Female Asperger Syndrome, Current Statistics and Gender Differences

I write based on my own clinical and anecdotal evidence,
research studies and the work of world experts.

The statistics for boys to girls with Asperger Syndrome sit at 1:4, so
for every 1 girl there are 4 boys who meet criteria for Asperger
Syndrome. However, for those of us professionals who work solely in
this field we know that the statistics reflect a prevalence rate of
Asperger Syndrome in girls that is in reality, 1:2, meaning for every one female, there are two boys. Dr. Judith Gould, director of the National Autistic Society’s Lorna Wing Centre for autism and co-founder of the Centre for Social and Communication Disorders discussess the difference in prevalence rates between boys and girls. The statistic most commonly reported is that ASDs are four times more common in males than in females. Many clinicians, however, believe that the ratio is as high as 16 boys to every girl. But Gould believes that significantly more girls have the condition than is recognised; she estimates the ratio to be 2.5 boys to every girl.

Girls with Asperger Syndrome present very differently to boys with the same condition and “fly under the radar of a diagnosis”, often being MISdiagnosed,
MISunderstood, MISmedicated and sometimes, institutionalized. In my
clinic, boys tend to be diagnosed before formal schooling or in
their primary school years. Whilst I have diagnosed girls with
Aspergers as young as two year of age, the majority are closer to
the teen years. They appear to be able to cope with the basic more
“play-based” socialization. However, in secondary school the social
world changes dramatically from play-based to a more socially and
emotionally based conversation, social hierarchies are more
apparent, and the typical “bitchiness” and “mean girl” behaviors of
teenage girls is distinct. This difference often flies over the
heads of the female with Aspergers, who are often left behind
repeatedly analyzing their social faux pas, social confusion and
replaying the day’s social events in their minds over and over
again, often late at night, in their attempts to make sense of
them. Their female peer group’s interests have changed from
childhood friendships to teenage talk, emotional conversations,
cliques, groups, backstabbing, and “bitchiness”. They find they
cannot understand or “read” the unwritten rules, the non-verbal
facial expressions/glances/eyerolls and the non-verbal body
language that is critical to being an important member of a group.
As much as they observe, copy, and mimic their peers, they finds
that they just cannot keep up or fit in appropriately. Their peers
sense that there is something “ödd” about the Aspien, despite the
enormous amount of energy that they generally expend in their
attempts to fit in. In secondary school, girls with Aspergers
utilize a variety of coping mechanisms in their attempts to “fit
in”, “pretend to be normal”, “be accepted”, hide and camouflage
their confusion, imitate, copy, fake it until they make it, but
still appear to come off just a little “ödd” or “strange”, despite
their best efforts. Most of the girls I have seen have had previous
diagnoses of anxiety disorder, depression, ADHD, an eating
disorder, oppositional defiance disorder, bi-polar disorder and
even Borderline Personality Disorder (although they are still young
teenagers) and at times, reactive attachment disorder or selective
mutism. An enormous amount of energy is spent on observing,
learning and trying to understand and then copying their peers
social behaviors. I have met females who have utilized some or all
of the following strategies: Reading body language books and
practicing in front of the mirror in a repetitive way until the
skill is perfected the mirror

Learning from television shows or books about others inner thoughts, feelings and
motives

Replaying specific daily social situations in their own play at home in an effort to learn and
understand

Using imaginary friends to specific daily social situations in their own play at home in an effort to learn and understand

Over-apologizing, appeasing or pleasing others, giving gifts for social faux pas or social
mistakes

I have seen many teenage girls who have been brought into to see me and are have been described as having “gone off the rails”, in terms of their appearance, their attitude,
their mood, skipping or dropping out of school, running away from
home, involvement in drugs, sex, crime and/or the Police. They later met formal criteria for Asperger Syndrome.

Image

Using “chameleon” strategies, where the Aspien girl can adapt and fit into a variety of roles. In one example, I met a female who successfully fit into a very rough
motorcycle gang, a conservative church sect, and a traveling
circus! She had acted so well for so many years that she came in
with clinical depression, having no idea who she was. I have seen
teenage girls with Aspergers reject all social norms/values and
turn to drugs and sex and even crime.

Image

Girls with Asperger’s need very specific and appropriate social skills
interventions designed for them, in terms of learning about levels
of friendships, boundaries, social hierarchy, the unwritten social
rules, non-verbal body language, cliques and groups and the role of
people in those particular groups. They also need interventions
designed to help them with identity, self-esteem, managing intense
emotions, rigid black and white thinking and negative thinking.
Most typically, Aspien girls have the greatest difficulty in the
adolescent years, when they tend to “go off the rails”. Most, but
not all, Aspiens tend to be non-conformists and conforming to
social rules they don’t understand begins to take it’s toll. I had
one parent show me a picture of her daughter just a few months
before she saw me. He appearance was one of a typical teenager.
Then I had the chance to meet her daughter, who had in just a few
months gone “goth”, gotten several piercings and tattoos, was using
drugs and hanging around “bikers”. This young teen was rebelling
against all those groups that had not accepted her. Her desire was
to be accepted and approved of by anyone. This group and the men
she was having sex with accepted her, approved of her and took care
of her. She felt both accepted and popular. It is imperative that
any girl who comes into a clinic with either/or an eating disorder,
social difficulties, intense emotions, difficulties expressing
themselves, anxiety or depression, must be screened for Asperger
Syndrome, in a female. Then, once a comprehensive and detailed
developmental history is taken by an experienced clinician, the
diagnosis of Asperger’s becomes apparent, and then the appropriate
intervention can take place. Currently, information on female
Aspergers and Autism is occurring at a
rapid pace and there will be a
knowledge explosion within the next 10 years.

A recent study Dr Meng-Chuan Lai of the University of Cambridge
found that Autism affects male and female brains
differently, http://www.bbc.co.uk/news/health-23613816

CAVEAT:
Generally speaking, my doctoral research is in the area of females.
Having said that I am not saying that males do not experience these
issues. I am merely writing about my
specialization.

Tania Marshall©. 2013-14.
Professional Q and A Series I. All rights reserved. Duplication in
whole or part is explicitly forbidden. Thank
you.

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19 thoughts on “Female Asperger Syndrome, Current Statistics and Gender Differences

  1. I found this extremely interesting. My 17 year old is diagnosed with pdd-nos anxiety and depression. She is currently in a pysc unit that says her anxiety and pdd set each other off and this is why she ruminates and can’t cope with thinking about the future. My daughter can’t even think about the next day for fear it starts off her thinking of ‘why are we here? what is the point of life/being born etc’ She can’t even look up at the sky without it triggering these kind of thoughts. I think she is more on the autistic spectrum than professionals say, because she is highly intelligent and was only diagnosed last year.

    • PDD is a bucket diagnosis. My eldest clearly has Asperger’s (like myself) but was given a diagnosis of PDD Other (from the ICD10). Simply due to there still being ignorance about female presentation such ridiculous diagnoses are given out.

  2. “They appear to be able to cope with the basic more “play-based” socialization. However, in secondary school the social world changes dramatically from play-based to a more socially and emotionally based conversation, social hierarchies are more apparent, and the typical “bitchiness” and “mean girl” behaviors of teenage girls is distinct. This difference often flies over the heads of the female with Aspergers, who are often left behind repeatedly analyzing their social faux pas, social confusion and replaying the day’s social events in their minds over and over again, often late at night, in their attempts to make sense of them”

    Story of my life right there. During the summer between 6th grade and 7th grade everyone seemed to have received a manual about social interaction and have gone through drastic changes while I was behind. Suddenly girls that were nice before started to hate me and became mean and I didn’t understand why. The class started to laugh at me all the time and bully me and they said I was a “baby” all the time no matter how hard I tried to dress and act like them.

  3. I don’t know if I am an Aspie (been researching but can’t decide – currently looking at PDA) but I certainly have been through this and more – Though I had really good friends I always wanted to be liked by the bitchy girls – I thought it was my brains (I was top of the class) or my very plain looks but really I was just ‘different’ in so many ways. Some people turn to drugs, some people develop anorexia – me, I tried to change who I was – After a very cursory psych meeting I was allowed to have extensive facial surgery on the NHS even though there was nothing physically wrong with me. Appalling now when I think about it but I was a fixed thinking 80’s girl before Aspergers was defined. What you say about females being screened for Aspergers when they present with social / emotional difficulties – couldn’t agree more.

  4. The other very important point of catching and diagnosing, then teaching the skills you have highlighted is that young women can “go off the rails” after high school. The structure and protection may have been there, but then without those boundaries in place, the search for affection and acceptance can occur right after high school, over even through the twenties.

  5. Pingback: Female Asperger Syndrome, Current Statistics an...

  6. such a great article…as an adult male with asperger’s…and someone who spent my entire adolescence memorizing social cues, learning to mimic body language, it’s overwhelming to read these descriptions, but in a good way…and it’s frustrating to know that asperger’s in females is often missed, underdiagnosed…social experiences are so much more difficult when you lack a diagnosis and are unable to receive help with learning constructive ways of navigating the world. i was a teen before there was a diagnosis, had to wing it and developed a variety of techniques that were too severe, too focused on mimicry…it was only later, as an adult, that i was able to re-learn body language in a more beneficial way, thx to the help of an autism specialist. again, great article, i hope writings like this can help people understand the issue of asperger’s as it relates to females.

  7. Tania, reading this makes me want to weep. My darling daughter was diagnosed with Asperger’s Syndrome when she was 18, she is now almost 21. Since her diagnosis I have been trying to get her the proper help for her severe social anxiety. She had a major ‘melt down’ when she left college (how she managed to get through school I will never know) and hasn’t worked or seen any friends since then. Her entire life is online with an online boyfriend.
    She is very talented in art, she is creative and intelligent and a delight but can be all the things you describe in your articles. She went from being a little girl at 11 to a full blown ‘goth’ at 13 and goes from obsession to obsession. The battles I had with her about getting peircings etc. were horrendous. #
    We have an excellent relationship now but the help she has received has been appallingly lax. We requested that she be seen by the Asperger Psycologist from the team in our county (Somerset, UK) as far back as January but her care coordinator felt it wasn’t necessary. He sent an STR worker round to our house to help with the anxiety who, I discovered, knew absolutely nothing about Asperger’s and did more harm than good.
    My daughter had a crisis at the of June and an emergency referral to the psycologist was done at that time for intervention. Here we are, 12th August, and still waiting.
    I found your blog while doing research for a blog post I’m preparing about Asperger’s and pets for a guest post. If you are interested, I attach a link to a post I wrote about my daughter during a particularly difficult time recently, which I called ‘No Longer Invisible Darling Girl’. I know you will understanding why I wrote what I wrote.
    http://sherrimatthewsblog.com/2013/05/29/no-longer-invisible-darling-girl/
    Thank you for the great information here, I have signed up to follow you.

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  9. This is an outstanding article that I plan to share with my clients, if that is alright with you (your link will be at the top). As a therapist, I specialize in Asperger’s Syndrome, with most of my clients being male. Because of that, every time I would suspect Asperger’s in a girl/woman, I would check myself to see if it fits the axiom, “just because I have a hammer, doesn’t mean everything is a nail.” Because Simon Baron-Cohen’s AQ test isn’t as valid for females,as it is for males, I rely pretty much on client history, family reports, and then I give them an article such as yours or others that I have come across to have them see if they can relate. I have been right every time. Do you know if there is any new assessment coming out specifically for evaluating female Aspies?

  10. It’s strangely good that, as an aspie, I never “got” the social rules that were primarily established by the “mean girls” in seventh grade. As an adult, I “get it” enough to play the game and survive.

    But think about it – it’s likely a good thing – on a spiritual level – that the ways of this evil world go over some people’s heads.

    I like to remind myself of the quote by the highly controversial author, Icke, “I see children starving, banks lending money that doesn’t exist, people paying with austerity. If that’s sanity I’m glad I’m perceived as insane.”

    • Hello Safetyharborwoman, thank-you for your message. Yes, the “mean girls” have many confusing social rules, such as a hierarchy, different groups, a variety of roles that group members play, levels of friendship, in addition to stabbing their friends in the back, gossiping, spreading rumours, lying, and so on. Yes, I do like Icke’s work, in that he discusses the insanity of the world, and I imagine he may have something to say about the US government shutdown. All the best.

  11. Tania, I have spent a wonderful portion of my morning reading over your articles here. I am deeply touched by them and have teared up more times than I can count. I’ve gone through so much in my life that most people have said “you should make a reality show out of that” or “are you sure you haven’t been on the Jerry Springer show” (dramatic talk show here in the US). I’ve often just stopped telling people of the various paths I’ve been on to get to where I am today. I was diagnosed at 41- I wish that work like yours had been in existence when I was a struggling teen! Or, even younger! I am really excited for your new book release. Thank you, thank you, thank you.

  12. Tania I personally feel that the true ratio is 1:1, it’s just simply down to the diagnostic criteria being researched and based on male presentation alone. There are thousands of undiagnosed autistic females out there who are not included in statistics, hence such misrepresentative guesses being bandied about. I am on the spectrum, as are both my daughters. I know other female Aspies with Aspie daughters, two of whom are undiagnosed. That’s just in my very close locality.

  13. Pingback: Misunderstood and Misconstrued; That is the Real Crime | PatientsRightsAdvocate.com

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