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.

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.

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.

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.

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

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 Reitman Part I

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.

Part I

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.

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

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”

https://taniaannmarshall.wordpress.com/2013/03/26/moving-towards-a-female-profile-the-unique-characteristics-abilities-and-talents-of-asperwomen-adult-women-with-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:

Aspienwomen: Moving towards an adult female profile of Autism/Asperger Syndrome

 

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Updated July 15th, 2018

Tania Marshall© 2013-2018. All rights reserved. Aspiengirl and Planet Aspien are trademarked. Thank you.

Aspienwomen : Adult Women with Asperger Syndrome. Moving towards a female profile of Asperger Syndrome. This blog has been viewed more than 500,000 times since I initially wrote it and was the inspiration for my second book, released August 29th, 2015, Foreword by Dr. Shana Nichols. and now an international bestseller. I am pleased to announce this book just received a 2016 IPPY eLit Gold Medal award in the ‘Women’s Issues’ category. This book is available at http://www.aspiengirl.com, Amazon, the Australian Council for Educational Research (ACER) and other fine bookstores.

Tania is available for fee-based in-person or Skype remote assessments, consultations, problem-solving sessions, intervention, and support. She also works regularly with a variety of professionals in many countries, in the areas of referrals and assisting individuals to obtain and/or receive an assessment, diagnosis and/or support in their own country. She can be contacted at tania@aspiengirl.com regarding fee-based assessments, intervention, support, problem-solving, referrals, her diagnostic impressions, book inquiries and translations, publishing inquiries, media enquiries, workshops and/or conferences.

The following list is an official detailed working screener document consisting of the unique characteristics and traits of adult women with Asperger Syndrome, or Aspienwomen. It is not a research-based formal assessment tool. It is a screening tool based on the many females I have worked with over the years. I have assessed, observed, diagnosed and worked with thousands of girls and women of all ages. This document is based on my clinical anecdotal evidence and research by other well-known professionals. I will be modifying and/or updating this list from time to time. This list was written from my reflections, observations, and experience, and is written in no particular order. No-one person needs to have every trait, and it is rare that a person would identify with every trait. Autism is a heterogeneous condition and as such, whilst people may share similar abilities and challenges, no two people with Autism are alike.  This is a descriptive anecdotal profile, much like the early day descriptions that Asperger, Kanner, and Frankl described of the boys they observed.

***Please be mindful that research often lags many years behind anecdotal, observational and clinical work.

***This list does not characterize all people and Autism is a heterogeneous condition. It presents itself differently in each person

***Research shows that everybody has Autistic traits. Out of a 100 piece jigsaw puzzle, everybody on the planet has a couple or a few pieces. Those that have 60 pieces would be said to have Broader Autism Phenotype (BAP) and those with 80 or more pieces are diagnosable or diagnosed with the condition.

***Self-diagnosis does not equal a formal diagnosis. Some people who self-diagnosis do not have Autism or Asperger Syndrome and some do. There can be false positive self-diagnoses.

The following profile was created for females who are self-diagnosing or considering formal diagnosis and to assist mental health professionals in recognizing Asperger Syndrome in adult females.

Females with Asperger Syndrome experience their symptoms at varying levels, so while some Aspienwomen are highly introverted, others are not. Many women would not meet formal criteria for a diagnosis due to their coping mechanisms. They would be defined as “sub-clinical”, “residual Aspergers”, otherwise known as Broader Autism Phenotype (BAP). Females with Asperger Syndrome or Autism tend to be discriminated against due to the wide spectrum of abilities or levels of functioning that exists. The majority of females do not receive a formal diagnosis until well into their adult years.

This list typifies many of the adult Aspienwomen I have worked with. These traits also depend to some extent on the severity, whether you’ve been assessed and diagnosed and/or receives support and intervention, and also whether there is a co-existing condition(s) (for e.g., a personality disorder) present.

1.  Cognitive/Intellectual Abilities

Tend to have high average to genius intelligence, often (but not always) with significant splits between verbal and perceptual reasoning abilities, lower working memory and/or processing speeds, learning disabilities (for e.g., dyscalculia, dyslexia, reading comprehension)

Superior long-term memory

Weaker short-term memory

May need academic accommodations in University

A distinct learning profile consisting of a spikey profile of strengths and weaknesses, peaks and troughs, learning disabilities/differences

Often have a rigid negative thinking, inflexible black or white thinking style or rigidity of thinking

Context Blindness

2.  Education/University Life

May have dropped out of high school and gone back later or may have repeated a grade. May have unfinished or partial degrees, may have many finished degrees, many have Doctorate of Ph.D. level qualifications. Many have taken longer to achieve their education, as compared to their peers.

May have a history of enrolling and attending university classes, followed by dropping out of classes or semesters. Sometime later, she then re-enrolls/attends later on, in life. This is usually due to being overloaded and overwhelmed. A history of deferring exams, not attending classes, dropping out of classes or programs, is common.

May have repeated high school or courses OR dropped out completely.

A history of many doctors and counselors visits throughout university life, without any significant improvement

Difficulty taking the same amount of courses or classes as her peers

May get lost on campus easily, lose possessions, be late for classes or exams

3.  Career/Work

Often drawn to the helping, artistic or animal professions, and often an “expert” in her chosen field. I know of many Aspienwomen who are successful in the following careers: Artists, singers, actors, poets, writers, teachers, psychologists, psychiatrists, special needs teachers/consultants, horse trainers/whisperers, doctors, scientists, accountants, authors, childcare workers, models, comedians, artists, computer-related specialists, animal handlers or zookeepers, university professors, nurses, psychics/mediums, entrepreneurs and photographers.

May miss days of work due to social exhaustion

May find great difficulty attending/participating in staff meetings, lunch breaks, work social events

May make up excuses for not attending work/staff functions

May have a history of being unable to cope with work/employment environments, often moving from job to job, especially in younger adult years

Hard-working conscientious worker

May get stressed if have a lot of work to do in a short amount of time

May become frustrated/stressed if asked to do too many things at once

Tries very hard to avoid making mistakes, forgetting things

Tries hard to please others

May burn bridges (for e.g., walk out or quit jobs or relationships without notice)

4.  Social and friendships/relationships

May appear narcissistic, self-centered,  egocentric or caring only about her/himself due to not understanding the unwritten social rules

Preference for one-on-one social interactions, single close friendships

May obsess over one friend to the extreme

Preference for friendships with men as they are easier to understand than women. They also find the interests of their peers boring and uninteresting

Need more time away from people than their peers (solitude)

May experience stress, anxiety, and confusion in social group or group work situations

Social Anxiety leading to Social Phobia: Overanalyzing social interactions where they overthink (on a ‘loop’), about what they said, did, did not say, should have said or not said and what they wished they should have said. On the other side of this is continual stressing about what the other person is thinking of them. This is usually done to the extreme that it can be incapacitating for the person.

Strong preference to engage in conversation related to their special interest

Strong dislike for social chit-chat, gossip, nonsense, lies or conversation that lacks a ‘function’ to it, but some are known to engage in it themselves

A history of being bullied, teased, left out and/or not fitting in with same-age peers unless she had/has similar “Aspie” friends

An intense dislike of lies, but may lie to others herself. Many have admitted this to me.

Has an ability to socialize, however, is unable to do so for long periods of time. Suffers from “social exhaustion” or a “social hangover” when socializing too much. The hangover can last hours to days, which can be debilitating

Experience great difficulty with conflict, arguments, being yelled at, fighting, war, stress

Has great difficulty asserting herself, asking for help, setting boundaries

May need to drink or do drugs to be able to socialize, perform (sing), be with and/or around people

May currently have or have experienced Post-Traumatic Stress, often due to being misunderstood, misdiagnosed, mistreated, and/or mismedicated.

Social Skills differences – is exceptionally good one-on-one and presenting to groups, however, has difficulty working within group situations

May find herself in social situations or relationships that she is unhappy with, but not know how to remove herself from them. Is highly at-risk for being with a toxic abusive person die to her nature. See ‘The Molotov Cocktail’ Series at http://www.vimeo.com/ondemand/femaleautism

History of being taken advantage of by others, even though she has taken the appropriate business, legal or social advice from others

Often bored in social situations or parties and/or does not know how to act in social situations

May say “yes” to social events, then later make up an excuse as to why she cannot attend, often staying home in solitude (reading a book or engages in her special interest)

Often prefers to be engaged in her special interest, rather than socializing

May be considered the “black sheep” of the family

Others consider her different, odd, eccentric or “weird” by others

May feel like she has to act normal” to please others OR does not care at all about fitting in

Copies, mimics, act in order to fit in and make others like her

A people pleaser, but then may burn bridges suddenly (for e.g., quit relationships), as they have difficulty managing conflict, confrontation, and stress

Females appear to be better than males at masking the traits of autism in social situations. However, girls are less able to do so in unfamiliar settings.

May be considered a “loner” OR may have many acquaintances, but no real friends

Social Naivety: may believe anything told to them by others (gossip, stories, jokes, and teasing), difficulty interpreting the intentions of others, misinterprets other peoples intentions, often jumping to conclusions about others, may be described as “gullible”

5.  Communication

Difficulties communicating her thoughts and feelings, in words, to others, especially if anxious, stressed or upset. Often can type or write her thoughts much better

May dislike asking others for help, be unable to ask or not know how to ask for help

Maybe passive, not know how to assert her boundaries in a healthy manner

May offend others by saying what she is thinking, even if she does not mean to; may appear aggressive or too intense

May point out other people’s mistakes

May give too much detail and end up boring others unintentionally

May ask embarrassing questions (usually when younger)

Unusual voice (flat, monotone, high-pitched, child-like)

The tendency to take things literally, missing what people are trying to say

May talk too loudly or too softly, often unaware that she is doing so

May talk too much or not enough

Often surprised when people tell her she has been rude or inappropriate

Poor pragmatic language skills

Struggle with eye contact and listening to someone at the same time

May have auditory processing issues

Struggles to understand non-verbal communication cues

Often overshare in inappropriate ways, not understanding the steps to a friendship or relationship

6.   Physiology/Neurology

A. Highly Sensitive

Highly sensitivity, may not be able to listen to or watch the news, listen to the radio, read the newspaper, watch violent shows/movies or horror movies, see hurt or injured animals, abuse, war, trauma, are sensitive to the emotions and “emotional atmosphere” of the environment, experience referred emotion and psychic “6th sense” abilities, may have strong intuitive and/or psychic abilities

B. Sensory Processing Disorder/Condition

May have sensory sensitivities in the following areas: hearing, vision, taste, touch, smell, balance, movement, intuition

May be very sensitive to pain or have a high pain threshold

May notice how food tastes or feels and one may be more important than the other

May be clumsy or uncoordinated

May dislike loud noises and/or be overwhelmed or stressed by bright lights, strong smells, coarse textures/clothing, sirens close by or people too close behind her.

May find children hard to cope with due to crying, screaming or other loud noises

Sensitive to the way clothes feel and how they may be more important than how they look

May have to withdraw, isolate herself when overwhelmed by her senses

May not be able to tolerate sounds, sights, smells, textures, a movement that she dislikes

May not like to be hugged, cuddled or held. “I only like to hug if it’s my decision”

Can get upset or distressed if unable to follow a familiar route when going somewhere

Things that should feel painful may not be (bruises but not know how they got there, due to clumsiness)

In social situations, the nervous system tends to be overwhelmed easily, leading to withdrawal (for e.g., wander off to a quiet spot at a party, play with children or animals)

Strong hunger may be disrupting her mood and/or the ability to focus

She may notice and enjoy delicate or fine scents, tastes, sounds, works of art, and pieces of music.

C. Anxiety, stress and/or anger. Recent brain scanning research points towards the enlarged Amygdala’s role in intense emotions, anxiety, and anger

D. May have auditory processing issues

E. May have Irlen Syndrome

F. May grind teeth or have lockjaw (anxiety)

G. May have Obsessive Compulsive Disorder (OCD) or traits

H.  May have one or more of the 7 types of ADHD (see http://www.amenclinics.com)

I.  Usually has executive function difficulties (i.e., time management, planning ahead, organization)

J. May rock, leg-bounce, fidget or other movements with hands, twirl hair, stroke soft fabric to self-soothe (aka stimming or self-soothing), doodle, draw

K. May be very sensitive to medications, caffeine and/or alcohol

L. May have gluten, wheat, casein or other food allergies/intolerances, gut issues

M. May have sleep difficulties, a preference for staying up late at night, usually not a morning person, may be very creative at night

N. May have Dyspraxia

O. May have tics (for example, throat-clearing, coughing)

7. Physical Appearance

Usually dresses differently from her peers, often eccentric, may dress more for comfort than appearance.

May dress “over the top” or unusually for occasions

May try very hard to fit in appearance wise or may not care at all

May have a special interest in fashion and femininity

May not shower or upkeep hygiene at times, due to different priorities (usually being involved in special interests)

Looks younger than her years

Has an unusual voice; maybe “child-like”, monotone, loud or soft, quality to her voice

Often does certain things with hands (twirling hair or items, different movements) or legs (leg “bouncing” or rocking while standing)

8. Lifestyle

Books, computers, the Internet, animals, children, nature may be her best friends

She loves quiet, solitude, peaceful surroundings

She may be ultra-religious or not at all. Buddhism appears to be common

May prefer to spend as much time as possible by herself, with animals or in nature

May have a strong preference for routine and things being the same day after day

Gets pleasure from being engaged in her chosen work and/or special interests

She may make it a high priority to arrange her life, events, work, and environment to avoid overwhelming, stressful or upsetting situations

9. Relationship Choices/Sexuality/Gender

May date or marry much older or much younger partners, same-gender partner, tending not to see the “age”, “gender”, but rather the personality of the person first

May be asexual, having preferences that are deemed as more important than sex or a relationship

May be ‘hypersexual”, fascinated by physical sexual contact

May differ from peers in terms of flexibility regarding sexual orientation or may think about or want to change gender. Some individuals may change gender or experiment with sexuality as a means to find social success or to “fit in” or feel less different

May not have wanted or needed intimate relationships (asexual)

There is a greater flexibility in sexuality and/or gender. Maybe heterosexual or may be asexual, gay, bisexual or transgender

May be androgynous and prefer to wear men’s clothing

As a teenager may experience Rapid Onset Gender Dysphoria (ROGD)

May be or have a history of being promiscuous OR asexual or inappropriate (i.e., following someone they like although they don’t know how to engage in the art of dating or flirting. This can lead to stalking someone and eventually the Police becoming involved)

Prone to safety issues due to not being aware of surroundings

10. Special Interests

Current research shows that individuals on the Spectrum do not have “restricted interests”, but rather a lifetime of interests that can vary. A special interest may involve the person’s career, Anime, fantasy (think Dr. Who, superheroes, and Harry Potter), just to name a few, writing, animals, reading, celebrities, food, fashion, jewelry, makeup, tattoos, symbols and TV Series (think Game of Thrones). This is not inclusive

May attend ComicCon, SuperNova, love dressing up as a character.

Ability to “hyperfocus” for long periods of time involved in the special interest, without eating, drinking or going to the toilet, is able to hyperfocus on her special interest for hours, often losing track of time

Loves and revels in solitude, peace, and quiet. Solitude is often described as “needing it like the air I breathe”

An intense love for nature and animals

Often not interested in what other people find interesting

May collect or hoard items of interest

Introspection and self-awareness. Many women spend years trying to understand themselves, reading self-help and psychology books and wonder why they feel so different, from another planet or that the “Mothership has dropped me off on the wrong planet”.

Justice Issues

May know every lyric to a song or every line to a movie from repetitively watching them or listening to them

11. Emotional

Feels things deeply (Category 5 emotions) and may be inconsolable (cannot be calmed down). Often has “over the top” reactions to events

May have severe “depression attacks” that last for a few days; may feel the world is about to end

Does not DO calm, stress, conflict, confrontation or fighting

Struggles with degrees of emotions

Think that people are laughing at her or making fun of her when they are not

Facial expressions do not match the situation. May have an inappropriate emotional expression to the situation

Other people’s moods affect her, especially if they are negative

Tends to be very sensitive to emotional pain

Emotions may be delayed so that for e.g., she can be a great ER doctor, but may fall apart a few days later about a traumatic work situation

Anxiety is a constant from the very early years and is often overwhelmed by the amounts of tasks that need to be completed. Triggers for anxiety are varied from too much thinking to catastrophizing to change in routine, change in general, people, perfectionism, fear of failure, sensory issues, the feeling of not fitting in, the stress of feeling that he/she has to do things right, any environment that is noisy, has a lot of people in it, perceived or actual criticism

Deeply moved by arts, music, certain movies

May be unable to watch horror, violence, disturbing movies, and news programs

Lives with continual generalized anxiety, bouts of depression that creep up on her

Difficulty regulating emotions and managing stress

Is socially and emotionally younger/immature than her chronological age, much younger if in her twenties

Emotionally too honest (inability or difficulty hiding true feelings when it would be more socially acceptable to do so) and naive

Experiences intense emotions of all kinds (for e.g. when she falls in love, she ‘falls’ in love deeply)

May think she is being compassionate, but her actions may not come across that way

Often too sensitive and possesses too much emotional empathy

Usually, connect and/or are very sensitive to certain characters in movies

Highly sensitive to issues affecting the earth, animals, people, advocacy, justice, human rights and the “underdog”

Some women are quite “child-like”, not reaching a maturity until roughly 40 years of age

Many create their own fantasy worlds

12. Personality characteristics and/or traits and abilities

A natural born leader, independent, strong-willed, determined and can be highly competitive (even with herself)

High levels of introversion OR can be extroverted

Generally lack a strong sense of self, self-esteem and/or identity. May use chameleon-like skills to assimilate and be involved with to a variety of groups or different people over time, in a search for true identity.

Has a high sense of justice and fairness, is a truth-seeker, sometimes to his/her own detriment

Highly creative and may have ‘rushes’ of original ideas

Dislikes change and may find it disorienting and stressful

Highly sensitive to criticism or perceived criticism

Dislikes being observed when having to perform (performance anxiety)

May have been told she cares too much, does too much for others and/or is too sensitive

Is perfectionistic (may have attended a perfectionism group program)

Attention to detail

Obsessions/special interests can be short-term (switching from one to another quickly) or long-term (can make a great career)

Naivety, innocence, trusting too much and taking others literally are a powerful concoction for being misused and abused

Masking: as above in this picture, giving off the illusion that everything is great or fine, when is it not. The mask often comes off at home with crying, meltdowns, or shutdowns.

A strong sense of feeling different from her peers often described as being from a different planet

May not have a sense of self and/or identity, self-esteem

Tend to be very serious, often too serious at times

Is intense in everything she does

In childhood, may have been described as highly sensitive and/or shy

Highly imaginative

May have trouble distinguishing between fantasy and reality

Does not like it when people move or touch her belongings; people interpret her as rude and aggressive

13. Past and/or current mental health history

A history of self-harm

May have a history of crying a lot, without knowing why

May have a lengthy history of going to therapists, psychiatrists, psychologists

May have tried a variety of medications

Experiences social anxiety and generalized anxiety disorder or selective mutism

May have Obsessive Compulsive Disorder or traits

May have one or more of the 7 types of ADHD

Has experienced ongoing depression and/or tiredness/exhaustion, without knowing why

A history of trying to understand oneself, of finding answers to explain oneself and why she feels she is different or doesn’t fit in, as a woman

A history of many doctors and counselors visits throughout university life

May have a family history of Autism, Asperger Syndrome, Bi-polar disorder, schizophrenia, ADHD, OCD, anxiety disorders

May have been misdiagnosed with bipolar disorder, borderline personality disorder or schizophrenia

May have been previously diagnosed with anxiety disorder depression, an eating disorder, borderline personality disorder, bipolar disorder and/or ADHD

A history of depression, anxiety, eating disorders, huge mood swings

May have ROGD or be transgender

14. Coping Mechanisms

Compensatory Mechanisms are unfortunately what lead many an individual to receive a diagnosis much later in life when they cannot keep the mask on anymore.

May have turned to alcohol, drugs, smoking in order to cope with intense emotions, self-medicate and/or socialize/fit in and/or be accepted with a group.

May use a different persona when out in the public, in order to cope

May have developed a variety of dysfunctional coping mechanisms (for example, arrogance and/or narcissism)

May change gender or sexuality in an attempt to “fit in” and/or find the right group

Has used imitation, social echolalia to pretend to be normal, fake it or pass for normal

May rock standing up, lying down, in a rocking chair to calm down or self-soothe

May need to withdraw into bed or a dark area or a place of solitude to gain privacy, quiet and manage sensory and/or social overload

Withdrawal and/or Avoidance

May have developed a personality disorder as a means of coping with Asperger Syndrome

15. Sixth Sense, Intuition, Psychic Abilities

Has the ability to feel other people emotions, take on the emotions of others

May “know” or have knowledge of certain things, but no idea how she knows, aka “vibing”

May be a professional psychic or medium

Possesses one or more psychic abilities

Is an “empath”

Sensitive to other people’s negativity

Often confused by the feelings she/he is having

May take on the pain of other, aka Mirror-Touch Synaesthesia

16. Unique abilities and Strengths

May have perfect or relative perfect pitch

Autodidactic – teaches herself

Intelligence craves knowledge and loves learning

Can teach herself just about anything she puts her mind too

Has a strong will, is determined and independent

Perfectionistic

Have a remarkable long-term memory, photographic memory

A great sense of humor

Can work very well in a “crisis” situation

Deeply reflective thinker

Resilience, an ability to go from one crisis to another, to bounce back, to start again time and time again

Attention to detail

Great in one-on-one situations or presenting to a group

More like “philosophers” than “professors, but can be both.

Seeing in the “mind’s eye” exact details, gifted visual learner

May be gifted with art, music, writing, languages, programming, acting, writing, editing, singing, an athlete

May be highly intuitive

Capable of deep philosophical thinking, females with Aspergers often become writers, vets, engineers, psychologists, social workers, psychiatrists, poets, artists, singers, performers, actresses, doctors, entrepreneurs or professors.

17. Challenges

May be difficult to understand subtle emotions, for e.g., when someone is jealous or embarrassed, uninterested or bored

Keeping up appearances, passing for normal

Managing emotions and getting easily hurt by others; even if the other person was innocent

Learning difficulties

May get very upset with an unexpected change

May not be able to tell when someone is flirting with her/him

Challenging to work and function within a group

Have a need for a highly controlled environment to sleep in

Great difficulty and very sensitive to conflict, stress, arguments, fighting, wars, gossip and negativity, however ironically may engage in it

Can be very negative and have catastrophic feelings; can be very self-deprecatory toward self

Social-chit chat, small talk, conversation without a “function”, maintaining friendships and relationships, social anxiety or social phobia

May like or prefer to be by herself as much as possible

May find it challenging to understand what others expect of her

Being taken advantage of due to naivety, innocence and trusting others too much; this often leads to being in toxic relationships or friendships

Boundaries issues

Executive function challenges: May have difficulty filling out forms, doing paperwork (completing taxes), budgeting money, finishing a task or job, planning (meals, the day, the week, answering the phone or talking to people on the phone, how to start a particular task and get it completed, knowing where their possessions are, going to appointments, waiting in line or at an appointment

May have difficulty recognizing or remembering faces (prosopagnosia)

May have Alexythymia: cannot verbalize their feelings as they are often unsure of what they are feeling

May have Synaesthesia

May experience existential dread

Has difficulties with unexpected visitors just “dropping over”

Gullibility or social naivity can get them into enormous trouble. Will often take at face value what a person says about another person

18. Empathy May have a lack of cognitive empathy and hyper-empathy (for e.g., too much affective or sympathetic empathy)

Cognitive Empathy: The ability to predict other’s thoughts and intentions, knowing how the other person feels and what they might be thinking. Also known as perspective-taking.

Affective/Emotional Empathy: The ability or capacity to recognize emotions that are being experienced by another person, when you feel the feelings of another person along with the other person, as though their emotions are your own. Social neuroscience has found that this kind of empathy has to do with the mirror neuron system. Emotional empathy contributes to an individual being well-attuned to another person’s inner emotional world, an advantage for individuals in a wide range of careers from nursing to teaching to social work, psychology and other caring professions.

Compassionate Empathy, or “empathic concern”. This kind of empathy helps us to understand a person’s predicament and feel with them, and also be spontaneously moved to help them, if and when others need help. Under stress, Theory of mind skills may appear to be completely absent.

Sympathy: often has too much sympathy, placing her in danger, for example, I once had a young client who brought a homeless man home because, as she said, ” he had no hone”

19. May have Ehlers-Danlos Syndrome, poor muscle tone, connective tissue disorder, double-jointed, fine and/or gross motor skill issues

20. May have an intense desire to please others and/ be liked by others and be a “people pleaser”. May become highly distressed if she has the perception that someone does not like her or actually does not like her.

21. Executive functioning difficulties may include: trouble making decisions, time management, planning ahead, organization, completing tasks.

22. May have spent a lifetime of using enormous effort to socially “pretend”, “fake it”, “fit in”, “pass for normal”. May have utilized body language books, mirrors, acting/drama classes to improve social skills.

23. May have tocophobia, the fear of childbirth or other fears (death, dying, a changing body, for example)

24. May have gender dysphoria, also known as gender identity disorder (GID) dysphoria, and is a formal diagnosis for individuals who feel and experience significant stress and unhappiness with their birth gender and/or gender roles. These individuals are known as transsexual or transgender.

25. Photographic visual memory

26. An intense and continual need to figure oneself out.

27. Hypermobility Syndrome

28. Typical sex difference has been reported (i.e., female advantage), in relation to the “Reading the Mind in the Eyes” test (Eyes test), an advanced test of theory of mind.

1. May be a high systemizer leading her to go into engineering or programming. High systemizing women see to feel the “weirdest” of the collective. May struggle with who she is gender-wise.

30. Subtypes

Within a very large group of females, we begin to see variations, preferences, and heterogeneity. Whilst all females struggle to some degree with social communication, intense interests, sensory issues and many traits as mentioned above, there is not one “type” of presentation. The most commonly known presentation of females in the Spectrum is the “Tomboy”, how there exist other presentations and it is important to talk about these, as it is these females who may never receive a diagnosis.

A. The FashionDiva

B. The Highly Sensitive Male

C. The hostess

E. The carer

F. The actor

More Coming

No one woman will have all of these traits. Some of the traits in this list may not apply to you. A level of insight and awareness is required in terms of recognizing the traits, characteristics, and behaviors in oneself. Asperger Syndrome often co-occurs with  Dyslexia, Dysgraphia, Dyscalculia, Irlen Syndrome, Dyspraxia/Disability of Written Expression, Auditory Processing Disorder and/or Ehlers-Danlos Syndrome. Individual traits and characteristics can vary from mild to severe.

About Tania Marshall

Tania Marshall is an award-winning author, presenter and psychologist. She holds a Masters of Science in Applied Psychology and a Bachelor of Arts in Psychology. She completed and 18-month full-time post-masters externship at a private special needs school, working with many neurodiverse people, K-12 and their families. During that time, she also worked in private practice under the supervision of a clinical psychologist. In December 2016, she was nominated for a 2017 ASPECT Autism Australia National Recognition Award, in the Advanced category for her work advancing the field of female Autism. She has previously been nominated for a 2016 and 2015 ASPECT Autism Australia National Recognition Award (Advancement Category) for her work. Her first book entitled I Am AspienGirl: The Unique Characteristics, Traits and Gifts of Young Females on the Spectrum, Foreward by Dr. Judith Gould, is an international bestseller and an IPPY 2015 ELit Gold medal award winner. Her second book entitled I Am AspienWoman: The Unique Characteristics, Traits and Gifts of Adult Females on the Spectrum, Foreward by Dr. Shana Nichols was released late 2015, is an international bestseller and recently won a 2016 IPPY eLIT Gold medal in the Women’s Studies category.

Tania is also an APS Autism Identified Medicare Provider, a Helping Children With Autism Early Intervention Service Provider, a Better Start Early Intervention Provider, a Medicare Approved Mental Health Provider and a Secret Agent Society (SAS) Trained Group Facilitator.

Tania regularly provides diagnostic assessments, impressions assessments, support, problem-solving sessions, coaching and intervention for neurodiverse individuals of all ages across the lifespan. She sees people of all ages who are are artists, scientists, engineers, entrepreneurs, gifted and talented, supermodels, singers, authors, performers, dancers, celebrities and/or Twice-exceptional (2e). To enquire or book Skype or in-person assessments, problem-solving sessions and/or support, interviews, articles, publishing inquiries, translations/translating of her books, presentations, workshops, conferences, please e-mail Tania at tania@aspiengirl.com

Tania is now completing the third book and fourth in her series of books on female Autism. Her book series is available for purchase at http://www.aspiengirl.com 

ADDITIONAL TRANSLATIONS

Tania Marshall© 2013-2018

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