Professional Interview Series: Professor Uta Frith

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This is the first in a series of interviewing professionals in the area of Autism, Aspergers and related conditions. It is with great honour that I was given the opportunity to interview Professor Uta Frith.

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Tania: Welcome Professor Frith and thank-you for agreeing to an interview with me. I am honoured to be interviewing a world expert on autism spectrum conditions. What attracted you to make a career in cognitive neuroscience and Autism?

Professor Frith: In the 1960s, when I started out as a PhD student, autism was hardly known and cognitive neuroscience did not exist. I had now idea that my career would take me deep into these mysterious directions. I suppose it was the very mysteriousness of autistic children, which attracted me to study them.

I was interested in development because I had been very impressed by lectures on Piaget by Ernst Boesch, Professor of Psychology at my University, Saarbrücken. Also at that University I was able to attend amazing Ward Rounds where different psychiatric cases were presented. This experience made me very curious about the mind and what was normal and what abnormal. I naively hoped that studying children at young ages might bring me closer to origin of the mind.

I was very fortunate to train in Clinical Psychology at the Institute of Psychiatry, a happening place in the 1960s, the place where Behaviour Therapy was pioneered. I intended to find a way to do research from the very beginning: It was very clear to me that we were distressingly ignorant about the mind, and that research was a necessity rather than a diversion from clinical work. Fortunately, I was able to get to get to know cases of autistic children at the Maudsley Hospital under the guidance of Michael Rutter, who was then already widely respected as an authority on autism. His PhD student, Lawrence Bartak, an Australian, and I were contemporaries and often worked side by side in the very first established special schools for autistic children. We felt that the teachers were doing a fantastic job. The children seemed remarkably similar to us, no matter what school they went to. But we often wondered what to make of those few autistic children who stood out from the others because they were not just clever but they had excellent verbal abilities. How did they fit into the picture?

 

My mentors were the experimental psychologists Neil O’Connor, an Australian, born in Kalgoorlie, and Beate Hermelin, born in Berlin. They were pioneers of the psychological study of mental retardation. They were among the first psychologists in the world to ask whether autistic children differed in their cognitive abilities from those of other children with intellectual disabilities and whether neurophysiological measures, such as EEG, would tell us about their brain function. They were way ahead of their time. Their work opened amazing possibilities to understand the nature of autism by teasing apart abilities and disabilities.

 By good fortune, Lorna Wing worked next door in the Social Psychiatry Unit. As the mother of an autistic girl, Susan, she had unique knowledge of autism and already at that time questioned Kanner’s rather narrow diagnostic criteria. She was convinced it was possible to distinguish in even the most intellectually disabled children those who had the ability for reciprocal social interaction and those who did not. I myself was not sure I could do this, and was more confident when the children had some language and showed some islets of ability. Here really was a form of autism that I could instantly recognise, a rare form as it turned out.

 The neuroscience of autism only started in the 1990s when it had just become feasible to use scanners to look at the signs of neural activity (as reflected in blood flow) in the living thinking brain. Here the collaboration with my husband, Chris Frith, was the vital link. Without his know-how and his expertise I would never have dared to enter this exciting field.

Tania: You received your PhD in 1968. Since then, can you please comment on the changes and the explosion of knowledge and research in the field of Autism?

Professor Frith: Knowledge about autism has accumulated steadily. A number of TV programmes were shown that portrayed a rather bleak view of autism, but they increased awareness. When the film “Rainman” came out in 1988, it was probably the first time that autism had been presented in an adult, and also presented as not all-bleak. It also made people aware of some very positive qualities. I don’t mean the savant skills here, although they do create permanent sense of wonder, but I am thinking of the lovely emotional naivety of Rainman that contrasted with the devious machinations of his non-autistic brother.

One of the unstoppable changes in the conception of autism was the recognition of atypical cases and cases that were not learning disabled. The term autism spectrum and the term Asperger syndrome had been introduced by Lorna Wing, who long wanted to push apart the narrow categories of autism. At the same time, Michael Rutter and Susan Folstein pushed apart these categories as a result of their famous twin studies. In these studies it became clear that when a narrow definition applied to one identical twin, the other twin very likely had a milder form of autism too. In fact they found that there was a 90% concordance in identical twins, if the criteria of autism were broadened. This was ground-breaking work not only because it broadened the category of autism, but even more importantly, it established that there was a genetic origin. Only then could a psychogenic origin be ruled out decisively – i.e. the idea that autism was a withdrawal resulting from profound rejection. This pernicious myth was at last eroded.  

 One of the biggest changes in the awareness of autism, in professionals and the general public alike, was the rise of Asperger Syndrome. I edited a book in 1991, which contained my annotated translation of Hans Asperger’s original paper. It was surprising to me how eagerly it was received. One of the unanticipated consequences was that the diagnosis of Asperger syndrome became fashionable, so that a number of people with successful lives began to diagnose themselves and even famous figures from history. But being a geek and being socially inept are not sufficient. I think there is a big difference between having an autism spectrum condition and being a shy, unconventional and obsessive.

 The new DSM-V has abolished the diagnosis Asperger syndrome. It still needs to be seen what the consequences will be, but I tend to think this is the right move. The label served its purpose in raising awareness of the autism spectrum. There is after all general agreement that it is a variant of autism and part of a very heterogeneous collection of autistic conditions. The difficult task ahead now is to see whether it is possible to identify subgroups hopefully, in terms of neuro-cognitive phenotypes.

 

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Tania: Please tell us about Theory of Mind, the theory that you developed along with Alan Leslie and Simon Baron-Cohen, in the 1980’s. How do the brains of people with Autism and people without Autism differ in terms of Theory of Mind?

Professor Frith: I think the history of Theory of Mind research needs a historian. I feel rather too involved and will not be able to give an unbiased account. In my view, the first part of the story is to do with two Austrian psychologists, Josef Perner and Heinz Wimmer, who devised an ingenious test. This test could show whether a child attributed a belief to another person, i.e. an invisible mental state, and whether the child predicted what another person would do next on the basis of the belief. It had to be a false belief rather than a true belief. In the case of a true belief you can’t tell whether the other person acts on the basis of a real physical state of affairs or an invisible mental state of affairs, because there is no difference. But in the case of false belief there is.

The next part of the story brings in Simon Baron-Cohen who had started his PhD at the time and who did the first critical experiments. Alan Leslie acted as co-supervisor and had already been thinking about the importance of invisible mental states, such as ‘pretense’ in the make-believe play of very young children. This was very exciting to me as I knew from a study by Lorna Wing and Judy Gould that autistic children showed very poor pretend play compared to non-autistic but intellectually disabled children.

 Now I must mention Tony Attwood, who did his PhD at the same time, but quite independently, and conducted a different and most interesting study. He asked how well – if at all – intellectually disabled autistic and non-autistic adolescents use nonverbal gestures. The results were very surprising, since at the time most people expected that autistic children would not use gestures in any meaningful way. But they fitted in beautifully with the Theory of Mind hypothesis: The intellectually disabled autistic children were well able to use gestures instrumentally, i.e. to get something, but much less able to use gestures expressively, i.e. to communicate an inner feeling state.

 The story heated up as we did the first PET studies, with trepidation, and with a number of eminent collaborators.  Obviously only very able and very brave adult volunteers took part. One of them was Heinz Wimmer. The autistic adults came from the clinic of Christopher Gillberg and Stefan Ehlers in Gothenburg and were scanned at the Hammersmith Hospital in London. Here we compared what happened in the brain when people were reading Theory of mind stories compared to Physical stories, invented by another of my now famous PhD students, Francesca Happé. When PET was replaced by MRI scanners, many more studies were carried out, and many different tests were used, frequently invented by Francesca Happé. For example, cartoons that either depicted jokes that required a mental state attribution compared to jokes that did not. Perhaps most successfully, we contrasted short movies where animated triangles interacted with each other. In some of the movies the viewer can’t help attributing mental states to the triangles, but in others, where the triangles move randomly, such ‘mentalising’ is not spontaneously evoked.

 Many labs all over the world have used neuroscience methods to study Theory of mind in the brain, in autistic and non-autistic people. It is still very surprising to me that one particular network of brain regions comes out again and again as being primarily involved. This network reliably encompasses regions of the anterior medial prefrontal cortex and the superior temporal sulcus at the temporo-parietal region; but there are also other but seemingly more variable regions involved.

Tania: Please tell us about your current ideas and theories on Autism today, in 2013?

Professor Frith: I continue to be fascinated by autism and by theories that try to explain the core features. I believe that the Theory of Mind hypothesis has had to be updated, in such a way that we distinguish between unconscious and conscious mentalising. I now believe that it is the unconscious type of mentalizing that is somehow failing in autism, but not the conscious type.

 Here is the problem: Why do able autistic adults who have learned to mentalize and pass all known Theory of Mind tasks, nevertheless still show the sort of interaction and communication problems in everyday life, the very problems that are supposed to be due to poor mentalizing ability. Do they not have real mentalizing ability, or is the theory wrong?

 A study that I did with Sarah White (my last PhD student), Atsushi Senju and Victoria Southgate, a few years ago, tried to answer this question. In this study we used anticipatory eye gaze to assess unconscious mentalizing, and this  distinguished autistic from non-autistic participants. Neurotypical individuals anticipated in their eye gaze where a character would look for a hidden object on the basis of the character’s mental state. But there was no such anticipation in the autistic adults. So we can reason as follows: in everyday life fast interactions are the norm, and here the unconscious form of mentalizing matters more than the conscious form. However, there clearly are advantages to having conscious metalizing – what precisely are these advantages? New research is needed.  

 Perhaps the most surprising part of the story of Theory of Mind is that such a complex and high-level cognitive ability as mentalizing, i.e. “attributing hypothetical mental states to others and predicting what they are going to do next”, is actually quite basic and has a signature in the brain.

Tania: I am very interested in the female phenotype of Autism. Could you please tell us your thoughts on the gender differences between males and females with Autism? Clinical anecdotal evidence suggests that females are not being diagnosed until much later in life or misdiagnosed with other disorders. Could you comment on this please?

Professor Frith: I believe this question has at last attracted enough attention so that interesting papers are now appearing that are trying to provide some answers.

 The gender difference in autism has fascinated me for a long time, but I never got a chance to study it. My favourite hypothesis for long has been that there is a special protective factor in being female and a risk factor in being male. This goes with the finding that in most neurodevelopmental disorders there is an excess of males. There are a greater number of boys who have dyslexia, or conduct disorder, or attention deficits.

I wish there was more evidence as to the way autism is expressed in the behaviour of females. There is an idea that girls are more likely to conform and more likely to be compliant. I don’t know whether this is the case, or simply an expectation that is part of the stereotype of being female. In either case, affected girls would less often be considered in need of clinical help. They can ‘pass for normal’ as we know from the gifted women who lucidly write about their autism.

Tania: Please share with us what work you are currently involved in?

Professor Frith: I retired in 2006 and have no longer a research group or students. So what I am doing is not work.

At Aarhus University I am fostering a highly inclusive autism network. This is to provide a forum for discussion involving people with autism, parents, teachers, clinicians and researchers from neuroscience, epidemiology, psychiatry, brain pathology, anthropology and so on. I am hoping to facilitate research by bringing together people from these different backgrounds, who bring a refreshing perspective, and can offer new ways of answering persistent questions.

 I am still writing papers with colleagues, some based on work done some time ago, but fewer and more slowly, which gives me rather more pleasure. I have to confess that sometimes I am a ‘free rider’, that is a co-author who does far less work than the others. I am still very interested to read about new research and I am particularly happy if I see publications by my wonderful former students and colleagues, who are vigorously advancing the field.

Apart from this I have other interests too, for example, promoting women in science, thinking about how neuroscience might provide some tools and some insights to improve education.   

Tania: Could you please comment on the research related to brain imaging and Autism? What are your thoughts on Temple Grandin’s brain imaging results?

Professor Frith: I loved being involved in brain imaging studies. It was exciting, but we were still very much at the beginning of the development of the method, and we did all studies with rather small numbers of participants. Things have changed a lot: the techniques have improved and we can now trust them to be safe also for children.

 Still, brain imaging results are only as good as the experimental design that is used. More often than not, brain imaging studies are difficult to interpret because the statistical analyses of brain images is very complex and error prone.  The main misunderstanding is that the blobs you see on a brain are actual signs of nervous activity. This is not the case. The blobs are depictions of statistical differences and it is hard to get one’s head around this. Furthermore, the activity in nerve cells cannot be seen directly, all we see is increases in blood flow. The rationale is that the more active the nerves are the more oxygen they need, hence the more blood is flowing in their direction.

 Just like behavioural studies, brain imaging studies rely on pooling together data from many trials and from groups of people, basically to remove noise in the data and thus make them more reliable.

 This leads me to mention another misunderstanding: You can’t take one single person’s scan and tell from this whether they are autistic. This is true even when the scan is done in the manner of an X-ray, that is, they were just lying still in the scanner and you take beautiful photographs of the anatomy of the brain. With our present techniques you can discover if there are grossly deviant features, such as tumours or injuries. This is not the norm in the case of autistic brains. But there are subtle differences when you superimpose data from many brains on top of each other to compute reliable averages. Many such studies now exist, and they always report differences in lots of places, grey matter, white matter, cortical regions, subcortical regions and so on. But we don’t know what the differences mean. 

The Brain image of Temple Grandin’s brain does not look like that of other autistic people. It does not like the brain of a neurotypical person either. There are so many differences that it is difficult to name them all, but these differences are very difficult to interpret. Temple Grandin during her whole life has built up a number of important compensatory strategies, and these leave their imprint in her brain. If we had an image from her when she was younger it would likely look different from now.

 Incidentally, most images of autistic people look perfectly normal to the naked eye. Some brains are particularly large, but then some neurotypical brains can be large too.

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Tania: I hear you have become Dame Uta Frith. Congratulations and a well deserved title for you. For those of us here in Australia, could you please comment on the process of gaining the title of Dame and how that came about?

Professor Frith: This was a most unexpected and amazing experience, something that never ever crossed my mind. I have no idea how it came about as the process is shrouded in secrecy. Amazingly, some kind people must have believed in me and proposed me and never claimed the credit. So I do not know to whom I should show my gratitude. I have retained my German citizenship since I would have had to give it up to obtain a British passport. This did not seem right to me as my accent immediately reveals that I am German, even after 50 years of living in London. This means that my DBE is honorary. I can put the letters after my name, and I am immensely proud to be able to do this, but I should not be called “Dame Uta”, you know, just as Bob Geldof should not be called “Sir Bob”.  I received the insignia from David Willetts, Minister of Science, in a special and very nice ceremony on 31st January, where I was able to invite some of my family and friends. This was also my mother’s birthday, which I thought was a wonderful coincidence. There are only few occasions when ‘decorations can be worn’, but I did wear mine recently at a special Guest Night at Newnham College in Cambridge where I am an Honorary Fellow.

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Tania Marshall©. 2013. Interview Professional Series. All rights reserved. Duplication in whole or part is explicitly forbidden. Thank you.

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The Neurodiversity of Females on the Autism Spectrum

Opening remarks on Day 2 of the II Symposium and Conference on Women and Asperger Syndrome, hosted by Mujeres Tea, in Argentina, 2017

You can now watch videos about my work on Vimeo at the Neurodiversity Academy

#vimeo #videos More educational videos coming soon.

What would you like me to share?

The following are just some examples and please feel free to give me your feedback on what you’d like me to present about: Female Autism/Aspergers, twice-exceptionality (2e), The gifted and talented, the highly sensitive person or an empath, the highly creative person, the association between Autistic Empaths and Cluster B Personality disorders, the assessment and diagnosis of girls and women on the spectrum, male Aspergers, the female profile of Aspergers from preschool to primary school to high school to University and beyond, ADHD, Anxiety, Extreme Self Care, careers for neurodiverse males and females, the first signs of Aspergers in young females, gender/sexuality dysphoria, the difference between gifted and talented and twice exceptional (gifted and Aspergers) individuals, masking and compensatory strategies, FAQ’s, IQ tests, educating Neurodiverse and/gifted individuals, Alexythymia, synaesthesia, Irlen Syndrome, Pathological Avoidance Syndrome (PDA)/Extreme Demand Avoidance Syndrome, the ‘lost’ generations, borderline personality disorder (BPD) and Asperger Syndrome and much much more. There is so much to discuss and learn. Thank you for your feedback.

#educationalvideos #vimeo #autism #aspergers #2e #ADHD #anxiety #genderdysphoria #neurodiversity #neurodivergent #G&T #creatives #extremeselfcare #careers #assessment #diagnosis #interventionandsupport #highIQ

#overexcitabilities #hsp #empath #empathy #education #parenting #synaesthesia #irlensyndrome #alexythymia #anger #PDA #somethingelse???

Copyright 2017 Tania Marshall and Mujeres Tea

The Female Autism Crisis: Assessment and Diagnosis of the Neurodiverse

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Updated February 18th, 2017

This is a sample of the book entitled Behind The Mask and is therefore under copyright law. Behind The Mask give voice to neurodiverse females and discusses the assessment diagnosis and support of females on the Spectrum.

Tania Marshall, M.Sc. is available for diagnostic impressions reports, assessment, diagnosis and intervention, support and problem-solving sessions in-person and/or via Skype. All queries, please email admin@centreforautism.com.au

I chose to write my book series after numerous requests for information on the topic. I also chose to self-publish, so that I can regularly update my work, keep my work current with the speed and amount of the research in the area (a challenge to keep up with for a professionals in the area), keeping my work fresh, current and in real time, rather than a long waiting period and being out-dated.

Over my career, I have I worked with hundreds of neurodiverse, Gifted and Talented, and 2e individuals.They may have labels that consist of Autism, Aspergers, Non-Verbal Learning Disability, Twice-Exceptionality, Semantic-Pragmatic Language Disorder, Oppositional Defiant Disorder, Anxiety Disorder, Bi-Polar Disorder, and many more. Irregardless of the ‘label’, these individuals have many significant strengths, gifts, abilites and/or talents, and this topic is discussed in ‘ AspienPowers’.

In working with neurodiverse individual across the lifespan, I have written and spoken about and or refer the ‘female autism crisis’. There are many factors involved, some of which include:  a lack of professionals trained in the area, gender differences, the female autism bias and the lack of assessment tools.  We are a long way from developing efficient tools for assessing neurodiverse girls and woman. The following slide is from the Recent presentation review of key measures, gender and autism at the 2016 XI Autism-Europe International Congress and shows that the ADOS/ADOS-2, the ADI-R and the SCQ favor males. This is a real problem and a crisis because these are the very tools that many professionals use when they assess females. They are sometimes a cause of females flying under the radar of a professional.

I have been referred many females who have had these tools previously completed on them and have not been given a diagnosis. This can be due to the tools inability to measure the subtle signs, client masking, compensatory mechanisms and strategies and/or the even the rigidness of the professional in using the tool or the over-reliance of using these tools versus asking the right questions and looking for the subtle signs in body language, facial expressions, asking the right social questions, evaluating areas such as context blindness, synaesthesia, Irlen Syndrome, sensory processing issues, and more.

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In assessing girls on the Spectrum, it is important to ask the right questions. I cannot emphasise this enough. There are many questions to ask and what follows are some examples. Keep in mind that high average to profoundly intelligent girls can tell you the socially acceptable answers that you as a professional want to hear, but they are unable to actually perform those unwritten social rules or if they can, they are not as fast at it as their peers or it comes off as just slightly awkward. You need to look at this subtle non-verbal signs which I will be discussing In an educational series.

Many girls and women with Asperger Syndrome or Autism have a tendency to be over-loyal and over-trusting, have a lot of emotional empathy, often just ‘seeing’ that a person needs help or saying they person needs help and taking things literally or not being able to ‘see’ the social context of a situation (for example, bringing home a homeless man because he has no home or food, yet not seeing the inherent dangers in doing this).

  1. What is bullying? What is teasing? What is bitchiness? How do you know the differences? When should you help someone? When shouldn’t you help someone?
  2. Sample questions in the area of friendship friendship should consist of: What is a good friend? What are some healthy ways of making and keeping friends? How long does it take to make and keep a best friend? Who are your friends? How do you know they are your friends? Do your friends try to get you to do things you dont feel is the right thing or that you feel uncomfortable with? (For example, do they try to get you to do your their homework, reports school work? Do they get you to buy things for them? Do they try to get you into trouble (for example, do they say they’ll be your friend if you do something for them?) What do you do at lunchtime? What do you do with your friends? What kinds of activities do you do with your friends? Do you prefer one best friend or a few friends? How long have you known your friend/friends for? Do they come stay over at you house and vice versa (if applicable). What do you talk about with your friend(s)? Professional Tip: Try to find out if the conversations are more one-sided or are they reciprocal, that is the conversation takes turns; it is a two way street rather than just a one person conversation involving 2 or more people.
  3. Sample Questions of play or hanging out may involve: How often do you play it hang our with your best friend/friends? Who initiates the play? Do you ask your friends to come over? Do they ask you to come over? Professional Tip: Often girls will text or cling too much to a girl, often driving them away.
  4. Does the girl or teen understand the social hierarchy? Do they understand how groups in school work? Do they understand the role the group members play? Why do you think the girls at school engage in these behaviors?
  5. Why is it important to keep a promise? Should every promise be kept?
  6. Why is it important to apologize when you’ve hurt someone? Professional Tip: Some girls adamantly refuse to apologize and some girls over-apologize.
  7. How do you know if someone is trying to get you into trouble? How do you know who you can and cannot trust as a friend?
  8. How do you know a particular person is safe to have as a friend? What kinds of clues might alert you that this person is dangerous? How would you know you are being taken advantage of?
  9. What are boundaries? How do you enforce a boundary?
  10. Do you prefer one-on-one friendships or hanging out in a group?
  11. Do you feel anxious around other girls? Girls often internalize their anxiety and can hide it very well. For those girls that are unable to “hold it in”, they may receive a diagnosis earlier than other girls. Remember that is it common for girls to be unable to explain why they are having difficulty in a social situation. They do often discuss not feeling well or may speak of feeling sick, feeling nervous or scared. They may often be in the sick bay.
  12. How long can you socialize for? Do you feel like you need a break? Does socializing make you tired?
  13. Teenagers with Aspergers often have eating disorders, an escalation of anxiety and depression and/or self-harm. Asking these questions is important. Investigating self-harm is also important. Girls are very good at hiding their cutting. Demand Avoidance is commonly seen in girls and women with Aspergers. Avoiding demands is caused by anxiety and/or not knowing how to do the task at hand and /or being embarrassed or socially anxious about a task. This is context-dependent and can look like making up excuses as to why she cannot do something that you know she can do to refusal to do something asked of her to refusing to comply with requests by an adult to avoiding the social playground.
  14. Many girl and women have a flat affect on their face, so that family members or professionals cannot tell how they are feeling.
  15. Some girls and women have Alexythymia and/or Faceblindness. Most experience extreme emotions and some girls may receive a diagnosis earlier than others to their meltdowns and/or violence.
  16. Many, if not all girls and women mis-interpret social situations (for e.g., “none of the teachers or kids at school like me”). Upon further investigation/assessment, it is found out that the individual misinterpreted facial expressions and social context, in an assessment.
  17. An assessment should involve reading of the eyes to see how well an individual can read non-verbal facial expressions from the eyes.
  18. An assessment may include listening to a variety of different tones of voice to see if the individual can distinguish the underlying feeling behind the tone.
  19. An assessment should also investigate other senses (both sensory issues and emotional empathy or “empath” characteristics). These questions need to be asked in a certain way as many females are literal, so a careful exploration is essential. An investigation of synaesthesia may be warranted.
  20. An assessment should also explore social naivety, the differences between lying and ‘white lies’, ‘pink lies’, social diplomacy, social tact and theory of mind.
  21. For teens and women, how do you know when someone is flirting with you or wants to go on a date with you? Do you know how to diplomatically reject the advance of another person? Professional Tip: Assertiveness training is essential for many females.
  22. In relation to gender and sexuality, a smaller group of girls (and boys) feel confused by their gender, and this can range from mild to severe. A thorough exploration of this issue often finds the individual relating better to the opposite gender, with girls getting along better with boys, being androgynous and/or Tomboy-like, and boys seeing other females as very socially successful and appearing to have lots of friends. Sometimes, an individual in their search for why they are different or why the social aspect of their life are so much more work for them, then come to the conclusion, for a variety of reasons (the feeling that others do not like or accept them, they do not like themselves, always having that feeling of being “different” to their peers), that they may have been born in the wrong body (they may be able to have more friends or be liked more, feel more accepted, feel “better” inside their body, be happier within themselves and within their family, be socially better or more popular), if they change their gender or their sexuality. Rarely, does changing one’s gender or sexuality fix the underlying social communication and identity issues, including being bullied, ignored or excluded and/or self-esteem challenges. Depending on how rigid or black and white the person is in their thinking, this can be a challenging issue to work on with the person.
  23. An exploration of identity in teenagers and women is important. This is because, over time, an assimilation of other people’s characteristics traits, voices, accents, behaviors has occurred, in addition to what others and society expect of them and from them. This high price (masking) often leads to a complete loss of identity.
  24. Many professionals are not aware that females can and do make eye contact, do make superficial conversation for short periods of time, and can have friends.
  25. Many professionals are unaware of the variety of sub-type presentations of girls across the Spectrum, with the ‘princess’ or ‘supermodel’ type, and/or those with higher intelligence, being the ones to be least diagnosed or diagnosed at a much later age. They are often Twice-exceptional (2e) individuals and blend in very well.
  26. Strengths and abilities are often overlooked due to the “presenting problem(s)”. Once these are addressed, then can an individual’s true gifts (for example, perfect pitch, artistic creativity, acting, dancing, programming, languages, just to name a few) can be nurtured and evolve into careers.
  27. Individuals on the Spectrum can and do lie, just like anyone else does. They dont do it as well as their peers and the reasons for lying may be different
  28. In terms of friendships, females are able to make friends, however they can often have a challenging time keeping them.
  29. A females sense of justice and high moral compass can be a clue and some females have been known to take their enlarged justice glands too far in their causes.
  30. Females with social problems often use their intelligence (sometimes quite successfully) to compensate for their lack of social skills, often falling into leadership roles, caring roles, teaching roles, acting roles, lawyers, professors, amongst other, where social reciprocity is least expected and social scripts (and slides!) can be adhered too.

Briefly, what we need to be asking are the right questions, looking and searching for and asking about questions that have to do with social confusion, camouflaging (how are the hiding it?), compensatory mechanisms (strategies they use to attempt to fit in, hide their confusion), eating disorders, gender, sexuality (if appropriate) and identity issues.

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This is a sample chapter of ‘Behind The Mask’, and is therefore under copyright law. In Part I of this book, it  explores the narratives and themes of the neurodiverse female clients that Tania has worked with over the course of her 20-year career. Part II includes chapters on assessment, diagnosis, how to explain the diagnosis, what next and support and intervention. For more information on female neurodiversity, go to:

http://www.aspiengirl.com

http://www.taniamarshall.com

Copyright 2014-2017 © All rights reserved. Duplication in whole or part is explicitly forbidden. Thank you.

The Neurodiversity of Autism and Asperger Syndrome in Females

The following article is copyrighted and may not be posted anywhere without permission from the author.

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In working with females (and males) on the Spectrum for approximately 20 years, I have learned a lot from my clients. When I first started out as a psychologist, I was seeing female on the Spectrum; they just were not called or labeled that back then. In working with hundreds of females, it is safe to say that there is much neurodiversity within this group. This is extremely important to talk about because these are their narratives.

By this, I mean that there exist varying presentations of girls and women on the Spectrum. Some are easier to diagnose than others. This is due to temperament, personality type, the severity or mildness of the person's specific Autistic traits, how many traits they have, gender differences, how much the traits impact on their ability to function, other conditions or disorders and much more.

Due to a variety of lagging skills and/or differences, many females with Autism do not get along with each other, yet many do, just like neurotypical people. Many females with mild symptoms are unable to get a diagnosis, even though their traits and exhaustion impact them on a cyclical basis. Those with the subtle traits usually never receive a diagnosis.

Now that I have worked with thousands of women, they have taught and shown me through their narratives, just how different they are from each other. It is important to discuss this issue so that no more females are left behind.

Stereotypes exist due to the history of Autism and describing boys rather than girls certainly comes into play. Other stereotypes include cultural perceptions and the social focus of culturally "female" interests. So, assessments based on males and cultural perceptions and biases are certainly factors. In my work, I have seen the stereotype of the "Tomboy" play a part in other females with a different presentation not receive a referral for an assessment or a diagnosis.

The use of a social mask, compensatory mechanisms, level of intelligence (for example, being 2e), being able to get by in life day to day and then have cyclical breakdowns, and the subtle differences all contribute to a delay in diagnosis or a misdiagnosis. These differences mixed in with genetics, temperament, personality, co-existing conditions, family environment and upbringing all impact and affect how Autism presents in a female (and male).

Subtypes or presentations are extremely important to understand if one is to be trained appropriately. It is imperative to understand how many different ways a female on the Spectrum can present to a clinician. A diagnosis is critical, not only for self-understanding; but for support, services, and academic accommodations. I am talking about how girls and women have presented themselves in my clinic over 20 years, from a variety of countries and cultures. This blog is but a small part of my book entitled, "Behind The Mask" due 2017.

There are a few ways that females on the Spectrum adopt a role. In particular, if they really want to fit in and conform with society. There exist some common types or sub-types of women on the Autism Spectrum. The reason this is important is so that, as I said before, no females are left behind, and that professionals are trained in the various presentations so that they do not miss a female and also to educate the wider population about the neurodiversity of neurodiversity itself! So, let's discuss just a few presentations:

TheTomboy is usually indifferent to gender, preferring to have boys for friends and dress in an androgynous way or dress in boys clothes. She finds it much easier to talk to boys (or men). However, some individuals have gender dysphoria and this is not to be taken lightly.

The Academic superstar uses her intelligence to achieve degrees, awards, honors and more. She has an intelligence above 130, qualifying for MENSA, and has used her intelligence to get through social situations. The higher the giftedness, the more different the presentation may appear.

The Passive female is a people pleaser. She is shy, quiet, cooperative, rarely asks for help and compliant, too compliant, and blends into the wall (in the classroom or at school). She rarely stands up to bullies and is often taken advantage of.

The Aggressivefemale has often had a history of misunderstanding and misinterpretations, both ways; on her part and on others parts. She often misinterprets others, burns bridges, is impulsive and is the type most often associated with or been diagnosed with Borderline Personality Disorder or BPD traits.

The Scientific female may have a special interest in physics and/or Quantum Physics, mathematics, chemistry, animal sciences, biology or space, programming, just to name a few. Often, this type of woman is quite focused on their topic of interest and reaching high levels of distinction (a Masters or PhD).

TheStyleIcon is aware, even overly aware of style and fashion. She may work in fashion design, be an actor or a supermodel. She has got the outfits, makeup, hairstyles and appearance perfect. Her appearance tends to intimidate males and females, who are threatened by her appearance, presence or knowledge of the fashion and stylist world. She grasps small talk, making her appear to be neurotypical and allowing her to cope in social situations and fit in with her peers. Even if her appearance is eccentric, she gets away with it due to her other talents; whether they be a singer, a costume designer, an actor or DJ.

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The Housewife or Cook loves to entertain and is very good at it. She is whom people want to hire for their home. She loves to have people over, but remains the ultimate host, so as not to have to socialise with others. 

TheArtist gets away with being different or eccentric because society expects them to be that way, so in this way, they often remain undiagnosed until they fall off the rails. they may be the more eccentric painters, writers, actors, supermodels, singers, and band members.

TheJusticeWarrior is obsessed with justice, fairness, and right and wrong. These are admirable traits, but not when it turns into obsession, misguidedness or inappropriate recruiting of members. Some women (and men) are 'one woman' groups because others do not want to join their cause due to the social way they attempt to get others to join their cause. These people end up starting their cause over and over again. It is true (although some may not like to admit it) that some women (or men or neurotypicals) have a “misguided sense of social justice”, going too far or the wrong way of going about their crusade. There is a socially appropriate way to get people to join your cause. I have met clients (both neurodiverse and neurotypical) who have gotten into trouble with the law or are in jail because of their enlarged justice gland, lack of social context and impulsivity.

In summary, this is just a brief look at how girls and women experience Autism and the variety that exists in presentation. There are other presentations that will be discussed in my book. Girls and women vary differently from each other and also differ in their ability of lack of ability to use compensatory mechanism and/or coping mechanisms. They also vary in intelligence levels. Those who are both Autistic and Gifted have a different presentation. However; they all share the same core challenges (from mild to severe) and some remarkable strengths or gifts.

This blog is written to address the neurodiversity with a large group of females and has nothing to do with sexism or ableism, nor that neurotypicals cannot have the same careers. Most importantly, it is imperative that we understand the differences in neurodiverse females, the different ways they cope or not cope, and the different ways they present.

Within the Neurodiverse population, there is no particular way to be a girl or a woman. Many of my clients have all kinds of preferences and interests, including my Lego pens sets. Many of my clients have a wide and varied style of clothing, from fashion to boys clothes to Victorian clothing to gender-neutral clothing to completely loving being in a princess Tulle dress or an Elf costume. Some of my clients wear "boy" clothing and "girl clothing". Some like cargo pants, some like dresses and/or corsets, some like dressing up in their favorite character, some love femininity and some do not and many like books, stationery, dolls, and theater.

Finally, the purpose of writing about presentations is to leave no female out; to never exclude not even one female. We understand the neurotypical world (to the degree that we do), but we are only on the cusp of learning about the neurodiverse female world and what this group are truly capable of, when given the right support. This is about understanding females on the Spectrum and then designing appropriate interventions according to their presentation. For example, the passive presentation will need assertiveness training whereas a different social type will need a different intervention. It would be unfruitful to put all females in the same social skills or intervention group.

Whilst these girls and women are different, they all share the same common core characteristics, that of social, emotional, cognitive, sensory, intelligence differences, in addition to other co-existing disorders or conditions. This makes for complex presentations. By no means can one type be put in a box. A female can be 2 or 3 types or morph into all types throughout their life-time.

These are just some of the various ways that Autism presents, how some females may present and how they may cope with having a different brain. Autism influences many factors and all types and interests are just as important as each other. We need as many different brains and as many different neurodiverse females as possible. We also need to know the differences in presentation, so that we can now design and implement the right support and intervention for the right girl or woman.

Neurodiverse girls and women have much to offer, regardless of neurotype, interests, dress, differences and/or similarities. There are no stereotypes, just a variety of presentations and profiles, all valid and all very special.

#nomoreemalesleftbehind #beyourownsuperhero #aspiengirl #aspienwoman #aspienpowers #behindthemask

Behind the Mask 3D

Copyright 2017 Tania A. Marshall http://www.aspiengirl.com http://www.taniamarshall.com

No part of this may be used, reproduced, borrowed or copied. This is an excerpt from Behind The Mask

AspienGirl.com is pleased to be nominated for a 2017 ASPECT Autism Australia Award

AspienGirl.com is pleased to be nominated for a 2017 ASPECT Autism Australia Award in the Advancement Category, for advancing the area of female Autism. AspienGirl.com advocates for neurodivergent females, educating and bringing a strengths-based awareness about the autistic female presentation/profile, and contributes to its’ goal of “no more AspienGirls left behind” and “Be your own superhero”, being the best version of yourself. Females will continue to be misdiagnosed, mis-medicated and/or receive the wrong interventions, until research is conducted on females, female-based screening and diagnostic tools are created, gender differences are clearly understood, and female-specific interventions and professionals are trained to assess, diagnose and work with females. In order to assist in getting closer to these goals, the AspienGirl Project was created and has already donated 450 books and will continue to donate a certain percentage of its profits to sending out free books and resources to professionals, schools, teachers, special needs coordinators, libraries, and Autism organizations.

 

 

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Tania Marshall, M.Sc., AMAPS, is an international best selling author, psychologist, publisher, educator, 3X and most recently 2017 ASPECT Autism Australia National Recognition Award Nominee (Advancement Category), recognized for her work in advancing the field of female Autism. Her first book, entitled “I Am AspienGirl©: The Unique Characteristics, Traits and Strengths of Young Females on the Autism Spectrum”, foreword by Dr. Judith Gould, won an IPPY eLIT Gold Medal Award in 2015 and is an Amazon best seller. I am AspienGirl has been translated into Spanish and is entitled Soy AspienGirl. She currently works with the gifted and talented, celebrities, performing artists, and twice-exceptional and/or neurodiverse individuals, across the lifespan. Tania was recently interviewed by Dr. Harold Reitman in a 2 part series by Different Brains, where Part I can be found here: http://differentbrains.com/aspiengirl-embracing-strengths-women-aspergers-syndrome-tania-marshall-edb-51/ and Part II here http://differentbrains.com/gender-differences-neurodiversity-recognizing-diversity-within-autism-spectrum-tania-marshall-edb-54/

Tania can be reached at admin@centreforautism.com for assessments, telepsychology (Skype) or clinic consultations, interviews, presentations, workshops, and/or conferences, translation inquiries, collaborations, publishing/book and/or media inquiries. She is an Australian Psychological Association (APS) Autism Identified Medicare Provider, a Helping Children With Autism Early Intervention Service Provider (HWCA), a Better Start Early Intervention Provider, a Medicare Approved Mental Health Provider and a Secret Agent Society (SAS) Trained Group Facilitator.

Copyright 2016-2017 Tania Marshall

Exploring Different Brains with Dr. Harold (Hackie) Reitman Part II

Exploring Different Brains with Dr. Harold Reitman Introduction – please click on the image to be taken to the Different Brains interviews available in visual interview format, podcast and transcripts. In this episode, Harold Reitman, M.D. continues his conversation with Australian psychologist and award-winning author Tania Marshall. Tania discusses maximizing the potential of women on the autism spectrum, the differences between resources for women in Australia and North America, and the subject of transgender individuals that are neurodiverse.

Source: Exploring Different Brains with Dr. Harold Reitman

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I would like to thank Dr. Harold Reitman for contacting me and interviewing me, to Joseph and his team for putting together a wonderful series of important interviews. I would also like to thank Mike. More Coming Soon.

For impressions diagnostic assessments, Skype consultations, interviews, translations, book, workshop or conference  enquiries, please contact tania and admin@centreforautism.com.au

Copyright 2016 Different Brains and Tania Marshall

Exploring Different Brains with Dr. Harold Reitman Part I

Video

Exploring Different Brains with Dr. Harold Reitman

Introduction – please click on the image to be taken to the Different Brains interviews available in visual interview format, podcast and transcript versions.

facetunes

Part Idifferentbrains2

I would like to thank Dr. Harold Reitman for contacting me and interviewing me, to Joseph and his team for putting together a wonderful series of important interviews. I would also like to thank Mike. More Coming Soon.

For impressions diagnostic assessments, Skype consultations, interviews, translations, book, workshop or conference  enquiries, please contact tania and admin@centreforautism.com.au

Copyright 2016 Different Brains and Tania Marshall

I Am AspienWoman wins a 2016 IPPY eLit Gold Medal Award!

The AspienGirl Project is pleased to announce that the sequel to ‘I am Aspiengirl’ entitled ‘I Am AspienWoman’ recently won a 2016 IPPY eLit Gold Medal Award in the “Women’s  Category” in April. I am AspienWoman is the culmination of a blog Tania wrote a couple of years ago entitled ‘Moving Towards a female profile of Asperger Syndrome’, with close to 300,000 views, to date. That blog is regularly updated. You may purchase copies at http://www.aspiengirl.com, Amazon or other fine books stores.

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AspienWoman April Elit Award1

 

2016 Award Announcements

Tania spends her professional time in private practice. She provides diagnostic assessment impressions reports regularly (across the lifespan), and provides interventions and support. For more information regarding diagnosis and assessment, bookstore wholesale discounts, book contracts, interviews, translations, workshops and conferences, please email admin@centreforautism.com.au

 

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