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Why is Female Aspergers so hard to Diagnose?

Why this form of neuro-diversity is so hard to diagnose and intervene is the presentation often mimics other conditions.  If you are presented with a teenager who is suffering from a mixture of traits plus anxiety, this is the most likely symptom that will be focused upon.  The person will be told not to worry it will sort itself out in time and will pass.  When the parent insists it’s more than this   or mentions a connection to Aspergers’ they may be given a quick run through of the big 3 of ASD communication/social interaction/stereotypical behaviours.

So it’s a case of does she talk to people? YES

Does she have a friend in school? YES

Does she have a fixation about one particular interest? NO

Does she put her hands over her ears? NO

Then it’s not Autism.

To understand why this type of screening doesn’t give an accurate picture we have to look more closely at how those difficulties manifest in the neuro-diversity of Aspergers’

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Communication in Aspergers

The way that communication difficulties present in female Aspergers’ is often in the way communication works rather than, if it happens at all.  A girl may very well speak with others but in order for her to try and have a conversation produces crippling anxiety.  She constantly battles with intrusive thoughts such as ‘what should I say, when is it my turn to speak, oh no I missed it again now it’s the wrong time to come in.  They are going to laugh at a stupid thing I say. Think of a time someone else had this conversation and do what they did’.  With the thought process occupied with the pragmatics of the conversation they are not in flow naturally but are mimicking others they have seen, remembering successful scenarios to play out and hopefully will ‘get away with it’  and then it will end.

School life is a constant worry about being told or asked to speak in a group situation.   Teachers may think they are helping the nervous pupil by challenging them to speak about something they are good at for example if the girl is good at history the teacher may say ‘tell us about the Victorians you are very good at this subject’ The narrative running through the girls head is something like ‘oh no she is not going to let me off.  I can’t do this, everyone will find out I’m not really good at it at all’.

Anxiety, Self-doubt and low self-esteem are common factors with Aspergers’ in both male and female presentations.  However at a glance the traits may be missed more in the girls whom are much more adept at hiding their true difficulties than boys.

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Social interaction 

At school the Aspergers’ child may appear to be socially functional in that they have one or a small few friends.  However they often feel they are on the back foot with the friend /s.  They are easily led, feel that they have to go along with what the friend wants as they don’t trust their own judgment and use them to an extent to speak for them and allow the limelight and focus to fall on them as much as possible.  They may also befriend a person with similar challenges to themselves and feel too intimidated to mix with the ‘popular’ kids. Interaction is usually in school only and they find enormous relief to get home and finally be alone without the pressures that interaction brings.  So there is not much carry on outside of school time.  Helpful parents and teachers often encourage participation in extra-curricular activities in order to promote socialisation outside of school however this is often more anxiety producing and exhausting.

Aspergers’ children want friends and to fit in because they feel so different and awkward from others, however there is only so much ‘fitting in’ they can do in a day.

Stereotypical behaviours

Aspergers’ children and adults often have many different interests and talents.  The compulsive and obsessive way they go at tasks often makes them very proficient at what they do but they rarely feel good at anything.  They have a picture of perfection in their minds eye due to an extremely analytical brain process and find themselves coming up short when assessing their own efforts.  They are confused and don’t trust others opinions when they say things like ‘that’s amazing’ or ‘that’s really good’ they assume people are just being kind or encouraging because what they have done is (to their judgement) so inadequate.  (After all it’s not perfect so why would they say it’s good?)

The way in which they focus on a task is to be obsessed about it for a time then drop it for something else later.  So you may have an extremely talented person who can do many things rather than fixated on one.

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Sensory Issues

A feeling of being constantly overwhelmed by the world is a characteristic trait of Aspergers and ASD in general.  Sounds, sights and smells are all experienced in a heightened state of awareness and combine to converge and overwhelm the senses, defying the Aspergers need to categorise and sort them for processing.

No sooner has something been assigned a place in their mind then it changes category again.   Initial processing is often sorted into good and bad in order to try and make sense of the world.  This produces a dichotomous thought process that leaves no room for shades of grey and often lands the person in a state of constant dilemma.  They are sure the item is rightly categorised as changing one’s mind is not an option. After all if something has been filed as black, how can it be reclassified as white?  This is not logical.  As one can appreciate the knock on effect of this is they learn not to trust their judgement but continue in the thought process for want of a better strategy to cope with what is going on around them.

A comprehensive assessment including  Occupational Therapy, Speech and Language Therapy and Clin/Ed Psych can help to devise an intervention plan to address all issues mentioned above.

087 459 7652    087 387 6841  info@waterfordpsychology.com

 Female Aspergers Failing Diagnosis – Get an answer 087 459 7652