This is a recent FAQ on self-deprecation in neurodiverse females. As always, If you like it please share and leave your positive comments or other questions below. This video was made by the Neurodiversity Academy, founded by and funded by AspienGirl girl.com
The following article is copyrighted and may not be posted anywhere without permission from the author.
In working with females (and males) on the Spectrum for approximately 20 years, I have learned a lot from my clients. When I first started out as a psychologist, I was seeing female on the Spectrum; they just were not called or labeled that back then. In working with hundreds of females, it is safe to say that there is much neurodiversity within this group. This is extremely important to talk about because these are their narratives.
By this, I mean that there exist varying presentations of girls and women on the Spectrum. Some are easier to diagnose than others. This is due to temperament, personality type, the severity or mildness of the person's specific Autistic traits, how many traits they have, gender differences, how much the traits impact on their ability to function, other conditions or disorders and much more.
Due to a variety of lagging skills and/or differences, many females with Autism do not get along with each other, yet many do, just like neurotypical people. Many females with mild symptoms are unable to get a diagnosis, even though their traits and exhaustion impact them on a cyclical basis. Those with the subtle traits usually never receive a diagnosis.
Now that I have worked with thousands of women, they have taught and shown me through their narratives, just how different they are from each other. It is important to discuss this issue so that no more females are left behind.
Stereotypes exist due to the history of Autism and describing boys rather than girls certainly comes into play. Other stereotypes include cultural perceptions and the social focus of culturally "female" interests. So, assessments based on males and cultural perceptions and biases are certainly factors. In my work, I have seen the stereotype of the "Tomboy" play a part in other females with a different presentation not receive a referral for an assessment or a diagnosis.
The use of a social mask, compensatory mechanisms, level of intelligence (for example, being 2e), being able to get by in life day to day and then have cyclical breakdowns, and the subtle differences all contribute to a delay in diagnosis or a misdiagnosis. These differences mixed in with genetics, temperament, personality, co-existing conditions, family environment and upbringing all impact and affect how Autism presents in a female (and male).
Subtypes or presentations are extremely important to understand if one is to be trained appropriately. It is imperative to understand how many different ways a female on the Spectrum can present to a clinician. A diagnosis is critical, not only for self-understanding; but for support, services, and academic accommodations. I am talking about how girls and women have presented themselves in my clinic over 20 years, from a variety of countries and cultures. This blog is but a small part of my book entitled, "Behind The Mask" due 2017.
There are a few ways that females on the Spectrum adopt a role. In particular, if they really want to fit in and conform with society. There exist some common types or sub-types of women on the Autism Spectrum. The reason this is important is so that, as I said before, no females are left behind, and that professionals are trained in the various presentations so that they do not miss a female and also to educate the wider population about the neurodiversity of neurodiversity itself! So, let's discuss just a few presentations:
TheTomboy is usually indifferent to gender, preferring to have boys for friends and dress in an androgynous way or dress in boys clothes. She finds it much easier to talk to boys (or men). However, some individuals have gender dysphoria and this is not to be taken lightly.
The Academic superstar uses her intelligence to achieve degrees, awards, honors and more. She has an intelligence above 130, qualifying for MENSA, and has used her intelligence to get through social situations. The higher the giftedness, the more different the presentation may appear.
The Passive female is a people pleaser. She is shy, quiet, cooperative, rarely asks for help and compliant, too compliant, and blends into the wall (in the classroom or at school). She rarely stands up to bullies and is often taken advantage of.
The Aggressivefemale has often had a history of misunderstanding and misinterpretations, both ways; on her part and on others parts. She often misinterprets others, burns bridges, is impulsive and is the type most often associated with or been diagnosed with Borderline Personality Disorder or BPD traits.
The Scientific female may have a special interest in physics and/or Quantum Physics, mathematics, chemistry, animal sciences, biology or space, programming, just to name a few. Often, this type of woman is quite focused on their topic of interest and reaching high levels of distinction (a Masters or PhD).
TheStyleIcon is aware, even overly aware of style and fashion. She may work in fashion design, be an actor or a supermodel. She has got the outfits, makeup, hairstyles and appearance perfect. Her appearance tends to intimidate males and females, who are threatened by her appearance, presence or knowledge of the fashion and stylist world. She grasps small talk, making her appear to be neurotypical and allowing her to cope in social situations and fit in with her peers. Even if her appearance is eccentric, she gets away with it due to her other talents; whether they be a singer, a costume designer, an actor or DJ.
The Housewife or Cook loves to entertain and is very good at it. She is whom people want to hire for their home. She loves to have people over, but remains the ultimate host, so as not to have to socialise with others.
TheArtist gets away with being different or eccentric because society expects them to be that way, so in this way, they often remain undiagnosed until they fall off the rails. they may be the more eccentric painters, writers, actors, supermodels, singers, and band members.
TheJusticeWarrior is obsessed with justice, fairness, and right and wrong. These are admirable traits, but not when it turns into obsession, misguidedness or inappropriate recruiting of members. Some women (and men) are 'one woman' groups because others do not want to join their cause due to the social way they attempt to get others to join their cause. These people end up starting their cause over and over again. It is true (although some may not like to admit it) that some women (or men or neurotypicals) have a “misguided sense of social justice”, going too far or the wrong way of going about their crusade. There is a socially appropriate way to get people to join your cause. I have met clients (both neurodiverse and neurotypical) who have gotten into trouble with the law or are in jail because of their enlarged justice gland, lack of social context and impulsivity.
In summary, this is just a brief look at how girls and women experience Autism and the variety that exists in presentation. There are other presentations that will be discussed in my book. Girls and women vary differently from each other and also differ in their ability of lack of ability to use compensatory mechanism and/or coping mechanisms. They also vary in intelligence levels. Those who are both Autistic and Gifted have a different presentation. However; they all share the same core challenges (from mild to severe) and some remarkable strengths or gifts.
This blog is written to address the neurodiversity with a large group of females and has nothing to do with sexism or ableism, nor that neurotypicals cannot have the same careers. Most importantly, it is imperative that we understand the differences in neurodiverse females, the different ways they cope or not cope, and the different ways they present.
Within the Neurodiverse population, there is no particular way to be a girl or a woman. Many of my clients have all kinds of preferences and interests, including my Lego pens sets. Many of my clients have a wide and varied style of clothing, from fashion to boys clothes to Victorian clothing to gender-neutral clothing to completely loving being in a princess Tulle dress or an Elf costume. Some of my clients wear "boy" clothing and "girl clothing". Some like cargo pants, some like dresses and/or corsets, some like dressing up in their favorite character, some love femininity and some do not and many like books, stationery, dolls, and theater.
Finally, the purpose of writing about presentations is to leave no female out; to never exclude not even one female. We understand the neurotypical world (to the degree that we do), but we are only on the cusp of learning about the neurodiverse female world and what this group are truly capable of, when given the right support. This is about understanding females on the Spectrum and then designing appropriate interventions according to their presentation. For example, the passive presentation will need assertiveness training whereas a different social type will need a different intervention. It would be unfruitful to put all females in the same social skills or intervention group.
Whilst these girls and women are different, they all share the same common core characteristics, that of social, emotional, cognitive, sensory, intelligence differences, in addition to other co-existing disorders or conditions. This makes for complex presentations. By no means can one type be put in a box. A female can be 2 or 3 types or morph into all types throughout their life-time.
These are just some of the various ways that Autism presents, how some females may present and how they may cope with having a different brain. Autism influences many factors and all types and interests are just as important as each other. We need as many different brains and as many different neurodiverse females as possible. We also need to know the differences in presentation, so that we can now design and implement the right support and intervention for the right girl or woman.
Neurodiverse girls and women have much to offer, regardless of neurotype, interests, dress, differences and/or similarities. There are no stereotypes, just a variety of presentations and profiles, all valid and all very special.
#nomoreemalesleftbehind #beyourownsuperhero #aspiengirl #aspienwoman #aspienpowers #behindthemask
No part of this may be used, reproduced, borrowed or copied. This is an excerpt from Behind The Mask
AspienGirl.com is pleased to be nominated for a 2017 ASPECT Autism Australia Award in the Advancement Category, for advancing the area of female Autism. AspienGirl.com advocates for neurodivergent females, educating and bringing a strengths-based awareness about the autistic female presentation/profile, and contributes to its’ goal of “no more AspienGirls left behind” and “Be your own superhero”, being the best version of yourself. Females will continue to be misdiagnosed, mis-medicated and/or receive the wrong interventions, until research is conducted on females, female-based screening and diagnostic tools are created, gender differences are clearly understood, and female-specific interventions and professionals are trained to assess, diagnose and work with females. In order to assist in getting closer to these goals, the AspienGirl Project was created and has already donated 450 books and will continue to donate a certain percentage of its profits to sending out free books and resources to professionals, schools, teachers, special needs coordinators, libraries, and Autism organizations.
Tania Marshall, M.Sc., AMAPS, is an international best selling author, psychologist, publisher, educator, 3X and most recently 2017 ASPECT Autism Australia National Recognition Award Nominee (Advancement Category), recognized for her work in advancing the field of female Autism. Her first book, entitled “I Am AspienGirl©: The Unique Characteristics, Traits and Strengths of Young Females on the Autism Spectrum”, foreword by Dr. Judith Gould, won an IPPY eLIT Gold Medal Award in 2015 and is an Amazon best seller. I am AspienGirl has been translated into Spanish and is entitled Soy AspienGirl. She currently works with the gifted and talented, celebrities, performing artists, and twice-exceptional and/or neurodiverse individuals, across the lifespan. Tania was recently interviewed by Dr. Harold Reitman in a 2 part series by Different Brains, where Part I can be found here: http://differentbrains.com/aspiengirl-embracing-strengths-women-aspergers-syndrome-tania-marshall-edb-51/ and Part II here http://differentbrains.com/gender-differences-neurodiversity-recognizing-diversity-within-autism-spectrum-tania-marshall-edb-54/
Tania can be reached at firstname.lastname@example.org for assessments, telepsychology (Skype) or clinic consultations, interviews, presentations, workshops, and/or conferences, translation inquiries, collaborations, publishing/book and/or media inquiries. She is an Australian Psychological Association (APS) Autism Identified Medicare Provider, a Helping Children With Autism Early Intervention Service Provider (HWCA), a Better Start Early Intervention Provider, a Medicare Approved Mental Health Provider and a Secret Agent Society (SAS) Trained Group Facilitator.
Copyright 2016-2017 Tania Marshall
The AspienGirl Project is pleased to announce that the sequel to ‘I am Aspiengirl’ entitled ‘I Am AspienWoman’ recently won a 2016 IPPY eLit Gold Medal Award in the “Women’s Category” in April. I am AspienWoman is the culmination of a blog Tania wrote a couple of years ago entitled ‘Moving Towards a female profile of Asperger Syndrome’, with close to 300,000 views, to date. That blog is regularly updated. You may purchase copies at http://www.aspiengirl.com, Amazon or other fine books stores.
Tania spends her professional time in private practice. She provides diagnostic assessment impressions reports regularly (across the lifespan), and provides interventions and support. For more information regarding diagnosis and assessment, bookstore wholesale discounts, book contracts, interviews, translations, workshops and conferences, please email email@example.com
I Am AspienWoman releases at #29 Amazon USA, #1 in Australia (2 categories) and 1st spanish world female autism conference
Pre-orders of I Am AspienWoman paperback from the AspienGirl webstore
Pre-orders of I Am AspienWoman hardcover from the AspienGirl webstore
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.
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.
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
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 firstname.lastname@example.org
2015 All rights reserved Tania Marshall
20 Reasons for obtaining an Adult Autism diagnosis
One of the most frequent questions I am asked is about the relevance of obtaining a formal diagnosis or formalizing a self-diagnosis. My 2nd book, I Am AspienWoman alludes to this very topic through powerful images, experiences, thoughts and feelings of many adult autistic women. There are many valid reasons for obtaining a diagnosis and the majority of women who receive one explain the benefits in the book. I have included a couple of pages from the book and you can now pre-order I Am AspienWoman, available in eBook, paperback and hardcover, at http://www.aspiengirl.com You will receive $10 off if you order an I Am AspienGirl© and I am AspienWoman Combo. I hope you enjoy the book as much as I did writing it!
Tania is available for in-person or Skype consultations, assessments or problem-solving sessions. To book appointments or discuss and/or book availability for presentations, conferences, publishing, translation and media interviews or inquiries, please email Tania@aspiengirl.com
ABOUT THE AUTHOR
Tania Marshall is a best selling author, a 2015 ASPECT Autism Australia National Recognition Award Nominee (Advancement Category) and a 2015 eLIT Gold Medal Award winner for her first self-published book entitled “I Am AspienGirl© : The Unique Characteristics, Traits and Strengths of Young Females on the Autism Spectrum”, foreword by Dr. Judith Gould. The sequel to this book entitled “I Am AspienWoman: The Unique Characteristics, Traits and Strengths of Adult Females on the Autism Spectrum”, Foreword by Dr. Shana Nichols is available September, 2015. Tania is currently writing the third book in her book series entitled “AspienPowers: The Unique Constellation of Strengths, Talents and Gifts of Females with Autism Spectrum Conditions”. The Spanish version of I am Aspiengirl© , entitled Soy AspienGirl is now available. Tania’s work has been translated and/or cited in numerous publications including Sarah Hendrickxs’ recent release entitled “Women and Girls with an Autism Spectrum Disorder” (2015), foreword by Dr. Judith Gould.
Tania currently works in busy full-time private practice, providing diagnostic assessments, intervention and support to males and females ages 2-76 years of age. Tania is an Australian Psychological Society (APS) Identified Autism Practitioner, a Helping Children with Autism Early Intervention Service Provider (HWCA), a Better Start for Children with a Disability Provider, an approved Medicare provider of psychological services and a trained Secret Agent Society (SAS) Practitioner.
© 2015-2017 All rights reserved Tania Marshall
Assessing the behaviors, traits and abilities of young females on the Autism Spectrum: For professionals and parents
Girls with high functioning Autism (Asperger Syndrome) often have subtler characteristics that lead them to be missed by professionals. Many (not all) are able to use compensatory strategies to mask their difficulties and these are learned from before they start grade school. Autism tends to be a condition of extremes; an either/or condition in which two girls who present quite differently can both be on the Spectrum. For example, one is shy, quiet and mute and the other is loud, has a lack of boundaries and talks too much. The both have social communication and interaction difficulties.
Girls on the Spectrum may present as shy, quiet and at times mute, taking a long time to warm up to situations or they may present as overly talkative, verbal and lacking boundaries.
The quiet girl can be described as passive, a follower, watching and observing her peers much of the time to learn what to say or how to act. She is very shy in social situations. The verbal girl is often dominating, described as “bossy and controlling”, often described as having to have the best at everything and have her own way. She dominates and controls social situations.
Both girls may not receive many birthday invites, prefer one or two close friends, prefer to play with younger or older children rather than their peers, prefer to talk to boys or have boys as friends.
The quiet type may be attracted to extraverted personalities who tell her what to do or are controlling towards her due to her passivity and shyness. The verbal type may be domineering and controlling in her interactions with others.
Why do girls who have an assessment not receive a diagnosis?
Females can and do make eye contact and can have superficial reciprocal conversations in initial interviews with professionals.
Females are reluctant to admit they are having difficulty and will say they have friends, that they know what to do socially, when they are actually socially confused
Females start learning, often from before grade school to camouflage their difficulties and pretend every thing is fine
Females will say everything is ok and there are no problems even in the face of contrary evidence or difficulties
Professionals are viewing the female as just a “shy” and/or “sensitive” child or a “hormone driven” teenager, when in fact they have Autism. Around the age of 12-13 are when the proverbial wheels may begin to fall off and the inability to cope comes to the forefront
Professionals may diagnose only the presenting issue (for e.g., anxiety disorder)
They may receive high scores on the ADOS but not enough for a diagnosis
The majority of assessment tools are based on males
Professionals are not trained in understanding the gender differences, the gender bias, the questions to ask, compensatory strategies and camouflaging techniques
Some clues look for in an assessment
The Social World
1. exaggerated facial mannerism or a flatter affect. Many girls I have worked with have a slight grimace to their smile. This is a clue that they may be having difficulties with their own non-verbal body language. Many childhood photos reveal either no smiling or a slight exaggerated smile or facial expressions
2. look for facial expressions not matching the mood or the situation being discussed. For example, it is common to observe smiling or laughing whilst talking about a situation that would usually be associated with a different emotion (and therefore a different facial expression and tone of voice).
3. many girls say they know what to do in a social situation but when asked, are not able to tell you what they would do or give an answer that leads to to believe otherwise. An investigation into levels and types of friendships and social skills often reveals difficulties
4. exaggerated non-verbal body language is often a clue. Some girls present in the clinic with body language that appears “odd”, unnatural or like they are acting with you in a conversation.
5. Many females are well-behaved (often too well-behaved) in school but the opposite at home (due to social exhaustion and holding it all in)
6. Many females are observed using behaviors or words from their peers, other people or television. They may copy, look like or act like others, taking on the characteristics, mannerisms, voice, sayings, of others.
7. Many females present in different ways depending on the situation and this can be confusing to family members.
8. Many females will tell you they know what to do in social situations, but the evidence is contrary and/or you will get the impression that they are confused or are not being truthful.
9. Some females may not apologize when they have made a social error and some females over-apologize due to being confused about social rules. Some females refuse to apologize even when it is plainly obvious it would be in their best interests to do so.
10. Many females are able to socialize quite well for small periods of time but them experience social exhaustion or a ‘social hangover’, needing solitude to recharge her batteries.
The Play World
1. Some girls have a preference to play with stereotypical boys toys, having no interest in dolls whilst others have an obsessive-like quality towards dolls and stereotypical girls toys (for e.g., collecting all barbie dolls).
2. Girls can often be observed spending the majority of their time putting together the scene of play, rather that actually playing. For example, spending the majority of time ensuring all the furniture, accessories and dolls are in the right place). They often have elaborate scenes of play set up and organized.
3. Whilst playing on their own, girls are often observed to be role-playing adults. For example, a girl may set up all her teddy bears bears, dolls, etc., and role play the teacher, doctor, nurse or other role. She may take attendance, give time-outs, write out lesson plans and/or teach class lessons.
4. Girls on the Spectrum are often far more imaginative than their peers. They are often observed pretending to be animals and/or imitating them. They may also have some difficulty distinguishing between reality and fantasy
5. A tendency to have imaginary friends and/or animals who are very real to the child, to the point that they may have table settings for them at the table, seats for them in the car, and so on.
6. Girls often spend more time playing with the family pets and/or on nature than their peers, having a natural affinity/gift in the areas of nature and animals. It is the intensity of the interest as compared to neurotypical peers that is key here.
7. May have obsessions with other people which can be observed as too clingy, not allowing the friend to have other friends, not giving them enough ‘space’, or obsessing over them
8. Females tend to have more avoidance traits and strategies when demands are placed on them
9. Some females may flitter from group to group in school not really having any real friends but giving the appearance of having friends, so that no one would pick up on this
Abilities, Gifts and Talents
Abilities, Gifts and Talents are plural due to the many females I have met who display multiple talents. These abilities often include:
hyperlexia/reading ability, perfect or near-perfect pitch, languages, art, performing arts (dance, acting/drama, singing, musical theatre, modelling, involvement in a band, comedy), the care of animals, mathematics, writing fiction and/or fan-fiction and/or poetry and/or songwriting, intelligence,
Mature interests may include interests advanced for her age (philosophy, psychology, opera, a language)
Immature interests may include an interest well past her developmental age (for example, my little pony, doll or teddy bear collections).
Some females present as more of a “tomboy” appearance (preferring an androgynous clothing style) and disliking make-up and sterotypical girls clothing
Some females present as a “ultra-feminine” or “princess” like appearance (love make-up, fashion, trends and shoes). they may spends time involved in shopping for clothes and/or designing clothes, perfecting the art of makeup and.or modelling
Regardless of presentation, a difference in terms of clothing as compared to her peers is usually observed. My screener which was the basis of I Am AspienGirlL The Unique Characteristics, Traits and Gifts of Females on the Autism Spectrum is here:
A female autism assessment tool I often use in conjuction with other tools includes this screening questionnaire developed by Kopp and Gilberg and it is excellent.
THE AUTISM SPECTRUM SCREENING QUESTIONNAIRE (ASSQ)-REVISED EXTENDED VERSION (ASSQ-REV), by Kopp and Gilberg
Kopp and Gilberg found that certain single ASSQ-GIRL items are often much more typical of girls than of boys with ASC. These items include “avoids demands”, “very determined” and “interacts mostly with younger children”. The ASSQ-REV is a new assessment tool that includes a set of “girl” items.
ASSQ-GIRL, 18 new screening items believed to tap into the autism phenotype of girls
ASSQ-GIRL item No Somewhat Yes
- Copies you (can be in a very discrete way)
- Episodes of eating problems
- No time perception*
- Too much sympathy
- Extremely interested in pop/ rock bands, soap operas or natural disasters
- Avoids demands*
- 34 Very determined*
- 35 Difficulties with choice; always avoids choosing
- 36 Difficulties with self-care*
- 37 Carefree or overmeticulous as regards physical appearance/dress
- Comes too close to others
- Interacts mostly with younger children*
- Engages in dangerous activities
- Exaggeratedly fanciful
- Talks without content*
- Writes long stories (can be in stark contrast to level of talk)
- Acts or lives different parts (TV stars, videos, animals)
Note. *indicates items which were considered most specific in girls with ASD (see study V)
To contact Tania for assessments, Skype or clinic consultations, problem solving sessions, workshops and presentations, book interviews, book translations, or publishing, please contact Tania at email@example.com
For more information about Autism Spectrum Conditions in females go to:
Copyright Tania A. Marshall 2015
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. and 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 to 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:
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.
Tania A. Marshall is an award winning and best selling author, a 2019, 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 an 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).
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.
Webinar: A Summary of The Female Autism Conundrum
By Tania. A Marshall, M.Sc. (App. Psych), Assoc. MAPS
Thank you to Sfari.org and female Autism researcher and experts David Skuse and Will Mandy for presenting a fascinating webinar discussing the gender bias.
Part One by Dr. David Skuse
More individuals who are termed “high functioning” are now being assessed and diagnosed. If Autism is defined by the male stereotype, then females are going to be missed and disadvantaged. We, and other professionals working in this area, believe a serious gender bias exists. So, where is the evidence that we are missing females?
- Studies are not recruiting a representative sample of females with Autism and therefore are making spurious conclusions.
- The under identification of females with Autism Spectrum Condition (ASC) with average IQ
- A South Korea Study screened approximately 55,000 school age children and found that the overall prevalence rate was 2.5:1 for male to female.
- A National Health Statistics Report (2013) found that changes in the prevalence of parent reported Autism Spectrum in school-aged children found that there was an 80% increase in the identification of school-age boys with ASC in the 5 year period as opposed to only a 43% increase in identification of school-age girls.
- By 2013, approximately 1 in 30 boys in the United States of America had been given a diagnosis of Autism Spectrum Conditions and ONLY 1 in 140 girls had been given a diagnosis of Autism Spectrum Conditions and this is most likely an underestimate. School-ages children (mostly boys) were largely responsible for this increased prevalence. Largest increase is between 14 and 17 years
- Identifying, ascertaining and assessing teenage females with Autism Spectrum Conditions if particularly challenging and problematic. Why is this?
- Compensation: Females from preschool onwards are much more aware to social behaviours and norms Girls are less able to identify due to their superficial social skills, fewer social communication issues, less stereotyped behaviours and/or unusual motor behaviours
- Co-existing Conditions: The majority of females internalize their problems with depression, eating disorder, depression and a lack of “conduct” or behaviour problems and less ADHD in school, but behaviours are often seen at home. Boys are often picked up earlier due to their disruptive behaviours at school.
- Biased recording of behaviours, symptom profiling, using standard instruments and tools. Autism has been defined as a male stereotype. Girls have less repetitive and stereotyped behaviours and less motor behaviours.
If Autism is defined by the male autism stereotype, we will not find the girls. The definition of Autism is based upon the male stereotype and there is biased identification
Examples from the Interests and Behaviors section of the ADI-R
- Is she unusually interested in things like metal objects, lights, street signs, or toilets? No, she is obsessed with Justin Bieber!
- Does she play with the whole toy or seem more interested in part of the toy (e.g., spinning the wheels of a car or opening and shutting the door? No, sheis obsessed with her doll’s hair
- Does she have anything to which she is particularly attached, such as a pieve of pipe, a clothes peg or a stone? No, but she does have a collection of 2000 soft toys which are all pink, makeup collections, stationary items (my observations are erasers, pens, pencils, journals)
A population survey of gender differences in Autism traits which was a whole population epidemiological survey of autistic traits called the Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, UK. All participants were screened with the Social Communication Disorders Checklist (SCDC). Results showed that there were not dramatic differences by gender in parent’s answers on the questions. The results showed a 1.9:1 ratio for boys to girls.
Can females with high verbal IQ compensate for their ASC traits? Yes, females may compensate to some degree.
Females are at high risks of developing co-existing psychiatric disorders in response to social adjustment difficulties in later life.
In secondary school, females often become alienated, depressed and/or suicidal. They may become obsessed with people (to the point of stalking) or self-harm. Obsessions with people are common and can be towards professionals (doctors, psychologists, a best friend) with use of the Internet used to stalk the professionals, their families or their webpages.
The definition of ASC is based on the “male” stereotype. Current diagnostic criteria and the way it is implemented in research and clinics and assessment tools are biased against females and a large proportion of girls are missed in assessment or not included in the research.
We need to develop a better understanding of the ASC female phenotype which is founded on empirical and scientific information.
Ascertaining and assessment of girls with and ASC in the teenage years if particularly problematic.
Part Two by Dr. Will Mandy
We need to understand the female Autistic phenotype
Current ASC assessment processes are biased against females
A disproportionate amount of girl are underdiagnosed and/or misdiagnosed and incorrectly excluded from research studies
The current DSM5 on page 57 now states ”girls without intellectual impairment or language delay may go unrecognized, perhaps because of subtler manifestation of social and communication difficulties”
The key task is to develop a better understanding of the autistic female phenotype founded on empirical and scientific investigation. So, what does current research, clinical experience, anecdotes, a network of collaborations with professionals and narratives by females with Autism themselves say?
The Autism Female Phenotype and distinctive tendencies, patterns and trends (some males have traits of the female type and vice versa).
- Females with ASC are more socially motivated than males with ASC, more typical and gender stereotyped interests (Hiller et. al, 2014). Females show greater interest in people and initiate friendships more.
- Female obsessions or focused interests include: fashion, people (peers or celebrities or professionals), Barbies, hair, animals, Manga and Anime
- More vulnerable to internalizing disorders and are prone to Eating disorders like Anorexia Nervosa, anxiety, depression and less likely to have conduct issues outside the home (Mandy et. al, 2012, Mandy & Tchanturia, in press)
- Social difficulties are misattributed to shyness or social anxiety
- Greater ability and capacity to “camouflage” and/or hide their autistic tendencies (Lai et. al, 2011)
- Gender differences play out or appear across the lifespan, in a developmental context. The greatest risk in gender differences across the lifespan is the issue of females; the greater female risk of missed diagnosis in the young, in pre-schoolers, in adolescence and into adulthood.
- Friendships: Girls are often ignored by others rather than rejected
- Female autistic difficulties are underestimated in school
- A much greater risk for anxiety and depression in primary school and then eating disorders in adolescence and sexual exploitation
- Camouflage: the “masking” of ASC behaviours in social situations and/or the performance of behaviours to compensate for difficulties associated with ASC
- Masking: Can be conscious (deciding to suppress stimming behaviours in public as they attract negative attention (Mandy & Tchanturia, 2015) or automatic (“doing social mimicry against whomever I’m with. I guess it’s like a cloaking device…I had no idea I was doing it until I as diagnosed”) (Bargiela & Mandy, in press)
- Acquisition of new skills and capacities to compensate for autistic difficulties and can be conscious (copying popular peers, dress, gestures, talk and practice it over and over at home; Mandy & Tchanturia, 2015) and unconscious (implicit learning from social experience; “it used to take me weeks to figure out what I had done wrong, but now I know pretty much immediately” HM, 15 years old)
What processes underpin camouflage? What drives the capacity to drive and adapt?
- Social Motivation
- Socially focused special interests; for example, psychology, anthropology, Jane Austen novels to crack the “social code”, to develop strategies to function socially
- Socialization experiences and pressures; the social pressures and expectations placed on women as opposed to men
- Executive control: the ability to inhibit, shift and generate plans
- Better social imitation and awareness
- Better Capacity for reflection
- Higher intelligence quotient and using intelligence to camouflage
So is Camouflaging a friend or foe? Both
The Pros include: allow people to function better in the workplace, in the social context, can open up a social world of friendships and can be a form of personal development/self-help
The Cons include: Exhaustion, loss of identity or identity confusion, underestimation of needs, missed and mis-diagnosis
At what age does female compensation start?
It begins in early childhood and breaking down in early adolescence, with adolescent talk and chit-chat being very exhausting, boring or uninteresting. Young girls have to learn from a very young age that you have to be nice, sweet, hug your relatives, act normal, develop a face you can put on and often acting convincingly so, which then makes it so much harder to get a diagnosis, leading to the theory that girls don’t get Autism or get is much less than boys.
Q & A Session with David Skuse and Will Mandy
- Q: What does all this mean in the context of early intervention?
A: Information from at-risk siblings revealed if assessment is done skilfully it can be picked up early in females. No evidence of intervention for females. The focus is on co-existing conditions or disorders. It is I,[perative to screen adolescents with anxiety, depression, self harm or eating disorder for an Autsim Spectrum Condition
- Q: If someone is able to camouflage e and there functioning better, what does this mean in terms of intervention and getting better, can this be seen as getting better?
A: People often find their own affective ways and strategies of handling difficulties. We need to be aware of the consequences (i.e. lying down in the foetal position after a demanding day pom arriving home). Many adolescents strive to be model students at school and all hell breaks loose at home. Parents are concerned and mental health blame the parents because they are not causing difficulties at school , which them leads to family therapy and parenting programs for the parents. This is sometimes seen in primary or elementary school
- Q: Is there a higher percentage of Gender Identity issues in females with Autism?
A: There is small growing literature on gender identity issues in females with ASC, but we are not aware of how common the wish to change gender is.
- Q: In the parent reported study you mentioned they weren’t formally diagnosed?
A: The Korean study ascertained cases that had not been diagnosed in the general population. A small proportion of those in the general population had been ascertained as being autistic. A lot of kids were picked up as school aged children, particularly girls who had not been picked up earlier as in clinically diagnosed. In the Bristol one, we screened at 8 and by mid-adolescence virtually everyone who had a diagnosis at that time had been picked up as having a high score in our survey and of course there were lots of children on our survey, the vast majority, almost all of them up with them, those who scored as high on the Social Communication Traits of an Autistic type may well have had secondary psychiatric problems during adolescence but those data are still being analysed
- Q: Are there any resources in particular for supporting suspected or maybe undiagnosed girls, teens, women for females, that are suspecting that they themselves or someone else
A: We are not aware of anything here in the UK. We have similar problems in the UK are almost certainly not being picked up and even if they are, the resources to help them are very limited indeed under the National Health Service (NAS). There is enormous popular literature on being a female with ASC. It is worth checking out the work of Tony Attwood on this topic and Tania Marshall and people like that. We are at the stage of interesting, rich and powerful descriptions of the female phenotype but now we need to get a proper evidence base that reflects scientific testing of all these ideas coming out in the literature and to my knowledge those studies haven’t been done yet.
Some thoughts from me
It is wonderful to see clinical anecdotal and qualitative evidence and evidence-based research merge. Thank you to Sfari, Greg Boustead, Dr. David Skuse and Dr. Will Mandy for an excellent webinar.
I do think an issue that makes it challenging for professionals pick up females is a lack of understanding about the female subtypes. Within a large group of autistic females, this can be seen clearly. Some examples follow and I am writing about subtypes in a future book.
1. The Blender. Shy, quiet introverted, maybe mute at times type. This type blends into the wall or the furniture. You often do not know she is there. May be misdiagnosed with social anxiety. If often on her own or follow others
2. The talker. Loud, more controlling and rule-bound, extraverted type who may come across as having ADHD, may control the relationship
3. The flitterer, goes from group to group with no solid friends and goes unnoticed
More to come about subtypes in upcoming book series
Collections can often involve also stationary items; the collecting of erasers, pens, pencils, journals and similar items.
There is still much to learn about female autism and I encourage those with an interest in this area to possibly research the following areas:
Motherhood and Autism
Gender Identity and Transgender
Autism and the sex trade
Body Dysmorphic Disorder
Sensory Processing Disorder in females with Autism
Mature females with Autism
For more information on the female phenotype, the best-selling book entitled “I Am AspienGirl: The Unique Characteristics, Traits and Gifts of Young Females on the Autism Spectrum” is available for order now. The sequel entitled “I am AspienWoman: The Unique Characteristics, Traits and Gifts of Adult Females on the Autism Spectrum”, with a large Mentor section of real-life adult females headed up by Dr. Temple Grandin, is being released shortly. Both are available from www.aspiengirl.com or Amazon
Tania A. Marshall is a Tania Marshall is a 2015 ASPECT Autism Australia National Recognition Awards Nominee (Advancement category), a best-selling author, psychologist, autism consultant and free lance writer.
For more information on female Autism, please visit http://www.taniamarshall.com
Please follow these female autism researchers:
Rachel Hiller, University of Bath
Christopher Gillberg and Svenni Kopp
Meng Chang Lai
Simon Baron Cohen, University of Cambridge
Marianna Murin and Rebecca Chilvers from Great Ormond Street Hospital