The Assessment and Diagnosis of Adult Females on the Spectrum
The following article is copyrighted and may not be posted anywhere without permission from the author.
Updated 11/12/2016
Pathways to a diagnosis for an adult
The most common pathways to diagnosis include:1. After the diagnosis of a family member, usually a child
- The client already has one or more children diagnosed with an Autism Spectrum Condition
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The client had been encouraged by their work or education environment, their parents or their partner to get an assessment
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The client initiated professional help for depression, anxiety, an eating disorder, bi-polar disorder, schizophenia and subsequently received a diagnosis of Autism or Asperger Syndrome
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The client had been reading about "male" Asperger Syndrome, did not identify with the male-biased information, and then came across information about female autism or female asperger syndrome, and then identify with many of the characteristics
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The client has been mandated for assessment
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The client has been either identified as or charged with stalking, obsessions over people
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The client has become in trouble with the law in relation to cybercrime and cyberstalking
What is involved in the diagnostic and assessment process?
The Assessment and Diagnosis of adult female Asperger Syndrome/High-Functioning Autism tends be quite a complex process. Generally speaking, the diagnostic process involves the following:
1. An interview to discuss family history, developmental history, childhood, teen life and early adult life. Questions are asked that have been modified to look for compensatory mechanisms.
2. Why the person believes they may have Asperger Syndrome
3. The clients presenting issues and current life context
4. Completion of one or more formal assessments together. The reason I complete the assessments with the client is because I gain much more information from the client by exploring some of the items in greater detail. Any confusion on the client's behalf regarding the items can also be clarified.
5. A review of a 4 page autobiographical description written by the client of their experiences from their earliest memories until around age 25. This is usually sent via e-mail before the first appointment. The autobiographical account is discussed with the client in terms of hallmark diagnostic features and qualitative themes. In addition, 1-4 description(s) from someone/others who know the client well is also invaluable in helping with the diagnostic process.
6. Perusal of photographs of the client when they were a child. This may help the client remember events and the actual photographs may also provide valuable clues.
7. Perusal of any talents and gifts (for example, artwork, poetry, writings, books, degrees, creative endeavors, jewellery making, photography, singing, etc.), by the client
8. Perusal of any previous reports or diagnoses, IQ tests
9. Perusal of school report cards and/or report card comments
10. A discussion or with a parent or family member, if possible
Masking and Chameleon Behaviors (Compensatory Strategies)
11. Observations of facial expressions, masking expressions, chameleon behaviors, body language, repetitive behaviors, tone, pitch and volume of voice and personal appearance. An investigation of social strategies, scripting and other compensatory strategies.
12. An investigation of face reading/mind reading and understanding of non-verbal body language
- An investigation of sensory sensitivities
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An interview with a family member, partner or someone else who knows the client well.
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One or 2 descriptions of the clients in terms of strengths and challenges by someone who knows the client well
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The results of the assessment are discussed and if a diagnosis is made, time is also spend on a "now what?" section, which involves future recommendations. Support is discussed in terms of social, emotional, career, family, and resources. A diagnostic letter or report is usually supplied to the client or to the clients doctor.
The diagnosis of adult female Asperger Syndrome is only the beginning. It is never too late to receive a diagnosis nor it too late to receive intervention or make changes in ones life or begin a new hobby, interest or career.
A diagnosis is only the beginning. The "What Next" section is the RoadMap for ones's future.
My "What Next" Section?
- Awareness and knowledge of the diagnosis
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Education
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Attitude and a positive identity. Creating a strengths and talents list and/or if unknown trying common strengths known to people with Autism
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Addressing any challenges
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Finding out how she thinks and learns (i.e. pattern, verbal/word or visual thinker OR for example auditory learner)
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Making environmental and/or academic accommodations
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Understanding the unique sensory profile and creating and using a sensory management kit
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Discussing and problem work, family or academic challenges
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Discussing the pros and cons of self-disclosure
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Understanding learning difference or disabilities
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Working of self-esteem and self-identity issues
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Addressing any co-existing conditions of disorders (for e.g. personality disorder, bi-polar disorder, eating disorder)
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Addressing and improving communication issues with family members, partner, and children
Further problem solving sessions may take place and focused on presenting concerns and/or priorities, which vary depending on the stage of life and the age of the client. Tania is available for fee-based diagnostic impressions assessments, support, intervention via in-clinic or Skype/Facetime/Phone consultation. Please email Tania at tania@aspiengirl.com
Tania Marshall. 2013-2017. All rights reserved. Duplication in whole or part is forbidden. Thank you.
It’s so great to know why I feel different and why I have to put so much effort into fitting in – I’m interested I knowing for sure if I have Aspergers but I’m also scared – I feel like I would be letting the world see and know who I really am and it terrifies me. My current label is bipolar, before that major depression and self harm, before that post natal depression and before that I was anorexic then bulimic. I’m not sure how helpful another label would be.
I put a post in to reply to your post and it’s down below. My name isn’t as above my name is francis.k.martin which is my facebook name and when it said name I put as above. I am not used to computer protocols at all. I am still wrestling with my paper form filling disfunction. Literal mind plus force of habit strikes again. My labels go like this…. Loosely in chronological order . Strange child. Gifted child. Wierd child. Foreign child. Intelligent child. Promiscuous teenager. Academic failure. Bullied child. Overtalented child. Depressed student. Self-harming depressed student. Post- natal deppression. Post puerperal psychosis. Unfit mother. Schizophreia. Anorexia. Bi-polar. I am 53. I was bi-polar for 15 years and fought it tooth and nail. I was rediagnosed only two years ago. One simple diagnosis restored me to a central integrity that the system had robbed me of. Now top repair the damage and make a life hey.
Thanks for your reply – you have been through the label process too! It’s nice to know there are more of us women out there and we’re not as alone as we feel some times 🙂 Do you take medication for the bipolar ? All the medication has always made me feel like I’m squashing who I really am. I’m toying with the idea of going for Aspergers diagnosis and perhaps I can grow in to my own skin with help. I have a family I love and a great job and workplace but deep down I want to be able to be the real me. I wish I’d been diagnosed at a young age like my son – I’ve always told him to be himself 🙂
So your Aspergers diagnosis has really helped you ? It’s good to hear. Perhaps I should look into diagnosis further.
Would love to keep in touch.
Sue
Scared? When I found out it was like winning a jackpot! Great revelation, explains everything I had problems with, why I had these numerous problems of relationships, work, keeping jobs, fixations, etc. When I was diagnosed, family members, friends, coworkers, everyone accepted me better with no more just toleration and total rejection. I WAS UNDERSTOOD, after they all read up on autism. Lots of their bitterness against me were dropped, doors opened, and lots of understanding. Lots of harmony. Getting the Diagnosis is like a miracle. Whole life changed. Susie
Hello, I would be very interested in being diagnosed by you. I live in NZ. Could you please give me an indication of the costs involved. I have family in Brisbane I could stay with.
Thank you, Lisa Harman
I was labelled bipolar as well and it was shit. it didn’t fit, but it bent everyone else to see me that way. After fifteen years I moved to a new consultant on purpose and after working with him for three years got rediagnosed because one time I was in the mental health unit for respite and this Asperger boy was in … the rest is history. I had never really known anything about it. Now I am learning more. This label fits. It fits in every direction it fits right back to early childhood and it doesn’t make ppeople assume I am a psychopath. I no longer have delusions of grandure. I really am incredibly intelligent! Trouble is! Now people know more they meet me and say “oh you can’t be Asperger because…. (insert stereotype) I am too social. I am not a computer genius. I am female. I don’t talk in a monotone. I have no interest in bus timetables. I don’t know the colour of the underpants of every American President…. etc. Now I am working with a lovely psychologist for a second opinion and I am very happy with the label. It is allowing me to throw away once and for all all the other labels they gave me which were not accurate. It is making a huge difference to my life – it explains things to me, and makes it easier to explain who I am to others… It allows me to refuse medication – big issue – because anti-psycho meds are profoundly brain damaging and invasive and downright not good and create psychopaths and social…. Don’t get me started! When I was mislabelled refusing meds was a symptom of my disorder. Now refusing meds is intelligent self-care of a massive intellect that has been wasted by failing to fit adequately into social expectations of females. The norm is getting so tight these days. I would recommend any adult female who has run ins with the psychiatric profession look into Asperger Syndrome because it is my firm belief that the missing four girls are visible inside the system misdiagnosed and maltreated as other so called mental illnesses. Scratch it and see. Thankyou for reading.
Dear Tannia
This blog has helped me and my partner endlessly these past few months, in fact it has been part and parcel in saving our relationship. Thank you so much!
I would love to take part in a diagnoses with you if at all possible.
Kind wishes
Emma
Hello Emma and thank-you for your message. I am pleased to hear your news:-) My assistant will contact you regarding a diagnostic assessment. Take care
Hi
I’m interested in diagnosis. Can you forward me some further information about your services.
Sue
Hi Sue, could you email me at tania@aspiengirl.com and my amazing PA will send you details?
Hi I am very interested in finding out how my 42year old daughter can get a diagnosis. She has never been able to work because of her severe lack of communication skills and was at one point advised by a psychologist that although she was almost certain louise was Asperger’s there was no one to diagnose her. She was recently put on a low dose of anti depressant which has helped a lot, but as her 14 year old son was diagnosed with Aspergers and her 12 year old daughter has anger issues and o.c.d. Her life is difficult. My daughter was a member of Mensa with an IQ of 158 and her children are very similar. I have always been there to do all the things she finds difficult but my other grandaughter also has Aspergers. Her mom is my other daughter who is a community nurse so also needs my support because of her commitments and different health problems. I am 66years old myself and still working as a teaching support assistant in a primary school but will soon be retiring so o would like to see my family get the best help possible while I have the energy and time.
I have been following these emails with interest and will continue to do so so thank you very much for all the valuable information.
Many thanks
Elaine
Hello Elaine, thank-you for your kind words. I will email you and I would be pleased to help you and your family.
Hey Tania,
I had an assessment done in November last year. The psychologist who did my assessment was hesitant to give me an ‘official’ diagnosis (or report) because I no longer come across as someone who has a disorder or syndrome. This is because I have spent a lot of time developing skills (e.g. stress management) and strategies to cope in life. So, I was told that I have ‘residual’ Asperger’s and that I think in an Asperger’s way. I feel a bit discontented because it seems like a yes-no answer (it is not a no or a yes).
I notice that I still miss out on certain social cues, so I continue to read about various topics e.g. flirtation. So, I was wondering if you think it was worthwhile for me to pursue another diagnosis even though I know that I have ‘Asperger’s’.
I’m looking at possibly get a diagnosis but not sure.
I’m looking at possibly get a diagnosis but not sure. I have listened some of the female traits on my blog and explained how they fit for me.
Hi, could you email me at tania@aspiengirl.com please?
I was wondering if I could get some help or at least pointed in the right direction. I have had numerous diagnosis but nothing totally makes sense. Now my oldest daughter who is only 7 is queried for aspergers. I would like to know what is going on for the two of us.
Hi Stacey, if you would like assistance please email tania at tania@aspiengirl.com
This makes so much sense to me it’s like finally the puzzle fits. I know why I am the way I am and can work on fixing what needs fixing. Thank you. I now just need to get my Drs on board because I’m 100% convinced this is me. I took two tests online and scored a 37/50 both times. Any tips on where to go next to get help?
And my son was just diagnosed with asbergers too.
Amy that does make sense. Asperger’s is highly heritable and often seen running down the female line
Amy you’re welcome. Whoever you see please ensure they are familiar and experienced in the area of female Autism. Where do you live?
My daughter was referred to a pediatric psychiatrist for behavior and academic problems. I went in there and said, It’s Aspergers, right? The NP talked to her for 5 min then officially ruled her out for Aspergers,(presumably because of her intermittent eye contact, reciprocity, and humor) gave her a ADHD/NOS diagnosis and signed her up for ADD meds. Two years later I ask about the DSM 5 update and what her diagnosis is now. The NP kindly tells me she is now officially ASD and I can learn more by googling Aspergers. Argh, grind teeth, duh. So, even with teenagers it can be a struggle to get HFA recognized in females. Now I am seeking a diagnosis for myself. Because, yeah, I’m an alien, and living on this planet is just hella hard without support. And I love labels, it helps me understand myself and other people. I’ve always been obsessed with personality quizzes and tests anyway, the diagnosis process sounds facinating to me. I’m just weird. But seriously, catagorizing, labeling, and studying the different types of people is the only way I have to know how I’m supposed to act around them. My challenge now is that I’m so good at passing, medical professionals are gobsmacked or dismissive when I bring up Aspergers for myself. My masking is getting in the way of getting a diagnosis, but I don’t know who I am if I’m not masking anymore. I wear makeup and style my hair because people treat me better when I look nice. I hide my obsessive interests because no one else gives a fig about anything actually interesting. I studied acting to learn how to behave in public. One of my seemingly natural talents is writing witty dialogue. I’ve been married 20 years and have 3 kids. One psychologist actually laughed when I self identified as an Aspie. Well I stopped hiding my stimming, stopped making a conscious effort to make appropriate eye contact and nod at the right times, and happily go on and on about my obscure hobbies in her presence now. She’s not laughing anymore. And she offered to help me rehearse for the all-teachers and the principal, what to do about my weird kid meeting coming up at school next month. Hah. I don’t see why medical professionals are so hesitant to consider an official diagnosis in high functioning individuals, especially women! We are so often crippled by anxiety and depression because we don’t understand ourselves and keep trying to meet standards and expectations that we just can’t. And we’re such literal people… Having a medical professional say you’re not what you are makes dealing with it so much more difficult.
I’ve found reading this page so helpful, my daughter suffers from schizophrenia, my 2 son’s have autism ADHD dislexia and CLDD, I did the QB test result high score, I’d love you to test myself, I’ve had to fight tooth and nail to get support for my children now adult’s they get nothing unfortunately, again really enjoyed your page, kind regards Dee
Dee, thank you for your comments. Glad it’s helpful 😃🙏
Hi, i’m Rebeca. Sorry my english, i’m brazilian. I’m very interested in your consultation, for some time I am distrustful of autism of high functionality, I fit into all categories, the difference is that I am more sociable and as stated in his article, I actually mask the symptoms. The problem is that here in Brazil one does not work so well in this area that is relatively new, and little know about female autism. Tomorrow I will consult a new autism psychologist to make the diagnosis, I am afraid of the result and fear that is not enough to ease my anguish, I would very much like to receive your help if possible. Thank you.
Hi Rebecca, thank you for your message and could I please have your email address?