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“She Looks So Normal” – Aspergers In Girls – What Does It Look Like?

Lately, I’ve come across several articles that touch on how Aspergers in girls is often misdiagnosed and missed altogether, robbing them of developmental opportunities, school resources, and the much needed praise and validation for who they are. Their symptoms often go unnoticed because they mimic the social behaviors of their female peers and are often quiet and unassuming in class. It wasn’t until we sent Chloe to treatment when she was 13 that she was officially diagnosed on the autism spectrum.

…I was extremely emotional due to the guilt I felt over robbing her of the love, support and understanding she needed for 13 years, angry at the school system and her doctors for missing her diagnosis and blaming her and us for her inadequacies and lack of skills at school, while feeling relieved that we could move forward with a better understanding of who Chloe was and how we could facilitate her growth.

I bring attention to this misdiagnosis because it was a huge “Aha” moment for us and a diagnosis that would have helped us structure our parenting and her schooling much differently during her young and critical developmental years. I remember the therapist and psychologist providing us that diagnosis and I just burst into tears. I was extremely emotional due to the guilt I felt over robbing her of the love, support and understanding she needed for 13 years, angry at the school system and her doctors for missing her diagnosis and blaming her and us for her inadequacies and lack of skills at school, while feeling relieved that we could move forward with a better understanding of who Chloe was and how we could facilitate her growth.

Autism is not a disease, or a reaction; it is a developmental neuro-biological difference in brain functions. People with autism may evidence difficulty in social interactions, problems with verbal and nonverbal communication, and odd or restricted activities and interests. Symptoms of autism are usually recognized during the first three years of childhood; however, high functioning autism or Aspergers Syndrome is often not recognized until children are of school age.

Autism, characterized in the past as a result of an “extreme male brain”, is far more prevalent in women than previously thought but is still often untreated because the stereotype focuses on male behavior. Girls mask their symptoms by learning to imitate the behavior of non-autistic people. But without a diagnosis, experts say, their difficulties with social interaction and attachment to routine are misunderstood at school and then work, leaving them at increased risk of mental health problems including depression, eating disorders and self harm. Often naive and fearful of displeasing people, autistic girls and women are also vulnerable to abuse, which Jeff and I experience often with Chloe. She is often so desperate for friends and boyfriends and naive about her surroundings, she’ll find herself in dangerous and risky situations with “friends” who are more interested in how much money they can get from Chloe for drugs than an actual relationship. These lessons have been hard and devastating for Chloe, to say the least.

Below are ways girls differ from boys with Aspergers Syndrome:

  • Girls use social imitation and mimicking by observing other children and copying them, leading to masking the symptoms of Asperger syndrome (Attwood, 2007). Girls learn to be actresses in social situations. This camouflaging of social confusion can delay a diagnosis by up to 30 years.
  • Females can experience “social exhaustion” from the enormous energy it takes pretending to fit in.
  • Girls, in general, appear to have a more even and subtler profile of social skills. They often adopt a social role based on intellect instead of social intuition.
  • Girls often feel a need and are aware of the cultural expectations of interacting socially. They tend to be often more involved in social play, and can be observed being led by their peers rather than initiating social contact. They often only have one or two close friends and/or may find boys easier to get along with.
  • Cultural expectations for girls involve participating in social communication, often made up of social chit-chat or surface-type conversation. Girls with Asperger Syndrome find this type of communication exhausting, tending to desire having conversations that have a function to them. Girls on the spectrum are also are socially confused by teasing, bullying, and bitchiness, and the teasing that often occurs at school.
  • Girls often misunderstand social hierarchies and how to communicate with others based on the level of the hierarchy that the person is on. This can tend to get girls in trouble with adults.
  • Girls have better imagination and more pretend play, with many involved in fiction, and the worlds of fairies, witches and other forms of fantasy, including imaginary friends.
  • While the interests of girls on the spectrum are very often similar to those of other girls, it is the ‘intensity’ and ‘quality’ of the interest which can be unusual. For example, many are very focused on their animals, celebrities or soap operas.
  • Girls and women on the spectrum are generally skilled in one-on-one social relationships, but are uncomfortable and anxious in large groups of people.
  • Girls may have great difficulty in attempting to explain their difficulties in social situations and/or groups. Instead, they may skip school, complain of headaches or stomach aches or refuse to go to school.
  • Girls facial expressions tend to not match their moods. They may say that are fine, but on the inside they are unhappy, anxious or both.
  • Girls tend to be more passive-aggressive (avoid social activities, refuse requests from others or refuse to complete tasks), tend to blame themselves and/or internalize their feelings and anger.
  • Girls on the autism spectrum are more likely to come to the attention of health professionals due to difficulties with anxiety, depression, eating disorders, behavioral problems and/or social skills challenges. The presenting problem then becomes the ‘diagnosis’, with the larger picture and explanation for feeling “different” is missed.
  • Women with Asperger Syndrome are most likely to have had a long history of misdiagnoses, often with borderline personality disorder, schizophrenia, anxiety disorder, depression, selective mutism, OCD, but somehow those labels just didn’t seem to fit adequately. Up to 42% have been misdiagnosed.

Many girls and women with Aspergers Syndrome are not being diagnosed and are therefore not receiving the help and support needed throughout their lives. Having a diagnosis is the starting point in providing appropriate support for girls and women in the spectrum. A timely diagnosis can avoid many of the difficulties women and girls with an autism spectrum disorder experience throughout their lives.

What should I do if I suspect my daughter has Aspergers Syndrome:

If you think your daughter may fall in the spectrum, you are most likely receiving psychiatric services. Bring this blog article or other articles to your next appointment and address your concerns. Your psychiatric provider should have some evaluation resources to make a proper diagnosis. If your daughter does in fact have Aspergers Syndrome or is on the autism spectrum, she will be eligible for special services from your school district that will make it much easier for her and you to navigate the social nuances of school.

Andrea with Bipolar Lemonade can also provide support through one-on-one services. Click here to Schedule An Appointment.

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Join the discussion 2 Comments

  • Jenet Johnsen says:

    Thanks for sharing. I have a soon to be 26 year old son who has been misdiagnosed and put on the wrong medications repeatedly in his life from the age of 9 on. He recently was reassessed and put on some new to him medications. I haven’t seen him this “well” and functional in several years. Our mental health system is in disarray and filled with assumptions. It is discouraging when your child is treated with assumptions instead of understanding, knowledge and compassion.

    • Andrea Berryman Childreth says:

      Thank you for sharing your story, Jenet. It can be so frustrating and isolating. It’s great to hear your son is finally feeling better. What a difference a correct diagnosis can make!

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