1. A Different Voice: TeEn Girls On the Spectrum
Mary R Cohen, PhD
Autism Spectrum Diagnostics & Consulting

2. My Inspiration

3. Why Girls are Misdiagnosed, Misunderstood or Missed
Myths that girls can’t have autism
Thoughts that girls with autism had only severe presentations with intellectual disability
Diagnostic criteria was developed specifically around males (4 to 1 ratio) *
ASD females are more socially aware than ASD males however…...
Less obvious “restricted interests”(not necessarily dinosaurs or trains)
Many ASD girls engage in pretend play with dolls or stuffed animals
Likely to be diagnosed with ADD, OCD or anorexia rather than ASD

4. Tale of Two Brains
Brain scans show that girls with ASD process social information differently from boys with ASD
Girls with ASD are more similar to typical boys, they process faces and nonverbal cues to a greater degree
They process social information more than ASD boys but less than typical girls. This causes challenges in social situations with their female peers.
Pelphrey 2016

5. Social Brain Activity

6. Girls with ASD are working twice as hard to be social

7. Studies of Gender Differences in ASD
Girls with ASD scored significantly higher on the Friendship Questionnaire than boys with ASD however they were lower than typically developing girls
Typical boys scored similarly to ASD girls (Head, McGillivray & Stokes, 2014)
Teachers are less likely to report social communication difficulties for females compared to males with similar issues.
Girls have less severe Repetitive Stereotyped Behaviors (RSB) and therefore are at greater risk for not meeting diagnostic criteria (Mandy et al. 2011)
Should the ADOS and ADI-R be revised?

8. Is there a “protective Factor” for Girls
Baron-Cohen’s “extreme male brain” theory: autism caused by fetal exposure to higher than normal levels of testosterone
ASD minds are more focused on “systemizing” (understanding objects & ideas) than “empathizing” (understanding social interactions and other’s perspectives)
Female hormones are thought to protect individuals from ASD unless a number of genetic mutations along with environmental factors is present (Jacquemont et al., 2014)
While boys are more prone to develop ASD there is still strong evidence that ASD is under diagnosed in girls
Possible 2:1 ratio instead of 4:1

9. Girls are Diagnosed on Average 2 years later than Boys
Researchers frequently include only boys in their studies***
Milder symptoms (relatively speaking) girls mask their deficits
Many ASD girls are verbal and outwardly social but are struggling on the inside
Girls are acculturated differently and don’t always present noticeable behaviors
In childhood girls are perceived to be more social (whether or not they are)
Clinicians are unable to recognize the subtle presentation of ASD and the compensatory skills girls with ASD develop
*** this is changing!! (Pelphrey et al., Dworzynski et al., McGillivray et al.)

10. Girls learn different Coping Skills
Girls learn to imitate others to “fit in”
Girls journal behaviors and create “scripts”
Girls are encouraged to be more social by parents, teachers
Girls with ASD are often chameleon-like, adapting to social situations without fully understanding female social rules

11. BeINg A TeenAGE GiRl is HArD Enough without being on the Spectrum!!!
Female social rules and friendships are complex and confusing
Girls with ASD are aware of gossip and know they’re being talked about (not paranoid as sometimes diagnosed by male clinicians)
Girls internalize their pain and may develop anxiety, depression and eating disorders as a result of ASD
Hormonal changes are critical (girls have a self-esteem drop after puberty)
Mean girls, Queen Bees and Wannabees (female social rituals are bewildering)
Often in Special Ed classes which are predominately male
Clothes, fashion, hair and make-up (when will it end!!)

12. “I get depressed and anxious because life is difficult
“I get depressed and anxious because life is difficult. It’s all secondary to the Asperger’s.”
Maya, 24 years of age who was diagnosed with depression at the age of 11 years, had crippling social anxiety in her teens and wrestled with anorexia.
Apoorva Mandavilli, The Lost Girls, The Atlantic 2015

13. Issues for Teen Girls With ASD
34% experience depression (rates also rising for typical teen girls)
36 % experience anxiety (rates also rising for typical teen girls)
At risk for anorexia: compulsions around calorie counting/perfectionism, possible sensory issues with food
Gender social issues : girls lose the early “social advantage” over ASD boys
Loneliness and social isolation from girl’s cliques
For girls socialization is about communication and social-emotional relationships
Often treatments that work with ASD boys are inappropriate for girls

14. Gender Identification issues
Lack of experience socializing with girls
Boys are easier to understand and socialize with
Confused by complexity of female “rules”
Lack of identification with female gender stereotype
Don’t want to fit into the gender binary

15. Healthy Sexuality for Teen Girls with ASD
Importance of understanding bodily changes and puberty
Importance of hygiene regarding menstruation, hair washing, skin, deodorant
Importance of understanding sexual attraction/ romantic feelings and how to handle these
Understanding sexual orientation : Friendship vs crushes
Obsessive crushes
Learning how to use the internet safely and what to avoid!!
Understanding how to safeguard oneself, learn safety skills (how to say no)

16. Books for Teen Girls with ASD

17. Books for Women with ASD

18. Positives & Negatives to being a girl with ASD+ -
Fiercely Independent
Creative thinker
Nonconforming
Artistic
Kind-hearted
Caring
Fiercely Independent
Perfectionistic
Self-critical
Masks confusion
Internalizes feelings
Misunderstood

19. Apoorva Mandavilli, The Lost Girls, The Atlantic 2015
“The more I understand Myself the more I can explain to other people what I find Difficult, and the more they can help Me.”
Maya, 24 years old
Apoorva Mandavilli, The Lost Girls, The Atlantic 2015