This is a recent FAQ on self-deprecation in neurodiverse females. As always, If you like it please share and leave your positive comments or other questions below. This video was made by the Neurodiversity Academy, founded by and funded by AspienGirl girl.com
The AspienGirl Project is pleased to announce that the sequel to ‘I am Aspiengirl’ entitled ‘I Am AspienWoman’ recently won a 2016 IPPY eLit Gold Medal Award in the “Women’s Category” in April. I am AspienWoman is the culmination of a blog Tania wrote a couple of years ago entitled ‘Moving Towards a female profile of Asperger Syndrome’, with close to 300,000 views, to date. That blog is regularly updated. You may purchase copies at http://www.aspiengirl.com, Amazon or other fine books stores.
Tania spends her professional time in private practice. She provides diagnostic assessment impressions reports regularly (across the lifespan), and provides interventions and support. For more information regarding diagnosis and assessment, bookstore wholesale discounts, book contracts, interviews, translations, workshops and conferences, please email firstname.lastname@example.org
On the Bright end of the Autism Spectrum and the female Autism Crisis: How and Why Do Bright Autistic Females fly under Professional Radar?
Female Autism is a new and complex area of research with information in this area of Autism growing exponentially. Both empirical studies and qualitative differences are starting to show show that females ‘meet the diagnostic criteria’ in different ways from males. This then leads to females being misdiagnosed, mistreated and/or medicated. In 2015 alone, there have been over 15 gender studies published regarding the differences between males and females. While research is starting to catch up with clinical and anecdotal research, the time it will take for this to trickle down to professionals and those at the ground level may take many years, with females continuing to be under diagnosed and/or misdiagnosed. Many girls and women exist today without a diagnosis. She may have even been assessed by a professional working in the area, but was told she did not meet the “criteria”. If a female can get an accurate diagnosis, she is then often left without intervention and/or support. This is what I call the ‘Female Autism Crisis’.
The ‘Female Autism Crisis’
There is a lack of awareness, understanding and education regarding the female profile or ‘phenotype’, a range of often subtler characteristics, strengths and challenges that do not fit the male profile nor does a female with a diagnosis of Autism feel she fits that profile Common characteristics have been outlined in my initial blogs which were then turned into my book series (bestsellers I Am Aspiengirl and I am AspienWoman).
There is a need for research on:
the differences between neurotypical girls and Autistic girls
camouflaging of autistic symptoms and impairments, adaptation, learning, masking or compensation abilities
diagnostic and classification challenges
the factors that increase or decrease the risk of a female being misdiagnosed or completely missed; the consequences associated with this
information as to how culture, social factors, gender and/or familial upbringing play a part in female Autism
Why do Autistic females fly under the professional radar and why will this continue to occur for some time?
- Autism was and still is presumed by many people, professionals included, to be a “male” condition. Some professionals acknowledge that females have Autism and may be unaware that males and females often present very differently.
2. Adherence to a very strict DSM5 criteria which has a gender bias. Whilst DSM 5 has hinted at sex differences in Autism, it does not acknowledge brighter individuals. It also does not elaborate much on what these actual differences are or whether there is a female profile or phenotype.
Unfortunately, some girls are now being diagnosed with the DSM5 Social Communication Disorder (SCD)
3. A female phenotype is emerging that suggests an inherent gender bias. The Sfari webinar entitled The Female Autism Conundrum is a great place to start to understand this bias
4. Professional ‘bias’
The child’s behaviors are more a function of the families “alternative” lifestyle
The child does not present with significant enough behaviors, appearing to be “normal” externally
The child does not present with the “male” stereotype or “female” stereotype of what Autism should look like
The childs anxiety, eating issues or behaviors are the focus and the diagnosis is missed
Strict adherence to the diagnostic criteria
5.The emerging female phenotype or profile
A steady collation of anecdotal, clinical and autobiographical reports and current research discuss different presentations, phenotypes or a “female profile” and when assessed with “male-biased” or male-centric tools, many females slip through the cracks. Females on the Autism Spectrum can and do hold eye contact and make superficial conversation. If fact, they can hold superficial conversation for an entire session with a professional!
The girl does not have stereotypical repetitive behaviors
1. There is a lack of assessment tools created for females across the lifespan. The ADOS often shows elevated traits, but not enough to meet the criteria for a diagnosis. Females are often missed because they do not meet the cut-off score, although there are often clues in the ADOS results. Females can have the ability to discuss many social-emotional areas by responding cognitively well. However, many parents, school officials, and/or professionals have found that those social-emotional areas are not often displayed or used adequately, and often then, see the individual using other strategies to cope. It appears that the characteristics and traits as captured by “gold standard” assessment tools may be male-biased due to the gender-centric items that contribute to the scoring. A further comprehensive assessment and/or a second opinion then reveals the individual does meet criteria for Autism or Asperger Syndrome.
2. Females often can and do engage in superficial conversation, make good eye contact and conversation, for the first initial session or hour. This can confuse professionals who are used to seeing particular social clues more immediately and who may think that a female is just “too social”.
3. A lack of understanding regarding coping strategies, compensatory strategies, masking behaviors and the more subtle presentations. Female body language can be expressed quite differently as they learn to act, pretend, mask and compensate for their social difficulties.
4. A lack of trained professionals working in the area of female autism
5. Confusion as to the diagnostic overshadowing, for example, whereby a female may be diagnosed may be told she is “shy” rather than “social anxiety”, may be diagnosed with an “eating disorder” rather than Autism.
6. A lack of understanding how females with Autism present across the lifespan
7. A lack of both quantitative and qualitative data and research regarding females
8. Co-occurring conditions can make assessment a complex and challenging process for diagnosticians working with adults. Whilst many adults have been or are misdiagnosed with a personality disorder, there are adults with both Autism and a personality disorder or those who have been misdiagnosed with Autism and really have a personality disorder
9. A lack of knowledge about the heterogeneity within the female group and the variance in how it presents. There exist different subgroups in females with Autism and range from a more “male” autism profile-type presentation (maybe diagnosed earlier) to those with many “masking” characteristics, where professionals or family members may not believe the person who is telling them about their diagnosis. The female group as a whole consists of much heterogeneity and thus females can present in sub-types (for example, a tomboy, a fashion princess, a bookworm professor type, the athlete). This further causes confusion for diagnosticians who are not familiar with the range of presentations within female Autism (often diagnosed much later, if at all). There is a tendency for an “obsession” to become the person’s identity.
10. For some young females, the need does not appear to be “obvious”, or the “issues” are misinterpreted, UNTIL the teenage years. Presenting concerns may be interpreted as another disorder or generalized. For example, “she’s just got some social issues”, “she”ll grow out of it”, “she is just shy”. Some females present with an eating disorder and Autism is never considered.
11. Some common misconceptions or myths about female Autism can contribute to this issue: “She can make friends, make eye contact and socialize, so she can’t have Autism” “She is too sensitive, so she can’t have Autism” “She holds down a full-time job, so she can’t have Autism” “She has too much empathy so she can’t have Autism”.
12. Females tend to exhibit better expressive behaviors (reciprocal conversation, sharing interests, integrating verbal/nonverbal behavior, imagination, adjusting their behavior by situation) despite similar social understanding difficulties as males), present with different manifestations of friendship difficulties (better initiation but problematic maintenance, overlooked rather than rejected by peers, better self-perceived and parent-reported friendship), and different types of restricted interests and less repetitive use of objects.
13. Some common female differences include: less repetitive behaviors, a greater awareness of the pressure and desire for social interaction, a passive personality, often perceived as “shy”, a “loner”, a tendency to imitate others (copy, mimic, or mask) in social settings, a tendency for social exhaustion (or as I like to call it a “social hangover”), a tendency to “camouflage” their difficulties by masking and/or developing strategies to compensate for the challenges and difficulties they are facing, a tendency to have 1 or few close friendships, a tendency to be “mothered” in a peer group in primary school, BUT often bullied in secondary/high school.
14. There appear to be better linguistic abilities, more imagination (fantasizing and spending time involved in fiction and pretend play and when observed closely the play can be observed to have a lack of reciprocity, to be scripted and/or controlling.
15. Less restricted interests/activities tend to be common involving people and/or animals rather than objects/things (e.g., animals, stationary, soap operas, celebrities, pop music, fashion, horses, pets, and books/literature), which may be seen as less recognized as related to autism. She may be viewed pr perceived as just a “moody bookworm”.
16. A lack of understanding sensory sensitivities and how they impact the ability to function from day to day. An individual may not be able to explain what they are experiencing. In particular, professionals may be more likely to view an individuals’ comments about how they perceive the world as “psychotic”, rather than sensory processing disorder or sensory sensitivities.
17. Diagnostic confusion and not asking the right questions or clarifying what the client has said, can lead to misdiagnosis. Many adult women have multiple labels or diagnoses before they receive the correct diagnosis. As mentioned previously, a lack of understanding as to how sensory sensitivities affect an individual can lead to misdiagnosis. Having a fantasy world and imaginary friends or animals can lead professionals to suspect prodromal schizophrenia in a girl or adolescent. A girl who has developed routines and rituals around food and calories, nutrition and/or exercise may be diagnosed with Anorexia Nervosa and the Asperger Syndrome is missed. Borderline Personality Disorder is a common misdiagnosis with females usually not fitting neatly in the diagnostic criteria. Furthur complications include individuals who meet criteria for both Autism and a personality disorder.
Professionals may not understand that many females have the ability to “feel” other people’s feelings and this can be quite overwhelming for them. They may not trust talking about their hyperempathy, hence they will be misunderstood. Females may not trust other people due to the ‘cognitive dissonance’ between non-verbal body language and what she “feels” off the person. In combination with social and relationship challenges, her behaviors look like Borderline traits or Borderline Personality Disorder.
Until professionals catch up with current research on females, they will continue to be diagnosed and/or misdiagnosed with:
Anxiety Disorder, Social Anxiety
The new DSM5 diagnosis of Social Communication Disorder
Borderline Personality Disorder
Intermittent Explosive Disorder
Schizophrenia or Schizotypal personality disorder
18. Cultural bias can leads to under-identification. For e.g., some immigrant women have been unable to gain an assessment as their differences in communication and behavior are not seen or viewed as unusual, but more of a ‘cultural’ difference
Even if a girl has subtler difficulties than other children with the disorder, those problems may nevertheless have a tremendous impact on her life.
Girls appear to use their intelligence and their abilities to to learn quickly how to combine non-verbal and verbal behaviors in addition to maintaining a reciprocal conversation and be able to initiate, but not maintain friendships. In combination with less to no and different restricted interests and an inability to communicate their needs, girls appear “less” impaired than they really are, especially in the school environment. Females on the Spectrum present with a “look” to them that suggest they are merely more sensitive, emotional and/or anxious than others.
Autism is particularly challenging to detect in girls, especially bright young girls, because generally there are little to no concerns at school. Typically, the Autistic female is doing everything to hide it, from using her cloaking device (hiding in a group) to blending in with the wall (hiding in the classroom) to chameleonism (adopting the social behaviors of another student or adult), allowing them to be much better socially over Autistic males but not neurotypical females. Their ability to hide their Autism is a superpower, but there is a high cost to pay.
Seen in private practice, the subtleties in bright females are abundant, from subtle clues externally (from a slight grimace in their smile to over-exaggerated body language) to social scripts (only observed if you see the girl a few times) to older children or teens who are questioning their gender (because they have always been unable to relate to their peers). Some females want to become boys, some are happy with their androgyny, some are happy to remain female and some change their gender entirely.
Observing, describing and understanding the unique presentation of autism in girls is the beginning to improve identification rates and create unique resources just for females. Understanding the heterogeneity of this group of females is also very important. In my 2nd book I Am AspienWoman, I discuss the differences and subtypes. Developing diagnostic tools is imperative as are intervention resources specifically for female
Tania can be reached for fee-for-service impressions assessments (in person or Skype), consultations, problem solving consultations and/or support, interviews and/or presentations/workshops, and/or book translations at email@example.com
Tania divides her time between full-time private practice, research and writing her books series.
To subscribe to the AspienGirl newsletter or to become and affiliate and earn 10% on all books referred, go to http://www.aspiengirl.com
To purchase I Am AspienGirl or I Am AspienWoman or pre-order AspienPowers or I Am AspienBoy, go to http://www.aspiengirl.com
For more information about female Autism or female Asperger Syndrome, go to http://www.taniamarshall.com
Future Books and Webinar Series
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)
To find I Am AspienWoman on Amazon:
The book is also available at http://www.aspiengirl.com
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 firstname.lastname@example.org
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.
20 Reasons for obtaining an Adult Autism diagnosis
One of the most frequent questions I am asked is about the relevance of obtaining a formal diagnosis or formalizing a self-diagnosis. My 2nd book, I Am AspienWoman alludes to this very topic through powerful images, experiences, thoughts and feelings of many adult autistic women. There are many valid reasons for obtaining a diagnosis and the majority of women who receive one explain the benefits in the book. I have included a couple of pages from the book and you can now pre-order I Am AspienWoman, available in eBook, paperback and hardcover, at http://www.aspiengirl.com You will receive $10 off if you order an I Am AspienGirl© and I am AspienWoman Combo. I hope you enjoy the book as much as I did writing it!
Tania is available for in-person or Skype consultations, assessments or problem-solving sessions. To book appointments or discuss and/or book availability for presentations, conferences, publishing, translation and media interviews or inquiries, please email Tania@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 for her first self-published book entitled “I Am AspienGirl© : The Unique Characteristics, Traits and Strengths of Young Females on the Autism Spectrum”, foreword by Dr. Judith Gould. The sequel to this book entitled “I Am AspienWoman: The Unique Characteristics, Traits and Strengths of Adult Females on the Autism Spectrum”, Foreword by Dr. Shana Nichols is available September, 2015. Tania is currently writing the third book in her book series entitled “AspienPowers: The Unique Constellation of Strengths, Talents and Gifts of Females with Autism Spectrum Conditions”. The Spanish version of I am Aspiengirl© , entitled Soy AspienGirl is now available. Tania’s work has been translated and/or cited in numerous publications including Sarah Hendrickxs’ recent release entitled “Women and Girls with an Autism Spectrum Disorder” (2015), foreword by Dr. Judith Gould.
Tania currently works in busy full-time private practice, providing diagnostic assessments, intervention and support to males and females ages 2-76 years of age. 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.
© 2015-2017 All rights reserved Tania Marshall
Assessing the behaviors, traits and abilities of young females on the Autism Spectrum: For professionals and parents
Girls with high functioning Autism (Asperger Syndrome) often have subtler characteristics that lead them to be missed by professionals. Many (not all) are able to use compensatory strategies to mask their difficulties and these are learned from before they start grade school. Autism tends to be a condition of extremes; an either/or condition in which two girls who present quite differently can both be on the Spectrum. For example, one is shy, quiet and mute and the other is loud, has a lack of boundaries and talks too much. The both have social communication and interaction difficulties.
Girls on the Spectrum may present as shy, quiet and at times mute, taking a long time to warm up to situations or they may present as overly talkative, verbal and lacking boundaries.
The quiet girl can be described as passive, a follower, watching and observing her peers much of the time to learn what to say or how to act. She is very shy in social situations. The verbal girl is often dominating, described as “bossy and controlling”, often described as having to have the best at everything and have her own way. She dominates and controls social situations.
Both girls may not receive many birthday invites, prefer one or two close friends, prefer to play with younger or older children rather than their peers, prefer to talk to boys or have boys as friends.
The quiet type may be attracted to extraverted personalities who tell her what to do or are controlling towards her due to her passivity and shyness. The verbal type may be domineering and controlling in her interactions with others.
Why do girls who have an assessment not receive a diagnosis?
Females can and do make eye contact and can have superficial reciprocal conversations in initial interviews with professionals.
Females are reluctant to admit they are having difficulty and will say they have friends, that they know what to do socially, when they are actually socially confused
Females start learning, often from before grade school to camouflage their difficulties and pretend every thing is fine
Females will say everything is ok and there are no problems even in the face of contrary evidence or difficulties
Professionals are viewing the female as just a “shy” and/or “sensitive” child or a “hormone driven” teenager, when in fact they have Autism. Around the age of 12-13 are when the proverbial wheels may begin to fall off and the inability to cope comes to the forefront
Professionals may diagnose only the presenting issue (for e.g., anxiety disorder)
They may receive high scores on the ADOS but not enough for a diagnosis
The majority of assessment tools are based on males
Professionals are not trained in understanding the gender differences, the gender bias, the questions to ask, compensatory strategies and camouflaging techniques
Some clues look for in an assessment
The Social World
1. exaggerated facial mannerism or a flatter affect. Many girls I have worked with have a slight grimace to their smile. This is a clue that they may be having difficulties with their own non-verbal body language. Many childhood photos reveal either no smiling or a slight exaggerated smile or facial expressions
2. look for facial expressions not matching the mood or the situation being discussed. For example, it is common to observe smiling or laughing whilst talking about a situation that would usually be associated with a different emotion (and therefore a different facial expression and tone of voice).
3. many girls say they know what to do in a social situation but when asked, are not able to tell you what they would do or give an answer that leads to to believe otherwise. An investigation into levels and types of friendships and social skills often reveals difficulties
4. exaggerated non-verbal body language is often a clue. Some girls present in the clinic with body language that appears “odd”, unnatural or like they are acting with you in a conversation.
5. Many females are well-behaved (often too well-behaved) in school but the opposite at home (due to social exhaustion and holding it all in)
6. Many females are observed using behaviors or words from their peers, other people or television. They may copy, look like or act like others, taking on the characteristics, mannerisms, voice, sayings, of others.
7. Many females present in different ways depending on the situation and this can be confusing to family members.
8. Many females will tell you they know what to do in social situations, but the evidence is contrary and/or you will get the impression that they are confused or are not being truthful.
9. Some females may not apologize when they have made a social error and some females over-apologize due to being confused about social rules. Some females refuse to apologize even when it is plainly obvious it would be in their best interests to do so.
10. Many females are able to socialize quite well for small periods of time but them experience social exhaustion or a ‘social hangover’, needing solitude to recharge her batteries.
The Play World
1. Some girls have a preference to play with stereotypical boys toys, having no interest in dolls whilst others have an obsessive-like quality towards dolls and stereotypical girls toys (for e.g., collecting all barbie dolls).
2. Girls can often be observed spending the majority of their time putting together the scene of play, rather that actually playing. For example, spending the majority of time ensuring all the furniture, accessories and dolls are in the right place). They often have elaborate scenes of play set up and organized.
3. Whilst playing on their own, girls are often observed to be role-playing adults. For example, a girl may set up all her teddy bears bears, dolls, etc., and role play the teacher, doctor, nurse or other role. She may take attendance, give time-outs, write out lesson plans and/or teach class lessons.
4. Girls on the Spectrum are often far more imaginative than their peers. They are often observed pretending to be animals and/or imitating them. They may also have some difficulty distinguishing between reality and fantasy
5. A tendency to have imaginary friends and/or animals who are very real to the child, to the point that they may have table settings for them at the table, seats for them in the car, and so on.
6. Girls often spend more time playing with the family pets and/or on nature than their peers, having a natural affinity/gift in the areas of nature and animals. It is the intensity of the interest as compared to neurotypical peers that is key here.
7. May have obsessions with other people which can be observed as too clingy, not allowing the friend to have other friends, not giving them enough ‘space’, or obsessing over them
8. Females tend to have more avoidance traits and strategies when demands are placed on them
9. Some females may flitter from group to group in school not really having any real friends but giving the appearance of having friends, so that no one would pick up on this
Abilities, Gifts and Talents
Abilities, Gifts and Talents are plural due to the many females I have met who display multiple talents. These abilities often include:
hyperlexia/reading ability, perfect or near-perfect pitch, languages, art, performing arts (dance, acting/drama, singing, musical theatre, modelling, involvement in a band, comedy), the care of animals, mathematics, writing fiction and/or fan-fiction and/or poetry and/or songwriting, intelligence,
Mature interests may include interests advanced for her age (philosophy, psychology, opera, a language)
Immature interests may include an interest well past her developmental age (for example, my little pony, doll or teddy bear collections).
Some females present as more of a “tomboy” appearance (preferring an androgynous clothing style) and disliking make-up and sterotypical girls clothing
Some females present as a “ultra-feminine” or “princess” like appearance (love make-up, fashion, trends and shoes). they may spends time involved in shopping for clothes and/or designing clothes, perfecting the art of makeup and.or modelling
Regardless of presentation, a difference in terms of clothing as compared to her peers is usually observed. My screener which was the basis of I Am AspienGirlL The Unique Characteristics, Traits and Gifts of Females on the Autism Spectrum is here:
A female autism assessment tool I often use in conjuction with other tools includes this screening questionnaire developed by Kopp and Gilberg and it is excellent.
THE AUTISM SPECTRUM SCREENING QUESTIONNAIRE (ASSQ)-REVISED EXTENDED VERSION (ASSQ-REV), by Kopp and Gilberg
Kopp and Gilberg found that certain single ASSQ-GIRL items are often much more typical of girls than of boys with ASC. These items include “avoids demands”, “very determined” and “interacts mostly with younger children”. The ASSQ-REV is a new assessment tool that includes a set of “girl” items.
ASSQ-GIRL, 18 new screening items believed to tap into the autism phenotype of girls
ASSQ-GIRL item No Somewhat Yes
- Copies you (can be in a very discrete way)
- Episodes of eating problems
- No time perception*
- Too much sympathy
- Extremely interested in pop/ rock bands, soap operas or natural disasters
- Avoids demands*
- 34 Very determined*
- 35 Difficulties with choice; always avoids choosing
- 36 Difficulties with self-care*
- 37 Carefree or overmeticulous as regards physical appearance/dress
- Comes too close to others
- Interacts mostly with younger children*
- Engages in dangerous activities
- Exaggeratedly fanciful
- Talks without content*
- Writes long stories (can be in stark contrast to level of talk)
- Acts or lives different parts (TV stars, videos, animals)
Note. *indicates items which were considered most specific in girls with ASD (see study V)
To contact Tania for assessments, Skype or clinic consultations, problem solving sessions, workshops and presentations, book interviews, book translations, or publishing, please contact Tania at email@example.com
For more information about Autism Spectrum Conditions in females go to:
Copyright Tania A. Marshall 2015
Asperger Syndrome (AS) is thought to be the highest functioning form of Autism Spectrum Condition. Females on the Autism Spectrum are underdiagnosed and often come into a clinic with other mental health issues, many labels or diagnoses, some of which include: anxiety disorders, ADHD, sleep disorders, panic disorders, obsessive-compulsive disorder, depression, bi-polar disorder, borderline personality disorder, eating disorders or schizophrenia.
Females on the Spectrum are generally much more social, really good at “faking” it, understanding non-verbal body language, working very hard to “fit in” and “pretending to be normal”.
Women tend to be much more social than men, observe and watch others more in order to learn what to do, learn how to hold their bodies, what to say and when to say it. All of these skills do not come naturally and an enormous amount of energy is put into these skills. Females are generally able to hold it all together during the day and then let it all out at night. At night, the “falling apart” may look like, jumping, screaming, flapping, outbursts or withdrawing into their caves.
Women generally tend to have better empathy and theory of mind skills. However, these theory of mind skills become affected by sensory issues, stressful situations, social situations, processing of verbal information, high levels of anxiety, conflict and/or arguments.
Of those that come into clinics, anorexia nervosa appears to be the most common eating disorder that females (21.7%) on the Spectrum tend to experience (Nichols).
What is the link between eating disorders and Autism Spectrum Conditions (ASC)?
There is a overlap, possibly a genetic link between ASC and AN.
The lifetime prevalence of an eating disorder is 0.9%. ASD is highly over represented in AN (12-32%). Some commonalities between ASC and AN include:
1. Executive function deficits
2. Mood and anxiety disorders
4. Rigidity in behavior and thinking
5. Theory of Mind Deficits
Autism Spectrum Characteristics that increase the risk of developing an eating disorder include:
1. Clumsiness and knowing where one’s body is in space
2. Body awareness issue, distorted image of body in space
3. Limited social insight; difficulty with understanding how others see their body
4. Stomach issues, a feeling of no appetite, bloatedness
5. A lack of sense of being hungry or thirsty
6. Medication side effects (SSRI’s, antipsychotic and associated side effects of weight gain)
7. Sensory processing sensitivities
8. Stress management
10. Picky eating
Where does a percentage of almost 1/3 of the population with AN having ASC come from?
51 women over 18 years were evaluated using formal interviews, developmental histories and 32% of those met criteria for ASC, but only 11% of them knew that they had ASC. Their families had no idea that they had ASC. The highest prevalence of personality disorders (OCD) were also present.
In terms of intervention and treatment, a modified treatment schedule is important due to learning difficulties, mental health issues including ASC, a balanced/different course load.
What is desperately needed is a routine global screening program for all females who come into a clinic with an eating disorder. It is critical to know if a client has an ASC or has symptoms of an ASC because the symptoms of ASC do not go away post-treatment. The eating disorder may be alleviated, however the symptoms of the ASC have not. This will help the client, their families and their treatment professionals.
Goals for treatment of an ASC and AN include:
1. Treating the sensory processing condition
2. Improving the rigidity and inflexible thinking processes
3. Improving the range of foods eaten
4. Rigid repetitive behaviors need to be replaced with more functional behaviors
5. Increasing and widening the range of foods eaten
6. Decreasing anxiety levels and improving depression levels
7. Work with the preference for sameness and routine
8. Improving sensory processing issues and desensitizing to aversive foods
S Baron-Cohen, A Jaffa, S Davies, B Auyeung, C Allison, S Wheelwright (2013)
Do girls with anorexia nervosa have elevated autistic traits?
Gillberg C, Cederlund M, Lamberg K, Zeijlon L: Brief report: “the autism epidemic”.
The registered prevalence of autism in a Swedish urban area. J Autism Dev Disord 2006,
Eating Problems and Overlap with ADHD and Autism Spectrum Disorders in a Nationwide Twin Study of 9- and 12-Year-Old Children
CAVEAT: My research is focused on females, due to the lack of research and information on the female profile
Tania Marshall 2013. All rights reserved.
Tania Marshall©. 2013. All rights reserved. Duplication in
whole or part is explicitly forbidden. Thank you.