Asperger's Syndrome: The invisible female

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The possibility that 75% of Low functioning autism cases among girls are hidden or misdiagnosed is quasi impossible.

Unlike AS, LFA is a very obvious disorder.

There are are more boys with LFA than girls, parents might not notice AS in children, but it's impossible to not notice LFA/classic/severe autism in their children, so it is very unlikely to have 'hidden severe autistic girls". AS and Autism are supposed to be cousin disorders ,so it shouldn't be surprising why there would be more AS boys than girls.

and why is 10:1 instead of 4:1?
AS is just way over-diagnosed as overall than LFA/Classic autism, it's the new ADHD (and probably way overdiagnosed among boys), hence the different ratios.

Not sure about the west' society, but at least where I live, girls are more expected to be social , earlier expected to be mature, more expected how to converse and more expected to know "how to be behave correctly". Even if shyness is more expected from girls, shyness does not equate social ineptness at all. All those expectations should make aspie girls even more noticeable than guys.

Huh, I just had this page open:





Social ineptness can easily be equated with shyness. It's not as if people are running around with clearly delineated definitions that put people into one box or the other. You're making a logical argument, but the data you're putting into it needs to be accurate.

Would also like to see support for the claim that AS is overdiagnosed. The 10:1 ratio is outdated from when AS was barely diagnosed at all, and as diagnoses have increased the ratio has moved closer to parity.

Anyway, perception can be a powerful thing and people will see what they expect to see. I do not think I have ever passed perfectly as neurotypical, but when people see traits that would mark me as on the spectrum, they tend to characterize those traits in other ways: Shyness being one. I mean I've also been characterized in other ways (once getting past the "shyness" appearance), such as being "too much" or "best taken in limited doses," which did wonderful things for my self-esteem, but they also signaled that I was not coming across as I thought I was. But no one ever suggested I was autistic.

This reminds me of a line from the Wizard of Oz.

I have read of several cases of parents knowing that their daughters were autistic (LFA), but still had trouble getting an official confirmation. I guess in these instances, their daughters did get diagnosed eventually (sometimes much later), but mostly because the parent was determined to find out what was going on. In one case, a woman took her daughter to a psychiatrist because she was showing pretty clear signs of autism- and the psychiatrist said "don´t worry, it´s highly unlikely. Girls hardly ever have autism". So, yes, I think this can and does happen, unfortunately.

Oops, edit: I guess it´s doubtful that it´s 75% of cases, that´s a pretty high number. But at least it does happen sometimes.

This sounds interesting....if you eventually find the article, can you post it? I never thought about this before, but it actually makes sense somehow. (In my non-professional opinion )

Yes. And even if a child clearly has some developmental delays, it may not be easy to tell if it's low-functioning autism or some other intellectual disability.

I have a very, very high tested verbal IQ. Very high. By the end of elementary school, my reading comprehension was on the college level and I was using words in my everyday vocabulary that my teachers didn't know. I also wrote stories--I would spend hours writing out stories by hand. But I also found talking counterintuitivein many situations and I was utterly clueless about verbal reciprocity.

Even now, at almost 40, relatively fluent in 3 languages besides English, well-read in literature, philosophy and science, and an experienced tutor and teacher, I still forget to greet and offer my name when I meet someone. I just dive right into a conversation, right to the information sharing part. I'm great at communicating information and asking info-seeking questions, but social reciprocity is still an work in progress for me, both verbally and in body language. Part of why I can work with kids in an educational setting is, as their teacher they don't expect me to stand around and chat with them--I'm there to teach them. I can do that. I'm very comfortable with that. But something like make eye contact and say hello to the grocery check-out clerk is still very awkward for me.

Yes. LFA is very obvious. So people do notice something is wrong. But just noticing something is wrong does not mean this "something" will be accurately characterized as autism. My daughter's pediatrician was absolutely convinced that her lack of speech was caused by a hearing or auditory processing impairment. She clearly wasn't deaf. The first wave of hearing tests ruled that out. But she had every auditory test that exists before the audiologist (who was starting to feel like a close personal friend, we saw each other so often) said "enough!". Perhaps if she was a boy, the lack of speech would make a doctor think autism first (or at least sooner than 3 years worth of hearing tests from age 2-5). But she didn't tick off the autism box in his head somehow and so he stuck to his guns for 3 years that her lack of speech was auditory impairment of some sort. So the problem was every bit as obvious as you say, but there was still misdiagnosis.

You may ask, what about the social difficulties? Stimming? The pediatrician explained away the social difficulties as being a byproduct of audotory impairment (or auditory processing impairment). Other kids made her nervous because she couldn't make sense of what they were saying. In a way that's true, but not the way he meant it. The stimming was remarked upon but also explained away. She played with her dolls by shaking them back and forth because she couldn't make sense of conversation to have conversational scenarios with them. In retrospect it all seems so obvious. But at the time, going down this incorrect path of auditory problems wound up being a way to see serious autism in a girl without actually seeing it.

A correct diagnosis happened when I got her a new pediatrician.

Last edited by Janissy on 15 Mar 2011, 4:36 pm, edited 1 time in total.

I have a sister with many problems and she hasn't had therapy a day in her life, and only has a tentative school diagnosis and she is rather obviously autistic. I think it's much easier to accept someone with severe problems as it just being the way they are and leaving it at that, especially when it is a girl and people can just treat her like she is fragile than a boy they might regard with wariness.

The ratio of boys to girls with LFA is estimated to be about 2:1 whereas just looking at HFA it is more like 7:1 according to my abnormal psych textbook. The ratio for AS: estimates vary but thought to be 4:1. The fact that the ratio is so different when they are supposedly variants of the same disorder (to me) is clear evidence that AS is often overlooked in girls!

Also one reason that AS/autism may be overlooked in girls is simply because of this ratio: autism like ADHD is thought of as a boys disorder. I had very obvious salient symptoms. I had a string on a sweater that I refused to part with and would carry with me to school and dangle in front of my face with my face scrunched up. My reports from elementary school said things like “she shreds paper (which I would similarly dangle in front of my face) and twiddles her fingers in front of her face constantly and goes off in her own little world. She hums and talks to herself . She gets angry when materials are moved out of place or there is a change in routine” . I was rated as “in the clinical range” for “social problems/withdrawn” and “odd behaviours” on child behaviour checklists that my mom and teacher filled out for years. I had an LD diagnosis. The other problems were attributed to “ emotional problems” or “adjustment problems”. I didn’t get diagnosed (with AS) until I was 13.

It was something mentioned in e-mail correspondance in my work e-mail. I want to see it myself. But the more I think on this discussion I had with the fella who made me aware of this theory. The more I actually buy into it.

I work with aspies for a living and the majority of undiagnosed people I see who are seeking a diagnosis are women in their 20's or early 30's with all sorts of misdiagnosis. Even if this group is not a majority. They are clearly a significantly marginalised group to warrent the kind of investigations my local social services and mental health teams are willing to invest in order to find such a population (and i'm so glad they are dead serious as well it makes a change when professionals and comissioners or services really LISTEN for a change)

Is this how your professionals percieve autism to be in Lebanon or it is just your personal conjecture? I don't know on what professional basis you make the claims you do of "overdiagnosis" and throw around ratio's and figures without referance to sources.

You know that in the middle east mental illness is grossly under reported in comparison to western cultures. Is that something you are aware of? Thats a very interesting comparison actually the culture of middle east and north african cultures vs southern european/Turkish western, eastern and scandinavian countries. Huge differances in interpretation of diagnostic criteria and all sociological not clincal based.

In Russia they have an entire school of thought that Autism is an anglo-americain myth.

Do you mind if I ask you another question? It´s a bit off topic, sorry. You said that you work with Aspies, and I would be curious to know what sort of jobs there are, and how one gets involved in this? I would be really interested to help AS adults, but I have no idea how to get started. Does one need certain degrees or something from University? Are there jobs for people with no degree? I was always a dancer, and now I may need to change my career. I have no other "skills", but AS is my special interest, and I would like to help people. If you have any advice, let me know. Feel free to PM me.....thanks!