ADOS-2 false negative (poorer test sensitivity for women)

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I received my ASD diagnosis. However per the ADOS-2 test, I do not have ASD. I am so pissed. I am dealing with workplace gender discrimination and now this?! !! !! ! Testplace gender discrimination?

I am so sick of being excluded from Standards. Just because I am a feeling, caring woman makes me MORE of an engineer and MORE of an Autist (meaning as a valuable member of the community, I am not implying better than). About five years ago my engineer boss said to me, "if you care so much, go be a nurse". And now after I have to self diagnose and after a professional confirms my ASD diagnosis this test effectively says "if you care so much, go be an NT".

I am fuming. I know belonging isn't one test, but it's all these "tests" I receive day in and day out... that I fail.

If you have some good thoughts or links on or related to this, please pass along.

I find this one. https://insar.confex.com/insar/2017/web ... 25811.html
"...a larger proportion of females [diagnosed with ASD] received [ADOS-2] scores in the non-ASD range. ...future research should further investigate when and why some females with ASD are missed by these instruments..."

and correct the problem.

Well, I believe you.
And it's about time someone produced a diagnostic tool based on the female phenotype.

Are we talking about 2 radically different conditions here , in terms of presentation between females and males , or it just about minor/subtle differences ?

One thought I have is that many Outgoing, Expressive ASD people have been missed - which are fewer men and more women.

And as @traven pointed out Special Interest (I extend that to Systemization) questions have traditionally been biased (e.g. train and machines) and not inclusive of other manifestations (e.g. animals and processes). So even though I have very strong Systemization impulse that shows up at work and home (standards, spreadsheets, databases, lists) and even driving my car (proportion of vehicles with each color and type, frequency of stops at a particular light), I "fail" the online systemization questions also. https://www.aspietests.org/ I come up as typical for NT male. I bet most of my testing comes up as "typical for NT male". Except I am not an NT male.

Yeah, autism looks different in women, especially those of us who slipped under the radar earlier in life.
Partly because we tend to be quicker than the boys at working out how to copy what others are doing and keep our mouths shut, so we don't appear as different. And also because our special interests are rarely mechanical (trains etc) and might be (say) animals or psychology. Many of us also enjoy reading fiction, and the old diagnostic tests based on the male presentation adopt "no interest in fiction" as a marker.

Two decades ago, most of us would have been denied a diagnosis entirely, because viewed from the outside, we don't seem to have the condition so obvously. But recently people working in the field have started recognising that just because our autism presents differently, and we seem more 'normal', doesn't mean we don't have autistic wiring, or that it doesn't cause us problems. For instance, there are terribly high rates of mental illness amongst autistic women, related to constant masking and the higher expectations of social competence we face.

When Kanner was first documenting autism (entirely in boys), he noted that their mothers often appeared cold and aloof (hence the "refrigerator mothers" theory).
What he was probably seeing was autistic women, I think. He just didn't recognise them as having the same condition.

I found something in support of my theory.

"Further, we hypothesise that the female tendency to have internalising (e.g., anxiety, depression) but not externalising (e.g., hyperactivity/impulsivity, conduct problems) difficulties is also a risk factor for non-detection of ASC..."

Source: https://www.researchgate.net/publicatio ... _Phenotype

So as a female I'm less likely to yell and throw the blocks at my assessor if s/he puts a couple out of my reach. In fact I was very polite indeed (too passive for my taste, but I have difficultly acting according to my thoughts --- so since explosive is frowned upon - passive is my go to).

Like me, my daughter is so "well behaved". Her teachers and doctors are all saying "no ASD", as did my therapists and doctors --- until I unmasked. I suppose there are Pros and Cons to both styles (internalization, externalization). In general a boy (or externalizing girl) is more likely to get help sooner but can't "pass" as easily and has anxiety related to that; a girl (or an internalizing boy) is more likely to "pass" (as I did, as my daughter is doing) but … the depression and anxiety can build...

And people wonder why I don't want to bother with a formal assessment.

do people tell you...

No because I avoid them like the plague because they give me panic attacks because I know that whatever they would like to tell me I don't want to hear it and would probably misinterpret if I did hear it because my TOM is useless and any solution apart from avoidance is beyond my capacity for executive functioning.

but answering no truthfully means I can't be autistic????! !! !!

Exactly. My school yearbooks were full of "strange", but thirty years later people don't write it directly anymore. Asides from looks, I most often get "you're cute?!". Which since I am near 50 years old, I take to be the equivalent of "odd". So, perhaps I am not supposed to take the test questions literally, and let the looks or "cute" qualify as "do people tell you..." But, to your point, I taking the Q literally is my true ASD self. In fact, I wonder that the more an adult person "fails" the Qs, the more ASD they are...