The Female Autism Crisis: Assessment and Diagnosis of the Neurodiverse

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Updated February 18th, 2017

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

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

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

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

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

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

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In assessing girls on the Spectrum, it is important to ask the right questions. I cannot emphasise this enough. There are many questions to ask and what follows are some examples. Keep in mind that high average to profoundly intelligent girls can tell you the socially acceptable answers, 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.

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.

behindmaskfrontcover

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.

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

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

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

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

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

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

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

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

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

I Am AspienWoman now on Amazon USA!

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

I Am AspienWoman August Cover

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

To find I Am AspienWoman on Amazon:

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

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

Back cover of I Am AspienWoman

Back cover of I Am AspienWoman

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

About the Author

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

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

24 Inspiring and Motivational Autistic Women and Positive Role Models

24 Inspiring and Motivational Autistic Women and Positive Role Models

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

I Am AspienWoman August Cover

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

AspienWoman Mentors

AspienWoman Mentor

Dr. Temple Grandin

Dr. Temple Grandin

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Dr. Temple Grandin

Lauren Lovejoy

Chou Chou

Chou Chou Scantlin

Jen Saunders

Jen Saunders

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Jen Saunders

Maja

Maja Toudal

ShanEllis

Shan Ellis

Jeanette

Jeanette Purkis

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Jeanette Purkis

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

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Both books in combo paks for $10 off

About the Author

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

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

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

2015 All rights reserved Tania Marshall

Autistic Women, Diagnosis, Disclosure and Mythbusting

Taken from I Am AspienWoman (2015), release date September, 2015

I Am AspienWoman, Foreword by Dr. Shana Nichols, is over 300 pages and covers the entire lifespan from late teens to the elderly woman. Included is a mentor section including 24 inspirational and motivational Autistic woman, headed up by Dr. Temple Grandin.

AspienWomanApril25th2016

A diagnosis does not always mean disclosure.  By this, I mean disclosure may not be helpful. It depends. In my work with women, I have had women who wanted a diagnosis just for themselves and planned to tell no-one (not even their partners family members), I have had people who have told the world, and I’ve had everything in between!  Disclosure can have positive or negative ramifications and it is context dependent. Once you have disclosed you cannot take it back, nor can you control how or what others will say or think. In an ideal world, it would be perfect if the workplace or educational institution or other people would act according to disability law or respond how you would like them to, but this is often not the case. It may or may not benefit you to tell people and the pros and cons need to be considered, even if a workplace says they are aware and accommodating of disability. What are the pros and cons of disclosure for you?

Be prepared that other people may not believe you

It is a common experience for women to be invalidated, disregarded and/or not believed after they disclose their diagnosis to family members, partners or friends. This is mainly due to a lack of education and/or awareness about Autistic females.

Other people may expect to see physical signs or behaviors to confirm to them that a woman is on the Autism Spectrum. They may compare her to the media stereotyped characters or the males they know or know of on the Spectrum. They may say inappropriate or upsetting things to the newly diagnosed, often coming from good intentions.  Other people on the Spectrum may not believe you or may say just as upsetting things. Educating others (by referring them to research or books) and self-advocating, where possible, may be helpful.

Be prepared for the stereotypes about females with Autism

In particular, educating others about how Autism in females presents and the sub-types. Some common stereotypes and myths regarding females include:

females are Tomboys, dislike make-up and clothing, don’t like fairies or the colour pink, females, cannot look at you and carry on a conversation, and more. In fact, the opposite is true. Whilst I have met some females like this, I have met many females who love pink, make-up, clothes, fashion and fairies. There is no one type of Autistic female. What are some scripts or responses you can have prepared ahead of time?

Another way of talking about a diagnosis without talking about the “A” word

Another way of discussing a diagnosis can be in the form of discussing characteristics, traits, abilities or challenges. For example, talking about neurodiversity and ‘different’ brains (just like there are different trees and flowers) can be a helpful analogy. Relating different trees or flowers to people gives others an understanding of different brain types. Learning to advocate for oneself is important and can be effective when done appropriately. The following are a couple of examples to get assist and reflect on:

“I’m the kind of person who likes to socialize for a little while but then I need a break to recharge my batteries”

“I’m the type of person who is really interested in talking about English literature and not so great with small talk”

“I’m an introvert and need more time alone than others so I can concentrate on my painting”

What are some ways you can explain your strengths and challenges? What are some ways you can advocate for yourself?

back cover

Tania is available for in-person or Skype or other remote consultations, assessments or problem-solving sessions. She offers bulk billing and sliding scales where applicable. 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.

20152017  All rights reserved Tania Marshall

Sample chapter of I Am AspienWoman: The Unique Characteristics, Traits and Gifts of Adult Females on the Autism Spectrum

Aspienwomanjune2015cover

Drawing from years of practitioner experience, Tania Marshall takes you inside the world of adult females with Autism or Asperger Syndrome. Using a highly visual format, this book combines powerful imagery and an insiders own words to showcase the complex profile of females with an Autism Spectrum condition. Included is a large Mentor section of positive and powerful women headed by Dr. Temple Grandin. Each woman discuss their strengths, their careers and provide important and helpful advice for women on the Spectrum. The focus of this book is on the female phenotype. Available in eBook, paperback and a special edition hardcover version, approximately August 2015. Pre order now at http://www.aspiengirl.com

insidepage

table of contents

crowd Growing Up Quietthe world

tomboys

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FashionDiva costume steampunkengineer

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Preorder at http://www.aspiengirl.com

For more information about female Autism go to http://www.taniamarshall.com or view the Free sfari webinar entitled The Female Autism Conundrum on gender bias at: http://sfari.org/sfari-community/community-blog/webinar-series/2015/webinar-the-female-autism-conundrum

Coming 2016

behindmaskfrontcover

Behind the Mask is a book for professionals and explores the themes of a large group of females across the lifespan. Drawing from years of practitioner experience, Tania Marshall takes you inside the world of females with Autism or Asperger Syndrome. Using a combination of academic research and autobiographical accounts, this books explores the female phenotype. More specifically, the who, how, why, when and where of a large group of females who utilize a variety of strategies and abilities to hide their Autism. Masking strategies, social echolalia and chameleon abilities are discussed. The advantages and disadvantages of these strategies are discussed.

Chapters discuss particular non-verbal and verbal characteristics to look for, particular questions to ask, and include helpful modifications to practitioners offices or clinics and professional approach.


Available in eBook, paperback and a special edition hardcover versions, 2016, at http://www.aspiengirl.com

Cover by Ardent Studios and Model Samantha Tomlin

Behind the Mask 3D

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