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.

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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.

 

 

http://www.aspiengirl.com

http://www.taniamarshall.com

Social Media

FB: http://www.Facebook.com/taniamarshallauthor/
T: http://www.twitter.com/aspiengirl

T: http://www.twitter.com/aspienwoman

E-mail: tania@aspiengirl.com

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 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.

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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 releases at #29 Amazon USA, #1 in Australia (2 categories)

I Am AspienWoman releases at #29 Amazon USA, #1 in Australia (2 categories) and 1st spanish world female autism conference

I Am AspienWoman, Foreword by Dr. Shana Nichols, is the sequel to the best selling IPPY Gold medal award winning I am Aspiengirl, Foreword by Dr. Judith Gould. This book is over 300 pages and explores areas including: social, communication, subtypes, sensory, strengths, challenges, work, family, gender and sexuality, stages leading up to a diagnosis, 24 mentors leg by Dr. Temple Grandin, who offer advice, a comprehensive screener of characteristics, the reasons for a diagnosis, disclosure and a strengths based exercise.
Amazon USA releases I Am AspienWoman paperbook at #29
Amazon USA released I Am AspienWoman this past weekend (August 22nd) at the #29 ranking in the Autism and Asperger Syndrome category and we are thrilled. The eBook version should be available any day now. The hardcover versions is set for release in the near future. All formats and will be available on Amazon USA, then Amazon UK, Canada and others stores as they roll-out over time

Amazon Australia releases I Am AspienWoman eBook Kindle at #1 in 2 categories. Barely released 1 week, we are thrilled to announce that I Am AspienWoman reached #1 in 2 categories August 29th, 2015.
1bestsellercroppedparentingchildren

Free sample chapters
Free sample chapter of both I Am AspienGirl and I am AspienWoman are available upon signing up on the homepages at http://www.aspiengirl.com

Pre-orders of I Am AspienWoman eBook from the AspienGirl webstore
For those of you all who preordered I Am AspienWoman in eBook format, all you need to do is locate the invoice that was sent to you when you purchased your book. Clink on the link within the invoice and your eBook will download.

Pre-orders of I Am AspienWoman paperback from the AspienGirl webstore

For those of you all who preordered I Am AspienWoman in paperback format, these books will be mailed out early next week.

Pre-orders of I Am AspienWoman hardcover from the AspienGirl webstore

For those of you all who preordered I Am AspienWoman in hardcover format, these books will be mailed out as soon as the hardcover version is ready.

The book are now available on Amazon Canada and Amazon UK and the formats will become available as Amazon’s time frame allows.

Here is another sneak peek at a couple of interesting pages from the book, clients I have seen over the years.

World’s first Spanish females Autism Conference
This week Tania was honored to be invited to provide the welcome opening introduction for the World’s first Spanish females Autism Conference taking place this weekend, August 29th-31st, in Beunos Aires, Argentina. We will upload the welcome on Facebook. The conference program can be viewed here: http://mujerestea.com/2015/08/26/298-programa-final-jornada-haciendo-visible-lo-invisible-en-tea/
Soy AspienGirl
Soy AspienGirl is now available on Amazon USA and Amazon Spain at: http://www.amazon.com/SOY-AspienGirl-caracter%C3%ADsticas-talentos-Espectro/dp/0992360978/ref=sr_1_1?ie=UTF8&qid=1440738556&sr=8-1&keywords=soy+aspiengirl
Asia Pacific Autism Conference (APAC)
We will be at the Asia Pacific Autism Conference (APAC) in Brisbane, Australia (Booth #30). APAC runs from 9th-11th September, 2015
You can purchase both books there with I Am AspienWoman hot off the press!
If you wish to email the author about her book, offer a testimonial or review, please email her at tania@aspiengirl with your comments or testimonials.
If you are having trouble downloading your eBook or any other questions or inquiries including Skype or in-person assessments, diagnoses, intervention, support, problem solving or interviews, articles, conferences and workshop or translations, please contact tania@aspiengirl.com
Best Wishes, remember to Be Your Own Superhero and enjoy the book
Team AspienGirl
#nomorefemalesleftbehind

I Am AspienWoman now on Amazon USA!

I Am AspienWoman, Foreword by Dr. Shana Nichols, and fabulous Mentor section headed by Dr. Temple Grandin is finally here on Amazon USA! It debuted at #39 (Disabilities) and #41 (Autism and Asperger Syndrome)

I Am AspienWoman August Cover

I Am AspienWoman August Cover, Foreword by Dr. Shana Nichols

To find I Am AspienWoman on Amazon:

http://www.amazon.com/AspienWoman-Unique-Characteristics-Females-Spectrum/dp/0992360943/ref=zg_bs_282950_44

The book is also available at http://www.aspiengirl.com

Back cover of I Am AspienWoman

Back cover of I Am AspienWoman

For more information on female Autism go to http://www.aspiengirl.com

About the Author

Tania Marshall is a best selling author, a 2015 ASPECT Autism Australia National Recognition Award Nominee (Advancement Category) and a 2015 eLIT Gold Medal Award winner. She is the author of I am AspienGirl(2014), I Am AspienWoman (2015) and AspienPowers. She currently works in busy full-time private practice, providing diagnostic assessments, intervention, support and problem solving consultations to males and females ages 2-76 years of age, in-person or via Skype. All inquiries to tania@aspiengirl.com

Tania is an Australian Psychological Society (APS) Identified Autism Practitioner, a Helping Children with Autism Early Intervention Service Provider (HWCA), a Better Start for Children with a Disability Provider, an approved Medicare provider of psychological services and a trained Secret Agent Society (SAS) Practitioner.

24 Inspiring and Motivational Autistic Women and Positive Role Models

24 Inspiring and Motivational Autistic Women and Positive Role Models

I Am AspienWoman is a highly visual book describing the newly emerging Autistic female phenotype in over 300 pages and features 24 inspirational and motivating Autistic Woman who serve as positive role models, showcasing ability and possibility. This section is headed up by none other than Dr. Temple Grandin, whose strengths based positive approach I admire. The mentors come from countries including the United States, Canada, Australia, the United Kingdom and Denmark and were chosen for their positive strengths based attitude, their personal abilities and their passion for advocating for Autism and/or helping others. Here is a snapshot of the Mentor section.

I Am AspienWoman August Cover

I Am AspienWoman, available September 1st, 2015, pre-order at http://www.aspiengirl.com

AspienWoman Mentors

AspienWoman Mentor

Dr. Temple Grandin

Dr. Temple Grandin

Temple1

Dr. Temple Grandin

Lauren Lovejoy

Chou Chou

Chou Chou Scantlin

Jen Saunders

Jen Saunders

Jen Saunders1

Jen Saunders

Maja

Maja Toudal

ShanEllis

Shan Ellis

Jeanette

Jeanette Purkis

Jeanette1

Jeanette Purkis

To see and read more about these inspirational mentors, pick up your copy of I Am AspienWoman, available in eBook, paperback and hardcover versions at http://www.aspiengirl.com

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Both books in combo paks for $10 off

About the Author

Tania Marshall is a best selling author, a 2015 ASPECT Autism Australia National Recognition Award Nominee (Advancement Category) and a 2015 eLIT Gold Medal Award winner. She is the author of I am AspienGirl

(2014), I Am AspienWoman (2015) and AspienPowers. She currently works in busy full-time private practice, providing diagnostic assessments, intervention, support and problem solving consultations to males and females ages 2-76 years of age, in-person or via Skype.

Tania is an Australian Psychological Society (APS) Identified Autism Practitioner, a Helping Children with Autism Early Intervention Service Provider (HWCA), a Better Start for Children with a Disability Provider, an approved Medicare provider of psychological services and a trained Secret Agent Society (SAS) Practitioner. All inquiries to tania@aspiengirl.com

2015 All rights reserved Tania Marshall

Adult Autism/Asperger Syndrome Assessment in Females

Adult Autism Assessment in Females 
Updated 23/09/2016

Autism spectrum conditions, including Asperger’s syndrome, are challenging to identify in adults. Without appropriate assessment, many individuals may go undiagnosed, without appropriate support and treatment.

Many girls and women are going undiagnosed or misdiagnosed because the majority of the research has been conducted on males and there is a great need of research based on females compared to NT females, research based assessment tools for females and interventions for females. There is also a great need for these tools to be made readily accessible to professionals, in other countries and other languages. At present, there are few professionals in the world both trained and experienced in assessing and/or working with females on the Spectrum, across the lifespan. At this point in my career, I have worked with hundreds, closer to 1,000 females, from ages 18 months to 78 years of age, of various sub-types, symptomatology, mild to severe traits, a variety of levels of Giftedness, many professional performers (singers, musicians, comedians, actors, models), professionals athletes, professional artists, professional authors, high-profile individuals, all at different points on the Social Spectrum, some with gender dysphoria, some with sexual fluidity, parenting and being a mother, being in trouble with the law, stalking and obsessiveness, working in the sex trade, being sectioned into a mental health facility (and the experiences that go with that), have work-related challenges, and much more.

Females with Autism or Aspergers may be picked up for Autism in the teenage years with depression, anxiety or an eating disorder, if they are at all. Many females exist who are undiagnosed or misdiagnosed and continuing to have mental health problems because of this. Some are diagnosed with Borderline Personality Disorder, which may or may not be appropriate, although many have BPD traits, and I have worked with individuals who have both. For adults, no-one knew of Asperger Syndrome or Autism back in their childhood. So a comprehensive early childhood and teenage autobiographical account is an extremely important piece of an assessment. In addition, other perspectives from people who know the person very well are important. A comprehensive assessment of an adult can include a variety of assessment tools, depending on the person. It also involves childhood photographs, report cards and comments, parental and/or partner perspectives, formal assessment tool(s) and an exploration of abilities, talents and/or gifts.

 

The vast majority of women I work with are on the bright end of the Spectrum, and tell me their reasons for seeking a diagnosis range from self-understanding and awareness to improving their relationships, to improving their works relationships, to treating their anxiety and or depressive episodes. are not seeking services, support, nor government support pension or services. They are wanting to know why they have “felt different” for so long, wanting to know what career is best for them, wanting to know how to structure their lives. They don’t want o be on government disability not do they see they value in that. They like working, want to work and contribute.

Presently there are ZERO adult assessment tools for females, very little research that is based on females and no specific research based interventions for females. This is a crisis for females. It is challenging for females to find a professional or organization familiar with the female autism research, how to assess females and then how to support them.

When I conduct impressions assessments, the assessment of adults explore the areas of social communication and interaction, repetitive and stereotypical behaviour, sensory issues and abilities or gifts. Feedback is provided, recommendations, highly recommended resources and a “What Next?” discussion is also involved.

Generally speaking, my comprehensive adult diagnostic impressions assessments include the following:

An autobiographical account from earliest memories until approximately age 25 (usually 4-6 pages)
A written or typed account of why you feel you might have female Autism/Asperger Syndrome
A 10-page Life History Questionnaire to go over various traits, and also collect extensive life/educational/employment/psychological history, developmental information.
Where possible, I interview family members, a partner, or any other family member or friend who know the person very well. I also base my diagnosis on my direct experience of how the person presents during the interviews. Non-verbal body language, facial expressions, the sound of the voice and intonations are all assessed.
An interview exploring present day context and day to day functioning
An exploration of the following is important:
 
Family history, including one’s own children (if any), who may be displaying traits or be formally diagnosed.
History of mental health issues, previous medical, psychiatric, psychological and psycho-educational history (previous IQ test and/or educational assessments), previous diagnoses and/or learning disabilities
Reading of previous reports, letters, hospital admission notes, medical, educational reports
Educational history
Social communication and relationship/friendship history, use of social compensatory strategies
Identity or persona (s)
A thorough exploration of compensatory strategies
A sensory processing assessment
Work history
School report cards, school/teacher comments
Childhood photos from each developmental stage
Abilities, gifts, strengths, talents and/or skills (some examples include samples of poetry, art, blog, short stories, books, singing and/or musical ability, acting, comedy routine, degrees and/or thesis/dissertation work, samples of jewellery, clothing or costumes, website, awards and so on)
Over-excitabilities, sensory sensitivities, self-soothing or stimming behaviors, sensory processing disorder and/or synaethesia
An exploration of visual, auditory, taste, touch, smell, balance, movement and intuitive differences, synaethesia and hyper empathy.
1-3 other perspectives from other persons who know the person really well
An exploration of personal journal entries, autobiographical and/or blog entries
Results of specific adult Autism assessment tools and other tools, completed by the person and also dependent on the person being assessed and the context
Other conditions (for example,  Central Auditory Processing, Irlen Syndrome, Ehlers Danlos Syndrome,  Hypermobility type Syndrome, food allergies)
Formal diagnostic tool(s) depend on the context of client. Research has shown that both the DSM5 and the ADOS are not very good at picking up the subtle characteristics of females on the Spectrum.
It is imperative that professionals learn to ASK females the right questions. These questions will vary from questions that would be asked of males. This is because we research is finally beginning to catch up with clinical experience, telling is what we as clinicians have know for years, that males and females present differently, in quite a few ways. Giftedness also impacts on the presentation of a female on the Spectrum, so professionals need to be aware of all levels of Giftedness and how they affect the assessment process.
So, when someone receives a diagnosis, what then?

A positive assessment or diagnosis is just the beginning.It is never to late to receive a diagnosis and the benefits outweigh any disadvantages.

While my diagnosis is based on the current DSM-5 Criteria, it is by no means a cut and dry process. The DSM is a working document and as such, does not accomodate well to females on the Spectrum.

Diagnosis, ultimately from my perspective, is best done when in collaboration with the client (and their partner or spouse when relevant) as a way to inform, educate, reflect and empower.

An important  “What Next” section is very important, and may or may not involve the following,  again dependent on the person, their situation and context of their life. Discussions of the following may include:
Self awareness and understanding
Education and highly recommended resources (including the best academic books, websites, research, researchers, webinars, etc)
Attitude
Strengths
Challenges
Recommended helpful therapy
The Social Spectrum
Referral to other professionals, professional support groups, etc.
Many adults have lived and died not knowing they had Autism or Asperger syndrome. Some benefits of an adult diagnosis include:
Knowledge and self-understanding of oneself and also for family members, friends, co-workers and/or partners
Access to appropriate therapy, medication, support and services
An answer for past experiences and challenges
Permission to ease up on oneself
Possible prevention of other conditions or disorders (i.e., personality disorders, difficulties distinguishing between reality and fantasy), difficulties with work, the law and court system and/or suicide
Prevention of mis-directed treatment
Learning about how one thinks (see the Autistic Brain, by Dr. Temple Grandin)
Identifying strengths, abilities and gifts
There are both benefits and costs to disclosing a diagnosis. Disclosure should be considered thoughtfully and used only if there is is potential benefit.
Who should I look for to help me? How can I find someone to help me?
Today, there are few professionals in the world trained and experienced in assisting females. At this time, the most important factor to look at is “Does the professional have both experience and training in the area of female autism”? Are they aware of the inherent gender bias? What types of assessment tools do they use? What is involved in an assessment? Do they use adult assessment tools? (Yes, I have had two clients tell me that child assessment tools were used on them).
I have developed a database of professionals who work with females which can be found at and is being updated on a regular basis at http://taniamarshall.com/female-asc-professionals.html
Please contact me at tania@aspiengirl.com if you or you know of someone who would like to be added to this database.
Common Pathways to an assessment or diagnosis
Having a child being assessed or who is formally diagnosed with  Autism
Difficulties with work or a current relationship
Discovering and learning about female Autism, aka self-diagnosis
A family member has recently or in the past received a diagnosis
Stalking and/or becoming involved in other criminal activities
I have read your writings and book I Am AspienGirl and it fit like a glove. Can you provide an assessment for me?
Yes, Tania regularly provides comprehensive impressions assessments across the lifespan. The vast majority of adults (both male and female) Tania has assisted are wanting a self-diagnosis confirmed formally. She is also in touch with other professionals who work in this area and also regularly refers to other appropriate professionals at the appropriate time. She can be reached at tania@aspiengirl.com
I really identify with the writings available on female Autism but I am not sure I want a diagnosis? Is Tania available to for sessions other than assessment?
Yes, Tania regularly provides services which may focus on assessment, diagnosis, problem solving, the pros and cons of a diagnosis, the pros and cons of disclosure, career directions, managing stress, anxiety, sensory sensitivities, “What Next” after a diagnosis, the different types of Autistic thinking, gender dysphoria, social difficulties and social skills, relationship difficulties, synaethesia, hyperempathy and the topic of being an “empath”.
For more information about the adult female phenotype, the sequel to the eLIT Gold Medal Award winning I am AspienGirl, entitled I Am AspienWoman: The Characteristics, Traits and Abilities of Adult Females on the Autism Spectrum is in press and due for release September 2015 and is based on her blog entitled “Aspienwomen: Adult Women with Asperger Syndrome. Moving towards a female profile of Asperger Syndrome”

Tania A. Marshall is an award winning and best selling author, a 2016 and 2015  ASPECT Autism Australia National Recognition Awards Nominee (Advancement category) and a psychologist. Her first book, I Am AspienGirl: The Unique Characteristics, Traits and Gifts of Females on the Autism Spectrum, Foreword by Judith Gould, UK, is a Amazon best-seller and a 2015 IPPY eLIT Gold Medal Book Award Winner.

I Am AspienGirl has been translated into both Spanish and Italian (release dates of July and August 2015 respectively). Additional completed translations include: German, Japanese and Brazilian Portuguese. Other languages currently under completion include: Dutch, French, Norwegian (by SPISS), Hebrew and Chinese.

 

Tania has completed the sequel to I Am AspienGirl, entitled “I am AspienWoman: The Unique Characteristics, Traits and Strengths of Females on the Autism Spectrum, foreword by Dr Shana Nichols (lead author of Girls Growing up on the Autism Spectrum). The release was 2015. This book includes a section of 24 females, all diagnosed as on the Spectrum, showcasing their strengths and also offering important advice to others. Tania is proud to announce that her 2nd book “I Am AspienWoman” recently won an IPPY eLIT Gold Medal in the “Women’s Issues” category.

Tania is an Australian psychological society (APS) autism identified medicare provider,
helping children with autism (HCWA) early intervention service provider, a better start early intervention provider and an Australian government medicare approved mental health provider. She is also a trained Secret Agent Society (SAS) social skills practitioner.

Tania can be reached at Admin@centreforautism.com.au for clinic or Skype remote impressions assessments, consultations, problem solving sessions, skills acquisition and intervention, interviews, book translations, presentations or workshops. She divides her time between busy full-time private practice, research and writing her book series.
Tania’s other books include:
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all 3
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AspienWoman April Elit Award1
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Aspienpowerscover
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