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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Sfari Webinar: Summarizing The Female Autism Conundrum and my Thoughts

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?

  1. Studies are not recruiting a representative sample of females with Autism and therefore are making spurious conclusions.
  2. The under identification of females with Autism Spectrum Condition (ASC) with average IQ
  1. 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.
  2. 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.
  3. 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
  1. Identifying, ascertaining and assessing teenage females with Autism Spectrum Conditions if particularly challenging and problematic. Why is this?
  1. 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
  1. 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.
  1. 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

  1. Is she unusually interested in things like metal objects, lights, street signs, or toilets? No, she is obsessed with Justin Bieber!
  2. 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
  3. 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).

  1. 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.
  2. Female obsessions or focused interests include: fashion, people (peers or celebrities or professionals), Barbies, hair, animals, Manga and Anime
  3. 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)
  4. Social difficulties are misattributed to shyness or social anxiety
  5. Greater ability and capacity to “camouflage” and/or hide their autistic tendencies (Lai et. al, 2011)
  6. 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.
  7. Friendships: Girls are often ignored by others rather than rejected
  8. Female autistic difficulties are underestimated in school
  9. A much greater risk for anxiety and depression in primary school and then eating disorders in adolescence and sexual exploitation
  10. Camouflage: the “masking” of ASC behaviours in social situations and/or the performance of behaviours to compensate for difficulties associated with ASC
  11. 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)
  12. 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?

  1. Social Motivation
  2. Socially focused special interests; for example, psychology, anthropology, Jane Austen novels to crack the “social code”, to develop strategies to function socially
  3. Socialization experiences and pressures; the social pressures and expectations placed on women as opposed to men
  4. Executive control: the ability to inhibit, shift and generate plans
  5. Better social imitation and awareness
  6. Better Capacity for reflection
  7. 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

  1. 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

  1. 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

  1. 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.

  1. 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

  1. 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.

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For more information on female Autism, please visit http://www.taniamarshall.com

Please follow these female autism researchers:

Will Mandy

David Skuse

Rachel Hiller, University of Bath

Christopher Gillberg and Svenni Kopp

Judith Gould

Meng Chang Lai

Simon Baron Cohen, University of Cambridge

Francesca Happe

Marianna  Murin and Rebecca Chilvers from Great Ormond Street Hospital

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.