentment of the group is expressed as ostracism of the allergic child and his family.

Many times, excluding the allergic child is rationalized:

  • He needs to get used to being left out because food allergies are a fact of his life.
  • Kids shouldn’t feel entitled to special treatment; the world isn’t going to change for them.
  • She’s used to being left out; it doesn’t bother her.
  • This child’s parents are overprotective; this level of caution is unnecessary.
  • Other people with food allergies can eat this, so this should be good enough for her, too.

The reality is that kids with food allergies get plenty of practice at being excluded.  Far from feeling entitled to special treatment, they internalize the message that their food allergies are a burden to others.  Children with food allergies do not take inclusion for granted.  This is especially true for children with multiple food allergies, or who are highly sensitive to the allergens.  They are at the greatest risk for stigmatization because the necessary precautions seem unusual to people.  In addition, there are many people with food allergies who are not aware of best practices for food allergy management 3, and their casual approach to the risks involved is seen as more socially acceptable.

Modeling exclusion

My daughter’s teacher once decided to bring candy to the class for Easter.  Since it was a last minute decision, the teacher didn’t take the time to ask me which candy was safe for my daughter who is allergic to peanuts.  She gave the candy to all the children, including my daughter who tried to refuse it.  When my daughter wouldn’t eat the candy, she was told she could eat a leftover part of her sandwich from her lunchbox while her classmates enjoyed the candy.  My daughter was six years old.

When adults exclude the child with food allergies, they are modeling exclusion for everyone.  They are sending a message to all the kids that it is okay to exclude the allergic child, and a message to the allergic child that they are not worth including.  Many kids with food allergies are bullied at school because of this social stigma.4  Allergic children deserve to feel safe and that their well-being is important to the adults in charge.  They deserve to have their basic needs for safety and inclusion met.

Take a moment to look at this diagram.  If it looks familiar, that is probably because it is based on Abraham Maslow’s Hierarchy of Needs 5.  Notice that the need to belong is part of the base of the pyramid.  We are all social beings, and belonging is a basic, human need.  The power of that need is probably greatest in adolescence 6, and that is reflected in the fact that teens are at a greater risk of dying from their food allergies than younger children.  Years of social stigma take their toll, and teens may place a higher priority on inclusion than safety.  And in the school context, when kids’ basic needs are not being met, their ability to learn is compromised.

If we can bring awareness to these very human reactions, we can choose to respond differently.  We can choose to include kids with food allergies.  This is going to require effort because accommodating food allergies means conscientiously checking ingredient labels and carefully cleaning cooking utensils and surfaces.  It means talking to the child’s parents to find out what is safe.  It means accepting that those parents may not feel comfortable trusting their child’s life to home baked cupcakes, and choosing to center a party around non-food activities instead.  It means remembering that families with food allergies live with those inconveniences every day.  Most kids take being included for granted.  Imagine what it means to a child with food allergies.

What can you do?

As a parent of a child with food allergies you can:
Advocate for inclusion at school, and help raise awareness
Mitigate some of the exclusion by volunteering to share safe food
Support your child’s self-advocacy efforts

As a teacher you can:
Choose to use non-food items for class projects, manipulatives, and incentives
Promote celebrations that focus on activities rather than food
Support the self-advocacy of children with food allergies

As a parent of a child without food allergies you can:
Choose to send non-food treats for holidays and birthdays
Make an effort to include the allergic child in social events outside of school
Model compassion for kids with food allergies to your own children


1. Stevens JR, Gilby IC.  A conceptual framework for nonkin food sharing: timing and currency of benefits. Animal Behavior. 2004;67:603-614.

2. Fehr E, Fischbacher U, Gächter S.  Strong reciprocity, human cooperation and the enforcement of social norms.  Human Nature. 2002;13:1-25.

3. Sicherer SH, Mahr T, et al. Clinical report: Management of food allergy in the school setting.  Pediatrics. Published online Nov 29, 2010. Available at

4. Pitchforth E, Weaver S, Willars J, Wawrzkowicz E, Luyt D, Dixon-Woods M. A qualitative study of families of a child with a nut allergy.  Chronic Illness. Published online Aug 16, 2011.  Available at

5. Maslow AH. A theory of human motivation. Psychological Review. 1943;50:370-396.

6. Resnick ES, Pieretti MM, Maloney J, Noone S, Muñoz-Furlong A, Sicherer S. Development of a questionnaire to measure quality of life in adolescents with food allergy: the FAQL-teen. Annals of Allergy, Asthma & Immunology. 2010;105(5):364-368.

This post originally appeared in The Creativity Post.

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I was interviewed by Dan Peters for his Psychology Today blog

I decided to consolidate various blog posts here on Microscopes are Prudent, and I’d like to include a link to this blog post by Dr. Daniel Peters of Summit Center. Dr. Peters interviewed me on his From Worrier to Warrior blog in April for Autism Awareness Month about anxiety and autism.

A First-Person Perspective on Anxiety and Autism


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What is IQ?

Sandeep Gautam wrote in “Why IQ is a Myth”:“To me, to be frank a score of 162 or whatever on a test means nothing, and I hardly care if the test is Cattels , WISC or stanford-binet. When a lay person sees a score of 100 or 160 he assumes that a) intelligence can be fully measured and quantified and b) IQ is that measure.”

It is very true that IQ scores divorced from their context are pretty meaningless. It’s like saying, “Forty-two is The Answer to the Ultimate Question of Life, the Universe, and Everything” [Douglas Adams, The Hitchhiker’s Guide to the Galaxy] Forty-two what? What was the question?

We can list a lot of things that an IQ score isn’t:

  • It isn’t The Answer to the Ultimate Question about a person.
  • It isn’t an immutable number carved on your brain.
  • It isn’t able to measure the full range of a person’s abilities.
  • It isn’t a measure of someone’s worth.
  • It isn’t a map of someone’s destiny.
  • It isn’t a limit (or an expectation!) placed on a person’s potential.

But instead of underestimating the “lay person”, perhaps we should attempt to explain what an IQ score is. It is information about how a person performed certain tasks, under certain conditions, on a particular day. A full-scale IQ score makes sense only when we understand it in its full context, including: the type of test, its standard deviation, its ceilings, its error ranges, the other composite scores, and the subtest scores. A good tester also makes behavioral observations about how the person approaches problems and emotional factors that may have affected the results. To interpret the subtest scores, we need to understand the specific cognitive abilities being drawn upon by those tasks. A full-scale score is only the broadest summary of someone’s performance ranked as a comparison to the scores of others in the same age group. It gives none of the details about strengths or weaknesses.A typical full-scale IQ score (such as given by the Wechsler tests), is called a standard score. This score corresponds to a percentile ranking of the sum of the scaled scores of selected individual subtests, which are themselves rankings of the raw scores for each task normed for each age group. It is essentially a measure of “unusualness”. The more unusual subtest scores someone has, the more that will be reflected in the sum, resulting in a more unusual full-scale score. The logic of this process can be confounded in situations where a person’s scores in one area are unusually low and unusually high in another, giving the appearance of an average sum. This is why we need to look at the other composite scores (for example, Verbal or Working Memory) and the subtest scores in order to interpret the full-scale score.

An unusually high score, like Neha Ramu’s, is possible only when all or nearly all of the subtest scores are unusually high. What does this tell us about a person? It means that in comparison to others her age, she excels in skills that are predictive of academic success, which is what most IQ tests have been designed to measure.In its various incarnations, IQ has been linked to certain personal characteristics and learning outcomes—I’m not going to summarize those volumes of research here. The important thing to remember when reading about such research is that statistical correlations can tell you only about the likelihood of a given outcome. They cannot be applied to individuals. We cannot know ahead of time whether a person is part of the majority who will experience a given outcome or the minority who will not. The fact that there is such a minority does not invalidate the research, just as the fact that IQ scores may be misunderstood by some does not mean they are useless or absurd.

No psychologist trained to administer IQ tests would claim that intelligence can be fully quantified by IQ. I completely agree that it is sloppy journalism to report Neha’s score as evidence that she is smarter than Albert Einstein, and equally sloppy to compare her score to an estimate (Einstein never took the test Neha took). But instead of dismissing IQ tests as nonsense, let’s set the record straight.

This post originally appeared on Undiscovered Gold.

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DSM 5: Diagnosis Should Describe, Not Pathologize

I’ve been thinking about Dan Peters’s post about pathologizing the human condition. I understand and share his concerns about the influence of health insurance requirements on how people are diagnosed and how they can get help, but I think that’s actually a separate problem from the question of “should we diagnose”. If people had freer access to health care in general, and mental health care in particular, there would be less pressure to diagnose for the sake of having access to a reimbursable treatment.

Let’s assume for the moment that insurance is not a factor; the question of whether to diagnose still remains and hinges on the meaning we make of diagnosis itself. Does a diagnosis mean there is pathology? Does it mean there is something wrong that must be fixed? Is it a judgment on a person’s worth? How we answer those questions depends on the social context, and the effect of a diagnosis on a person depends partly on how that diagnosis is seen by society.

Instead of worrying that the DSM 5 is pathologizing temper tantrums and grief, what if we examine what we mean by “disorder” in the first place? Is a developmental difference like Asperger’s really a disorder? Do we call it a disorder because these differences cause suffering? Is every mental condition that causes suffering a disorder? Dyslexia is a similar example. Both can cause suffering but can also confer unusual strengths.

Is everything different from the norm a disorder? In contrast, PTSD could reasonably be seen as an emotional injury. PTSD is a documented human response to trauma. It certainly causes suffering, but if many “normal” people who are exposed to trauma develop PTSD, how can PTSD be abnormal?  It would be more accurate to describe it as a normal response to an abnormal situation.  And consider anxiety: anxiety is a normal human emotion and necessary for our survival. It’s only a problem if the anxiety is excessive or somehow inappropriate to the situation. So anxiety itself is not a disorder, and we wouldn’t want to completely eliminate it.  Still, all four of these are considered “disorders” by the DSM. Perhaps the DSM is unnecessarily pathologizing much of what it describes.

On the other hand, I think that the proliferation of diagnoses in the DSM 5 is the result of increasing specificity in our descriptions of mental conditions. That is not necessarily a bad thing! Categorizing mental conditions and exploring their differences are important steps toward greater understanding of the mind and brain. If our society conceptualizes those mental conditions as pathology, I don’t think that’s necessarily driven by the DSM. The DSM is a product of our social concept of mental health and seems to be a response to people seeking relief from various symptoms. If anything, it lags behind changes in society’s views on mental health and illness. Our lack of knowledge about the causes of many mental conditions means that the DSM must consist of symptom-focused descriptions. I would be the first to agree that these are subjective and people sometimes mistake the symptoms for the cause, but description and diagnosis still serve important purposes.

The word “diagnosis” comes from Greek and means “to know apart”, in other words, “to differentiate between”. In its function of describing people, diagnosis does not inherently pathologize them. That’s a judgment we place on the description after the fact. The best clinicians use diagnosis as a means to describe and explain a client’s experience.

Diagnosis can validate people’s experiences, empower people to seek treatment or accommodations, honor and encourage their adaptive efforts, and foster connections with others who share their experience. If I could change one thing about the DSM 5, it would not be to erase any of the descriptions, it would be the word “disorder”. Difference is not disorder. Emotional pain is not disorder. These are aspects of being human. Let’s keep describing human experience in all its variety, keep trying to help those who are suffering, but work to change how our society views those who are different or in pain.

This post originally appeared on The Creativity Post.

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Gender bias in the Reading the Mind in the Eyes test

The Reading the Mind in the Eyes test (RME) was developed by Simon Baron-Cohen to test aspects of his extreme male brain theory of autism. Recently, it has become popular with researchers studying affective empathy and autism, and is now available online in various places, mostly as a diagnostic tool for adults on the autism spectrum.  It has been revised, and the current version contains 36 items, each with four possible responses in a multiple choice format. Unfortunately, even in the revised version, the test items are highly gender biased which could affect its accuracy even though it has decent test-retest reliability.  I have analyzed the content of the test items, and broken them down by gender in order to highlight this problem and bring it to the attention of psychology researchers.

Restricted range of female images

Here are examples of the range of male eyes depicted in the RME:


The images are cropped black and white stills of actors in movies.  These are not taken from real life, and are not representative of the population although the items are balanced in terms of number of male and female eyes (18 female and 18 male).  There is a much greater range of ages represented by the male faces as compared to the female faces.  This may be due to the restricted pool (movies) that the items were drawn from.  All the female eyes are model-like in their symmetry, and all are made up with eye makeup and have plucked eyebrows.  In other words, all the female eyes are conforming to a gender stereotype of feminine beauty as seen in movies.


Restricted range of female emotional expression

I made a list of all the response choices (77 different choices) and found that there were only 48 different choices presented to the test subject as possible responses for the female eyes while there were 54 different choices presented for the male eyes.  Thus the range of possible emotions for the female eyes was restricted as compared to the male eyes.

Similarly, among the correct responses, there were 18 different correct responses for the male eyes (a unique response for each item), and only 15 for the female eyes since three of the female items (“fantasizing”, “preoccupied”, and “interested”) were duplicated.  Again, a greater emotional range  was available to describe the male eyes.  There was apparently no effort made to ensure parity between the range and types of emotions expressed in the male and female items.

Sexualized content of female items

Among the correct responses for female eyes, we find: “desire”, “flirtatious”, “interested” (twice), and “playful”.  Similar emotions in the male eyes are described as “anticipating” and “friendly”.  The correct responses for the female eyes have a strong bias toward expressing sexual interest directed toward the viewer.  This perception is reinforced by the camera angles and lighting that were used in the movies from which the items were drawn.


Also among the correct responses for the female eyes are: “contemplative”, “fantasizing” (twice), “preoccupied” (twice), and “reflective”.  The eyes in those items are not expressing much emotion.  Similar items for male eyes were described as “pensive” and “thoughtful”.  All of these indicate inwardly directed attention.  Fantasizing is not really an emotional state; it is an activity during which one could experience a variety of emotional states. When someone’s attention is directed inward, less communication about their emotional state is directed outward making the actual emotional states depicted in these items ambiguous.


Answering these ambiguous items correctly is more about eliminating answers than making a distinction between “thoughtful” and “fantasizing”.  Also, ambiguous items may muddy the results since test subjects may be more likely to project their own emotional states or be more suggestible to response items. Six female items (out of 18) were ambiguous as compared to two (out of 18) for the male items, so fully 33% of the female items were ambiguous compared to 11% of the male items.  This cluster of similar items among the correct answers for the female eyes further restricts the range of emotions expressed.

Using the RME to look for gender differences in empathy could be very problematic.  One study concludes that men have more trouble reading the emotions of women than of other men based on their performance on the RME.  Given that there is a significantly higher percentage of ambiguous items among the female eyes, and the range of emotions expressed in the female items is limited, I’m not sure that is a valid conclusion.  If the RME is to be used for testing hypotheses about autism and gender or gender and affective empathy, it needs to be redesigned with careful attention to gender parity in both the range of different ages and facial types presented as well as the range and types of emotions represented.


Baron-Cohen S. The extreme male brain theory of autism. Trends in Cognitive Science. 2002; 6(6):248-254.

Baron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I.  “Reading the Mind in the Eyes” test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. Journal of Child Psychology and Psychiatry. 2001; 42: 241-251.

Best C, Minshew N, Strauss M. Gender discrimination of eyes and mouths by individuals with autism. Autism Research. 2010; 3(2): 88-93.

Fernández-Abascal E, Cabello R, Fernández-Berrocal P, Baron-Cohen S. Test-retest reliability of the ‘Reading the Mind in the Eyes’ test: a one-year follow-up study. Molecular Autism. 2013; 4:33.

Schiffer B, Pawliczek C, Müller B, Gizewski E, Walter H. Why Don’t Men Understand Women? Altered Neural Networks for Reading the Language of Male and Female Eyes. PLOS One. 8(4): e60278.

This post originally appeared in The Creativity Post.

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