On the bright end of the Spectrum and the female Autism crisis

On the Bright end of the Autism Spectrum and the female Autism Crisis: How and Why Do Bright Autistic Females fly under Professional Radar?

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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?

  1. 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.

DSM-5 may better serve girls with autism

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

The female autism conundrum

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

Eating Disorders

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 femaleCoverJune2015

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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 tania@aspiengirl.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

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20 Reasons for obtaining an Adult Autism Diagnosis

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!

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20 reasons for a diagnosis

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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

Adult Autism/Asperger Syndrome Assessment in Females

Adult Autism Assessment in Females 
Updated 23/09/2016

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

 

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

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

Tania can be reached at Admin@centreforautism.com.au for clinic or Skype remote impressions assessments, consultations, problem solving sessions, skills acquisition and intervention, interviews, book translations, presentations or workshops. She divides her time between busy full-time private practice, research and writing her book series.
Tania’s other books include:
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I Am AspienGirl Book’s 1st Week!

I Am AspienGirl Book’s 1st Week has been insane! The book came out in e-book format and made it straight to the Amazon #2 best seller list! Today I received the paperback version which will begin shipping out the end of the month of June 2014. We are also putting out a special hardcover edition, coming soon.

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If you like the book, please go to Amazon.com and leave a book review and let your friends, school staff, professionals, Autism organisations and libraries know.

For more information on the book series or the book’s author:

http://www.Taniamarshall.com
http://www.aspiengirl.com
http://www.Facebook.com/TaniaMarshall author
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Moving Towards A Female Profile: The Unique Characteristics, Abilities and Talents of Young Girls and Teenagers with Asperger Syndrome or Autism

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The following list is an official working document consisting of the unique characteristics and traits of young girls and teenagers with Asperger Syndrome, or High Functioning Autism. This list comes from the many young females I have worked with over the years and currently work with. I have assessed, observed, diagnosed and worked with hundreds 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. ***This list is not a research-based female profile.  It 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 behind anecdotal, observational and clinical work. Updated October 04, 2016

The following profile was created for older teens and family members who are considering a formal diagnosis and to assist mental health professionals in recognizing Asperger Syndrome or Autism in young females.

Females with Asperger Syndrome experience their symptoms in varying levels, so while some Aspiengirls are highly introverted, others are not. Females with Asperger Syndrome or Autism tend to be discriminated due to the wide spectrum of abilities or levels of functioning that exists. The majority of females do not receive a formal diagnosis until teenagers or well into their adult years. This list typifies many of the girls and teens I have worked with. 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.

  1. Natural born leaders, seen by girls who are strong willed, often very serious, intense, independent, “My Way” and/or stubborn and bossy

  2. Intelligence. Bright with an Intense and insatiable curiosity about the world, people, how things work, what people are doing. May be seen in the persistent asking of questions. Usually high average to genius level, uneven profile of abilities

  3. Intense emotions and mood swings

  4. Highly Sensitive and sensory issues (visual, hearing, smell, touch, balance and movement, intuition). A feeling of being different to their peers.

  5. Social skills differences, which may be displayed in a variety of ways that vary from their same-age peers. For e.g., may be shy in social situations, have one best friend or be a floater (floats from one group to another and having superficial connections with others). A less developed or little understanding of facial expressions, social context, non-verbal body language, theory of mind.

  6. Self-taught. The ability to teach themselves or learn about anything they are interested in. A preference to direct their learning, rather than teacher-directed learning.

  7. A high sense of justice and fairness (empathy for the “underdog”) and adherence to rules about how the world and people should operate and/or behave

  8. Perfectionistic and high standards towards self and others

  9. Anxiety and/or fears, including negative all-or-nothing thinking and/or Obsessive Compulsive Disorder or obsessive tendencies.

  10. Gifts or Talents, which may include but are not limited to singing (perfect pitch) and/or music, writing, reading, artistic creations, languages, self-taught, fast learner or other talent(s)

  11. Fine and/or gross motor difficulties, clumsiness, a lack of co-ordination

  12. Difficulties understanding the human social hierarchy, age groups and roles within a group, family

  13. Sleep issues (difficulty getting to sleep due to thinking too much and/or worrying about events that happened that day or what may or may not happen the next day), often not a morning person, tend to prefer staying up later at night

  14. Stomach issues (cramping, bloating, diarrhea, constipation, gas) are quite common, due to gluten, wheat and/or casein allergies/intolerances

  15. Hyperfocus. May not respond to their name being called due to being fully engaged in thought or an activity

  16. Hyperempathy, emotionally empathic and very caring (for e.g., may lead to bringing home stray or injured animals)

  17. Intense love and/or interest in animals, nature, celebrities, fiction, art, mathematics, languages and/or other cultures. May be obsessed with a person, real or fiction, in an unhealthy manner. Other common special or obsessive interests may include but are not limited to: philosophy, psychology, history (for example, Ancient Egypt or Rome, hieroglyphics), languages, Wicca, Vampires, Occultism, psychological profiling and/or criminology/serial killers/detective/FBI/forensic psychologist, science/space/NASA/Stephen Hawking, technology and programming, physical appearance (for example, Gothic, ultra-feminine, tomboy), fantasy, English literature, Law, make-up artistry, art, acting).

  18. Usually stand out as different from her peers, in terms of her dress (some girls are ultra princess-like in their clothing choices while others prefer to wear more comfortable and functional clothing

  19. Facial expressions may not match the situation or her mood (for example, smiling or laughing in a serious situation)

  20. May have interests that are mature/advanced AND/OR immature for her age (for example, a young child’s interest in english literature, opera or creative writing

  21. May be advanced in reading ability OR have trouble with reading comprehension

  22. May be advanced with mathematics/numbers OR have difficulties (dyscalculia)

  23. May have Irlen Syndrome

  24. May have Dyslexia

  25. May have Auditory Processing Disorder

  26. May have attention/focusing/impulsivity/hyperactivity issues (see Dr. Daniel Amen’s 7 types of ADD/ADHD at http://www.amenclinics.com/conditions/adhd-add)

  27. In social situations, she may be shy, quiet, even mute at times OR loud, very verbal and/or aggressive, imposing on other’s boundaries

  28. Has difficulty with asking for help when needed, saying “no” or asserting her own personal boundaries

  29. As mentioned previously, she may have trouble with her own boundaries, in addition to the boundaries of others

  30. May be naive, vulnerable and have a tendency to be taken advantage of. Often confused socially, saying she knows what to do in a social situation when she really does not. Girls appear to be better than boys at masking the traits of autism in social situations. However, girls are less able to do so in unfamiliar settings.

  31. May bring home stray animals, homeless friends or homeless strangers, much to their parents chagrin

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  1. May avoid demands that cause her anxiety (Pathological Demand Avoidance, see http://www.thepdaresource.com/)

  2. Usually has a low frustration tolerance

  3. May have a different voice, for example, younger than her age, talks “babyish” for her age at times, speaks in an accent or in a monotone voice.

  4. Avoids complying with requests from adults and may have difficulty with authority figures

  5. May be clingy with one or two friends and has trouble sharing her friends with other children

  6. May be a tomboy, a fashion diva or a princess. May or may not be interested in looking feminine.

  7. May not be interested in fashion at all or be obsessed with it

  8. Experiences social exhaustion or “social hangover”, from an inability to socialize as much as her peers are able to.

  9. Many females can look people in the eye and have superficial conversations with them

  10. Often well-behaved at school and has “melt-downs” at home (usually due to social exhaustion)

  11. May play with younger or older children

  12. May have language issues, particularly in semantic-pragmatics and expressive and/or receptive language

  13. May prefer to talk and/or play with boys

  14. May not apologize when she has made a social error OR may appease and apologize too much, even when she does not have too

  15. May watch and/or observe others playing before joining in

  16. May copy, minic or clone herself on other girls, also known as “Social Echolalia”, a mirroring of other children, giving her a superficial social confidence and skill-set by acting the part of another person. However, the complexities of the next step of unwritten social skills soon becomes apparent when she has to navigate the expectations and demands that come with reciprocal relationships and maintaining them. This is both confusing and exhausting for her

  17. May have imaginary friends and/or imaginary animals

  18. May spend more time setting up a play scene, rather than playing with the characters in the scene

  19. May be obsessed with fantasy worlds of fairies, witches, imaginary friends, imaginary animals, dragons, anime, or other

  20. May be highly visual, creative, more imaginative then her peers

  21. She may dominate when playing or talking with other girls OR be passive, quiet and “invisible” within the group. If she is dominating, her play tends to appear to be shared with others but she dominates and insists that others follows her rules and themes. If and/or when others refuse to be engaged she continues on with her own ideas or play. Her play tends to be mostly repetitive. If she is passive, she’s more likely to be compliant and may not come across as having social impairments. She may also be shy, embarrassed, coy, naive, innocent, unassuming, and hide or “camouflage” her difficulties, even lying about whether she needs or understands something or needs assistance or help. She is most likely to be described as “flying under the radar” or “blending in with the walls”.

  22. A tendency to collect information on people rather than things. May be interested in psychology, social work, nursing, teaching or helping others

  23. A tendency to ask a lot of questions, often challenging her parents or other adults, who are unable to provide her with the appropriate or the right answers; may correct the adult or teacher and point out their mistake

  24. A tendency to imitate other girls in order to initiate social contact but then have great difficulty maintaining and keeping the reciprocal friendship going. It is this part that often girls find stressful and they will often ruminate about the social situation, what they could have said or done differently, often late at night

  25. She may appear to have a rich imaginative world but the quality is atypical, tending to be a blend of fantasy and reality

  26. She may have an intense interest in the family pets, who may be her best friends, rather than other children or her peers

  27. May have motor tics, Tourette’s Syndrome

  28. May have a different quality of eye gaze/eye contact. May stare at others

  29. May not have a best friend, but be a “flitterer”, having many acquaintances, some to whom she may refer to as a best friend

  30. May have difficulty completing tasks

  31. May be highly organized, ordered and/or clean OR unorganized and have hygiene issues

  32. May follow other children closely, studying their mannerisms, actions, words, and so on

  33. Intense. There is no other word for it. AspienGirls have an intensity in everything they do. If they cannot do it right, do it properly, do it right the first time, they tend to refuse, avoid, and or express frustration/distress. When taught to persevere, to develop frustration tolerance, to manage their emotions, they are most often successful in whatever they pursue, to the point of becoming an “expert”.

  34. Superior photographic memory and weaker short-term memory

  35. Can be obsessive about people, especially if they feel or perceive that they have been “wronged”. This can get them into trouble at times for hurting others or taking revenge. May obsess over or stalk people. May have a misguided sense of justice that leads them to getting in trouble with other people, lawyers or the legal system/law.

  36. May question why they are “different” or what is “wrong” with them or why they can’t seem to “fit in” of feel that the “mothership dropped me off on the wrong planet and I’m just waiting for it to pick me up”

  37. Lack a clear sense of identity

  38. May be described as “serious”, “shy”, “odd”, “eccentric”, “adult-like”, “weird” in some ways, yet “babyish” in other ways

  39. A tendency to not be accepted by her same-age peers

  40. High likelihood of being bullied and/or teased, overlooked or ignored

  41. Intense dislike of disagreement, conflict, arguments, people yelling or shouting at them or around them. This them tends to an avoidance of conflict causing more serious communication difficulties. For example, this may be observed in a person who is unable to deal directly with a person they may have an issue with, but rather engages in talking or gossiping about their issue with that person with everyone else.

  42. An inability to handle and/or cope with stress, conflict and/or change

  43. An inner resilience, strength and ability (strong will and determination) to bounce back from stress and setbacks time and time again. This does depend on particular internal and external factors at play.

  44. Some strengths, abilities, talents and interests may include: enjoying fantasy worlds, fiction, acting, modelling, art, mathematics and numbers, music, song-writing, perfect pitch, writing fiction, languages and/or translating, caring for nature and/or animals, research, learning and studying, intelligence, teaching, helping others, science and medicine.

  45. May invade other’s personal space or stand too close to them or be unaware of boundaries

  46. May dislike people looking or staring at her. This is often a huge barrier for talented and gifted performers (for example, singers performing in front of others or crowds, actors being on the red carpet).

  47. May be perceived as being “just shy and quiet”

  48. Most often confused by the conversations of their teenage peers

  49. May walk on her tip-toes or have an “odd gait”, motor difficulties

81. May be very social, very loud, extroverted and make continual attempts to be part of a group. Her attempts are clumsy and her peers may see her as not quite fitting in. She lacks social skills and a social understanding to help the interactions go gracefully. Her peers don’t quite understand her social awkwardness and may be be mean to her, ostracize her and/or make fun of her, taking advantage of her naivety. She may appear to “flitter” from one person to the other or one group to the other, unable to have a typical friendship, due to smothering people or groups. Her peers take advantage of her, make fun of her and/or will be mean to her, saying they are her friend one day, but their actions prove otherwise. The issues revolve around girls being mean to her and cutting her from the group. She often smothers others and doesn’t understand the levels of friendship or social boundaries.

  1. Thumb-sucking may last well-past pre-school age, until 9 or even 10 years of age.

83.  Often as a teen, spending breaks/lunches alone in the hallways, toilets, library, or with a teacher, due to not being part of a group and/or having no friends.

84. May have Alexithymia, an inability to identify and describe emotions in the self 

  1. May have Synaesthesia, in particular mirror-touch synaesthesia. Research studies hypothesize that empathy is experienced by a process of simulation. So for example, when we see someone feeling happy or sad, the same neural circuits used to make them feel happy are activated in our brain. Since mirror touch synesthetes have heightened activation of mirror systems, it can be hypothesized that that these individuals may also experience higher empathy, and this has been confirmed by research in this area. Mirror touch synesthetes experience more empathy than non-synesthetes. A research study by Michael Banissy et. al  determined this by using the empathy quotient (EQ), consisting of three main scales: cognitive empathy, emotional reactivity, and social skills. Mirror touch synesthetes showed significantly higher EQ scores in emotional reactivity than in controls. However, synesthetes did not show higher scores in cognitive empathy and social skills. Thus empathy is multifaceted, and the tactile mirror system may not be fully responsible for the ability to empathize (For more information, check out Banissy, Michael; Jamie Ward (July 2007). “Mirror Touch Synaesthesia is Linked with Empathy”. Nature Neuroscience 10 (7): 815–816. doi:10.1038/nn1926).

References

Attwood, Tony (2006). Asperger’s and Girls. Future Horizons.

Kopp S, Gillberg C. Res Dev Disabil. 2011 Nov-Dec;32(6):2875-88. Epub 2011 Jun 12.

Gould, Judith and Ashton Smith, Jacqui. (2011). Diagnosis or Misdiagnosis? Women and Girls with Autism and PDA

FAQ: Why do your pictures include visuals of girls or women in superhero outfits? In my clinical experience and work, I never cease to be amazed by an Aspiengirls’ ability to bounce back from stress and setbacks time and time again. I refer to Aspiengirls’ abilities as “aspienpowers” because there is no other group of girls or woman I know of with the unique profile of abilities, traits and characteristics (aspienpowers) that enable them to be highly successful in their chosen careers and/or life, given the right environmental fit and support.

About Tania Marshall

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Tania holds a Masters of Science in Applied Psychology and a Bachelor of Arts in Psychology. She is a best selling author, child and family psychologist and Autism consultant. She is 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.

Her areas of interest include: Gifted and Talented, Autism, Asperger Syndrome, Twice-Exceptionality, Highly Sensitive Individuals, Learning Disabilities, Performance Anxiety and Psychological Profiling

She regularly provides diagnostic assessments, support and intervention and divides her time between private practice, writing and research.

To enquire or book consultations, assessments, problem solving sessions and/or support, please e-mail Tania at tania@aspiengirl.com

Tania has now completed the first two in a series of books on female Autism. She is now writing her third book entitled AspienPowers: The Unique Constellation of Abilities, Strengths and Talents of Females on the Autism Spectrum”.

Her book series is available for purchase at http://www.aspiengirl.com

To inquire about interviews, articles, workshops, presentations, or translations/translating of her books, please email Tania at tania@aspiengirl.com

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Tania Marshall© 2013-2015. All rights reserved. Thank you.