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Saturday, April 25, 2015

Young Women on the Spectrum

From the MGH Aspire Program Blog

By Alyssa Milot, Ph.D.
April, 2015

Young women on the spectrum face the same social expectations and demands that their typically developing female peers face. How women on the spectrum interpret and respond to these expectations, however, can be quite different. Women with autism spectrum disorder (ASD) also differ from their male counterparts in several ways.



According to recent research, females diagnosed with ASD present with unique characteristics in these key areas (1):
  • Social Interaction: Females tend to have greater awareness and desire for social interaction, propensity to mimic others in social interactions, tendency to camouflage difficulties by developing coping strategies, and have one or two close friends.
  • Communication: Females tend to engage in imaginative and pretend play but their play is limited to nonreciprocal interactions and is scripted in nature. Their speech contains more emotional/feeling vocabulary words and expression.
  • Restricted, repetitive patterns of behavior, interests or activities: Females tend to have special interests that are more likely to be people or animal focused (e.g., celebrities, pets) rather than objects (e.g., Legos, trains).
  • Additional characteristics: Females may also have the tendency to be perfectionistic, controlling (particularly when they are younger) with peers during play, avoidant of demands, and may engage in disordered eating during adolescence.

Women with ASD also differ from their male counterparts in several ways. Females with ASD, for instance, have a slight but greater tendency to show empathy than males. Males, on the other hand, are somewhat more likely to view the world through approaches that use logic and rules to understand their relationships with others. (1) These are not hard, defining lines but do tend to appear more often in each respective gender. 

Societal Expectations

One explanation for the different expressions between males and females on the spectrum may be due to societal expectations. In general girls’ play behavior is more relational than object or action oriented. Female play groups, for example, are often more intimate than male play groups and involve greater expectations for conversation skills and empathy. These expectations provide females with ASD more opportunities to study/observe and mimic socially expected interpersonal skills during their early development. (2)

“As a woman on the spectrum, I am well-acquainted with the thorns that cut us until we bleed. In addition to the typical hurdles put in our way by ASD, there are a variety of ominous scenarios females are particularly susceptible to. I have walked smack into many of those bad places. I have come face-to-face with some cruel people. Unfortunately, I am not alone.”
Liane Holliday Willey, “Safety Skills for Asperger Women: How to Save a Perfectly Good Female Life.”

At the same time, the social intricacies and demands placed on women with ASD may also be greater than those placed on males with ASD. In adolescence, females begin to be held up to high standards concerning their personal appearance: from their choice of clothing and hair styles, to hygiene practices, to interests and hangouts. These demands continue throughout adulthood. If they don’t develop or put emphasis in these areas, it adds an additional emotional or psychological burden to the woman with ASD.

Another important difference from males with ASD is in how young women develop a healthy sense of sexuality; namely: gender identity (what does it mean to be a female?); sexual orientation (what does it mean to be attracted to females, males, both and/or neither?); and, romantic feelings, behaviors, and relationships.

Unfortunately, statistics continue to show that women are more likely to be victims of intimate partner abuse and violence. Issues of bullying and peer victimization continue to permeate our culture. Young women diagnosed with ASD may be even more susceptible to these dangers due to their naiveté, difficulties in recognizing social cues, and engaging in self-advocacy.

Because of the increasing social demands and complexity of interpersonal relationships during young adulthood, some studies have shown (2) that young women diagnosed with ASD are more susceptible to:
  • Anxiety, depression, and somatic symptom (and less risk for externalizing behaviors such as verbal and physical aggression);
  • Eating disorders (i.e., anorexia nervosa);
  • Sensory issues;
  • Difficulties with sleep.

Strengths and Abilities

While it is important to understand the potential risks that women with ASD face, it is just as important to understand their many strengths and abilities. Australian psychologist Tania Marshall views women diagnosed with ASD as possessing an abundance of strengths that she describes in her popular book series Aspien Girls.”

A small sampling of these include (3):
  • Creative, active imagination;
  • Strong willed;
  • Keen attention to detail;
  • Creative and idiosyncratic sense of humor;
  • Able to acknowledge the importance of and utilize solitude/”time for oneself” in daily life;
  • Special interests often related to topics such nature, animals, children, art, and music that have the potential to yield prosocial behavior (e.g., volunteering in the community);
  • Conviction for honesty in relationships.

Supporting and Championing Young Women on the Spectrum: Resources and Strategies to Help Them Thrive 

Luckily, young women with ASD have recently begun to share and write about their experiences as well as the coping strategies that they have used. This kind of support helps break down walls of many who feel alone and misunderstood. Many other resources, unique to this population, are also available and worth looking into.

Here are some strategies and ideas by women with ASD:

1.) Strategies to Support Healthy Friendships and Romantic Relationships
  • Identify a trusted “go-to” person (a family member, friend, or mentor) who knows you well and understands your challenges. Use this person to check in with when you feel unsure or uneasy about a friendship or potential romantic partner. Allow them to give you feedback regarding their perspectives (e.g., “I think her intentions are genuine and it would be nice if you went to the movie with her.” Or “Did you notice how he smirked when you mentioned your love of Taylor Swift? I doubt that you will find shared interests.”)
  • Self-awareness is an important life skill and especially important in forming relationships. The more you know about yourself the easier it will be to form relationships and express yourself.
  • Disclosure/honesty is important in a romantic relationship. When you feel comfortable, disclosure such as “sometimes I have trouble reading facial expressions or social cues so I may misunderstand our conversations at times and ask you to explain yourself in other ways” can be helpful with trusted friends and potential romantic partners.
  • Remember not everyone who is nice to you is your friend. Acting friendly is not the same as being your friend. Discerning who is a friend and who is not a friend is complicated because of the complexities and unwritten rules of friendships. Understand that friendships typically have trust between each person and trust has to be earned and takes time to develop.
  • Friendships typically include: shared interests, ideas, and principles that both people believe.
  • Friendships take time to develop and both people care about each other. Know how to show caring for the people in your life and if you don’t know how to then ask them.

2.) Strategies to Support Overall Mental and Physical Health
  • Find a trusted professional team (e.g., physician, therapist, psychiatrist) to help you navigate your relationships with others and overall mental health.
  • Engage in daily practices of gratitude (e.g., writing in a journal, naming one or two things you are grateful for each day).
  • Contribute to others (e.g., engage in service projects, causes that you believe in).
  • Find ways to utilize your special interests every day (e.g., make it your career, volunteer and teach others your talents, whether it be music, knitting, or writing, etc.).
  • Monitor your eating and sleeping patterns and notify your providers when you noticed changes.
  • Take time for yourself each morning or before you go to sleep at night.
  • Engage in physical activity as often as possible (e.g., walking, biking, hiking, or even cleaning).
  • Understand how you respond to your different negative emotions (i.e. anger, fear, sadness) and what you need from others when you experience them.

3.) Local Support and Social Connections Groups
  • Aspire Integrations Young Women’s Group (See Aspire's adult programs page for more information.)
  • AANE Young Women's Group, Watertown (Contact AANE (aane.org) for more information regarding schedule/topics, policies, and location.

4. Books
  • Aspergirls by Rudy Simone - Written by an adult woman diagnosed with ASD for women diagnosed with ASD; includes commentary on a variety of issues including gender role and identity, puberty, sexual attraction, friendships, college, employment, marriage, and motherhood.

5.) Blogs and Online Resources
  • Aspiengirl (http://www.aspiengirl.com/blog) - Focused on young women diagnosed with ASD; a series of books and online resources that allows young women to recognize and utilize their strengths in everyday life.
  • Autism in Pink (www.autisminpink.net) - A site that was created as part of a research project conducted in the UK a few years ago which has a variety of information and materials tailored to girls and women with ASD.

Certainly people on the spectrum possess unique characteristics as compared to their typically developing peers. While we need to raise awareness across the board, let’s not forget that females have unique needs that need unique attention and resources. 

About Alyssa Milot, Ph.D.
Postdoctoral Fellow

Alyssa is a postdoctoral fellow with Aspire. Trained as a psychologist, she currently develops and coordinates groups and summer programming for teens and young adults and engages in school consultation. Alyssa has been with Aspire since 2008, and she has held multiple positions including job coach, social skills clinician, and summer program manager for teens and young adults.

References
  • Lai, Meng-Chuan, Lombardo, M.V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), 1-24.
  • Kreiser, N.L., & White, S.W. (2014). ASD in females: Are we overstating the gender difference in diagnosis? Clinical Child and Family Psychology Review, 17, 67-84.
  • Attwood, T., and colleagues (2006). Asperger’s and Girls. Arlington, TX: Future Horizons.
  • Willey, L.H. (2012). Safety skills for Asperger’s women: How to save a perfectly good female life. Philadelphia, PA: Jessica Kingsley Publishers.

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