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?


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


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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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.


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?

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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


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

Female Autism Infographics

Female Autism Infographics to share for awareness and education. More Coming

The following article is copyrighted and may not be posted anywhere without permission from the author.

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For more information go to:



To contact Tania regarding consultations, assessment, problem-solving strategies, Skype consultations, book distribution, interviews, book translations, publishing queries, please email her at tania@aspiengirl.com


Sneak-A-Peek of I am AspienGirl: The unique characteristics of young females on the Autism Spectrum

Sneak-A-Peek of my first book, I am AspienGirl: The unique characteristics of young females on the Autism Spectrum. Check it out:-)



“Although people told me I was “different” from birth, I didn’t fully understand what they meant. The word I would use is ‘unique'” ~ Teenage Aspiengirl


“She is often described by others as an ‘old soul’ and often others tell me she has been here before. People have referred to her as different, odd, quirky, unique … even from another planet.” ~ Mother of 8 year old Aspiengirl


Available for purchase at http://www.aspiengirl.com and on Amazon.com NOW

I am AspienWoman: The unique characteristics of adult females on the Autism Spectrum, coming  January, 2014
Tania Marshall. 2013.  All rights reserved. Duplication in whole or part is explicitly forbidden. Thank you.