Female Asperger Syndrome, Current Statistics and Gender Differences

I write based on my own clinical and anecdotal evidence,
research studies and the work of world experts.

The statistics for boys to girls with Asperger Syndrome sit at 1:4, so
for every 1 girl there are 4 boys who meet criteria for Asperger
Syndrome. However, for those of us professionals who work solely in
this field we know that the statistics reflect a prevalence rate of
Asperger Syndrome in girls that is in reality, 1:2, meaning for every one female, there are two boys. Dr. Judith Gould, director of the National Autistic Society’s Lorna Wing Centre for autism and co-founder of the Centre for Social and Communication Disorders discussess the difference in prevalence rates between boys and girls. The statistic most commonly reported is that ASDs are four times more common in males than in females. Many clinicians, however, believe that the ratio is as high as 16 boys to every girl. But Gould believes that significantly more girls have the condition than is recognised; she estimates the ratio to be 2.5 boys to every girl.

Girls with Asperger Syndrome present very differently to boys with the same condition and “fly under the radar of a diagnosis”, often being MISdiagnosed,
MISunderstood, MISmedicated and sometimes, institutionalized. In my
clinic, boys tend to be diagnosed before formal schooling or in
their primary school years. Whilst I have diagnosed girls with
Aspergers as young as two year of age, the majority are closer to
the teen years. They appear to be able to cope with the basic more
“play-based” socialization. However, in secondary school the social
world changes dramatically from play-based to a more socially and
emotionally based conversation, social hierarchies are more
apparent, and the typical “bitchiness” and “mean girl” behaviors of
teenage girls is distinct. This difference often flies over the
heads of the female with Aspergers, who are often left behind
repeatedly analyzing their social faux pas, social confusion and
replaying the day’s social events in their minds over and over
again, often late at night, in their attempts to make sense of
them. Their female peer group’s interests have changed from
childhood friendships to teenage talk, emotional conversations,
cliques, groups, backstabbing, and “bitchiness”. They find they
cannot understand or “read” the unwritten rules, the non-verbal
facial expressions/glances/eyerolls and the non-verbal body
language that is critical to being an important member of a group.
As much as they observe, copy, and mimic their peers, they finds
that they just cannot keep up or fit in appropriately. Their peers
sense that there is something “ödd” about the Aspien, despite the
enormous amount of energy that they generally expend in their
attempts to fit in. In secondary school, girls with Aspergers
utilize a variety of coping mechanisms in their attempts to “fit
in”, “pretend to be normal”, “be accepted”, hide and camouflage
their confusion, imitate, copy, fake it until they make it, but
still appear to come off just a little “ödd” or “strange”, despite
their best efforts. Most of the girls I have seen have had previous
diagnoses of anxiety disorder, depression, ADHD, an eating
disorder, oppositional defiance disorder, bi-polar disorder and
even Borderline Personality Disorder (although they are still young
teenagers) and at times, reactive attachment disorder or selective
mutism. An enormous amount of energy is spent on observing,
learning and trying to understand and then copying their peers
social behaviors. I have met females who have utilized some or all
of the following strategies: Reading body language books and
practicing in front of the mirror in a repetitive way until the
skill is perfected the mirror

Learning from television shows or books about others inner thoughts, feelings and
motives

Replaying specific daily social situations in their own play at home in an effort to learn and
understand

Using imaginary friends to specific daily social situations in their own play at home in an effort to learn and understand

Over-apologizing, appeasing or pleasing others, giving gifts for social faux pas or social
mistakes

I have seen many teenage girls who have been brought into to see me and are have been described as having “gone off the rails”, in terms of their appearance, their attitude,
their mood, skipping or dropping out of school, running away from
home, involvement in drugs, sex, crime and/or the Police. They later met formal criteria for Asperger Syndrome.

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Using “chameleon” strategies, where the Aspien girl can adapt and fit into a variety of roles. In one example, I met a female who successfully fit into a very rough
motorcycle gang, a conservative church sect, and a traveling
circus! She had acted so well for so many years that she came in
with clinical depression, having no idea who she was. I have seen
teenage girls with Aspergers reject all social norms/values and
turn to drugs and sex and even crime.

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Girls with Asperger’s need very specific and appropriate social skills
interventions designed for them, in terms of learning about levels
of friendships, boundaries, social hierarchy, the unwritten social
rules, non-verbal body language, cliques and groups and the role of
people in those particular groups. They also need interventions
designed to help them with identity, self-esteem, managing intense
emotions, rigid black and white thinking and negative thinking.
Most typically, Aspien girls have the greatest difficulty in the
adolescent years, when they tend to “go off the rails”. Most, but
not all, Aspiens tend to be non-conformists and conforming to
social rules they don’t understand begins to take it’s toll. I had
one parent show me a picture of her daughter just a few months
before she saw me. He appearance was one of a typical teenager.
Then I had the chance to meet her daughter, who had in just a few
months gone “goth”, gotten several piercings and tattoos, was using
drugs and hanging around “bikers”. This young teen was rebelling
against all those groups that had not accepted her. Her desire was
to be accepted and approved of by anyone. This group and the men
she was having sex with accepted her, approved of her and took care
of her. She felt both accepted and popular. It is imperative that
any girl who comes into a clinic with either/or an eating disorder,
social difficulties, intense emotions, difficulties expressing
themselves, anxiety or depression, must be screened for Asperger
Syndrome, in a female. Then, once a comprehensive and detailed
developmental history is taken by an experienced clinician, the
diagnosis of Asperger’s becomes apparent, and then the appropriate
intervention can take place. Currently, information on female
Aspergers and Autism is occurring at a
rapid pace and there will be a
knowledge explosion within the next 10 years.

A recent study Dr Meng-Chuan Lai of the University of Cambridge
found that Autism affects male and female brains
differently, http://www.bbc.co.uk/news/health-23613816

CAVEAT:
Generally speaking, my doctoral research is in the area of females.
Having said that I am not saying that males do not experience these
issues. I am merely writing about my
specialization.

Tania Marshall©. 2013-14.
Professional Q and A Series I. All rights reserved. Duplication in
whole or part is explicitly forbidden. Thank
you.