The document discusses how autism spectrum disorder (ASD) manifests differently in females compared to males. It notes that females are often diagnosed later in life or miss a diagnosis altogether due to gender biases in diagnostic criteria and research. Common misdiagnoses for females with ASD include ADHD, anxiety disorders, and personality disorders. The document advocates for more gender-inclusive research to better understand the female experience of ASD and tailor support and interventions.

1. Thank you for the opportunity to speak to you today.
My personal journey to receiving diagnosis of Asperger's:
• Diagnosed at 26 years old in October 2013 – in 2nd year of my Master's degree. Diagnosis took
place at the Center for Autism Research at Virginia Tech. Official diagnosis was “Autism Spectrum
Disorder without accompanying intellectual impairment” due to the changes in the newest version of
the DSM (released in May 2013), unofficially called “high functioning autism”, but I resonate much
more with Asperger's, which is becoming obsolete. A key barrier was being diagnosed with seizures or
epilepsy just before I turned 1 year old, so my parents for the longest time attributed all of my
challenges to epilepsy.
• What it meant to receive the diagnosis of high functioning autism at age 26: I finally found a
reason – backed up by science – that explains in what ways I am different, one that describes me with
an exceptionally high level of accuracy! Started to be aware at age 12 or 13 that I am very different,
and self-diagnosed (as having Asperger’s) at age 15 when a teacher in grade 10 asked me whether I
have Asperger's, so suffered for 11 years wondering why I was struggling so much socially to fit in –
why relationships were and are still so difficult for me. For example, never made any friends in high
school, nor in my first 3 years of my undergraduate studies at UBC. As I do more advocacy or activism,
I have come to the realization that maybe I am not that weird and there really is nothing wrong with me.
I am different, and there is – or at least should be – nothing wrong with being different. However, I still
have to prove to almost every person I meet that I do have a form of autism, and the process of doing
this is exhausting!
Transition from personal information to thoughts about research on women with Asperger's:
Setting aside the controversy whether high functioning autism and Asperger's are synonymous, I will
abbreviate HFA to denote individuals on the autism spectrum that do not have intellectual impairment
nor significant language delays – what I call the milder end of the autism spectrum, or what is
sometimes known as the invisible end of the autism spectrum.
My thoughts on how HFA manifests in female adults – 19+ years old:
• I find it very common for women – over 19 years old – to be diagnosed with HFA. Yes, women,
especially those that were born in the 70's or earlier, are definitely being screened out in the current
diagnostic process. Thus, it is unquestionably more common among women to be diagnosed in
adulthood than men, with one of the most common paths (to diagnosis) being after their children are
diagnosed with some form of autism. This implies that a large proportion of women live most of their
life missing out on the supports that could make a huge difference to their lives!
• Biggest sources of misdiagnosis (based on mostly qualitative research I have read and drawing
from my experience interacting with females with HFA): Attention-Deficit/Hyperactivity Disorder
(ADHD), Anorexia, Bipolar II, Borderline Personality Disorder (or other personality disorders),
Depression, and Post Traumatic Stress Disorder.
• In my attempt to highlight how differently HFA manifests in females than in males, I
would like to mention 3 HFA traits in females not present in males*: (1) Better at mirroring than
males and so may mirror many different types of personalities. (2) Emotional instability – Adult
females are prone to both temper and crying meltdowns, even in public; sometimes over seemingly
small things due to sensory or emotional overload, whereas adult males are not prone to crying. (3)
Tends to receive less tolerance and more expectation from others because she appears more socially
adept. *based on a chart by Rudy Simone (help4aspergers.com) listing female Asperger's traits. I
identify very strongly with the 3 traits I listed, as well as most of the traits listed on Simone's chart.
• According to Dr. Tony Attwood, and numerous adult females with HFA – including myself:
females despise femininity and defy – or at least loathe – social and gender conventions or

2. stereotypes. This can lead to females having a weaker sense of identity than males. Personally, I do not
defy but definitely loathe such gender conventions or stereotypes! I have a female body but a male
brain according to Dr. Simon Baron-Cohen, so should I identify as a female or male?
• In terms of what is being written on the topics I mentioned so far, a rapidly increasing number
of books and newspaper articles are being written by adult females with HFA that report mainly on
their personal journey to living successfully being on the autism spectrum. E.g., (Frenz, 2013; Kim,
2014; Lawson, 2000; Purkis, 2006; Willey, 2011). However, there is a huge shortage of research that
amalgamates all these personal accounts to highlight similarities and differences in how HFA
manifests in adult females, as well as what factors influence specific behaviours or conditions.
• One major source of gender conventions: Baron-Cohen's autism as “extreme male brain”
theory – female vs male (i.e., Empathizing vs Systematizing) brain types. The biggest problem in my
opinion is that this theory undermines the high social standards placed on females from a very young
age – before adolescence. Basically, I find Baron-Cohen’s definition of empathy to be extremely
problematic. Empathy is inherently complex, and Baron-Cohen's definition is not the only one out there,
but is likely the dominant one. In fact, another way of looking at empathy becoming more widespread
(Szalavitz, 2013) is that people with HFA or autism in general have empathy but too much – not too
little!
• Aside: in case you are not familiar with Baron-Cohen's work, his definition of empathizing is:
“spontaneously and naturally tuning into the other person's thoughts and feelings, whatever those may
be. ... it is about reading the emotional atmosphere between people” (2004, pp. 21–22). (Two
components of empathy explained on (2004, pp. 26–28).) The problem is not so much about the ability
to read feelings as much as the other people's feelings and thoughts all coming in a lot faster than I – or
others with HFA – can process it. In other words, individuals with HFA, especially adult females,
feel others' emotions way too intensely to cope – being overwhelmed by emotion. Hence, we have
empathy but in a different way!
 (Very high) Social standard for females: Enormous pressure for adult females with HFA to
conform to expectations of stereotypical gender roles. Females are supposed to be more empathetic and
therefore more socially adept, aren't they? Society says so! Females very well may be better at
socializing than males, but are they acting as a different person or are they showing their genuine self?
For this reason, females very much still have to prove to almost every person they meet that they
do have a form of autism until the diagnostic process dramatically changes! Among female adults,
including myself, the problem may not be the level of social life as much as the quality of it. Example:
In work environments, when your symptoms are less obvious, expectations are way higher. And if you
do not meet them then you are perceived as being unproductive, moody, difficult, incompetent.
Females particularly might be extremely sensitive to the emotional atmosphere.
 With April being Autism Acceptance month, I recommend that all of you be supportive of the
autistic community – especially females – as they make efforts to advocate for themselves.
Unsettled ratio of males:females officially diagnosed with HFA:
• Typically reported as 4-5:1, as high as 15:1; but a few nationwide population-based studies
show a lower ratio of 2-5:1 (Lai, Lombardo, Auyeung, Chakrabarti, & Baron-Cohen, 2015). Dr.
Francesca Happé, professor in cognitive neuroscience at King's College London, comments on the
importance of population-based studies. An increasing number of very recent reports comment on the
predominant bias toward males in the past and current diagnostic criteria (Des Roches Rosa, 2016;
Griswold, 2016; Happé, 2015; Simmons, 2016; Szalavitz, 2016; Wallwork, 2016; Willingham, 2015).
Dr. Kevin Pelphrey, psychologist at Yale University's Child Study Center: “Everything we thought
was true of autism seems to only be true for boys” (Szalavitz, 2016).

3. Questions for Psychology 208 Students:
• Do you think there is a gender imbalance with diagnosis? If so, then why? What do you think
the most accurate ratio is (of males:females officially diagnosed with HFA)?
• Dr. Meng-Chuan Lai, assistant professor in psychiatry at University of Toronto: “A key question
is how the brain characteristics of men and women with autism relate to similarities or differences in
their behavior. We also need to investigate whether the brain variation largely stems from different
causes in men and women with autism. If that turns out to be the case, we should prioritize interventio n
and support strategies tailored to the different needs of men and women with autism.”
• If research were to be conducted regarding the adult female experience of HFA then what
aspect(s) could be a focus? Investigating overlap with common mental health issues? Which ones?
Refuting existing stereotypes? Which ones?
• Dr. Francesca Happé, professor in cognitive neuroscience at King's College London: “Research
that is population-based is vital because clinic-based studies run the risk of confirming any existing
stereotypes and biases in diagnosis. Without population-based studies of gender differences in autism
and autism traits, it will remain unclear to what extent females in the population fail to receive an
autism diagnosis, and whether in such cases females ‘suffer in silence’ or achieve genuine
compensation that renders diagnosis unnecessary.”

4. References
Baron-Cohen, S. (2004). The Essential Difference: Male And Female Brains And The Truth About
Autism. New York: Basic Books.
Des Roches Rosa, S. (2016, January 29). How Can We Do Better By Our Autistic Girls? Retrieved
from http://www.blogher.com/how-can-we-do-better-our-autistic-girls
Frenz, F. (2013). How to Be Human: Diary of an Autistic Girl (First Printing edition). Creston Books.
Griswold, A. (2016, March 11). Diagnostic tests for women with autism fall short. Retrieved March 17,
2016, from https://spectrumnews.org/news/diagnostic-tests-for-women-with-autism-fall-short/
Happé, F. (2015, October 19). Male slant to research may skew autism’s reported sex ratio. Retrieved
March 23, 2016, from https://spectrumnews.org/opinion/male-slant-to-research-may-skew-
autisms-reported-sex-ratio/
Kim, C. (2014). Nerdy, Shy, and Socially Inappropriate: A User Guide to an Asperger Life. Jessica
Kingsley Publishers.
Lai, M.-C., 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 & Adolescent Psychiatry, 54(1), 11–24.
http://doi.org/10.1016/j.jaac.2014.10.003
Lawson, W. (2000). Life Behind Glass: A Personal Account of Autism Spectrum Disorder. Jessica
Kingsley Publishers. Retrieved from http://www.jkp.com/uk/life-behind-glass.html
Purkis, J. (2006). Finding a different kind of normal: misadventures with Asperger syndrome. London,
England: Kingsley.
Simmons, E. (2016, February 29). Women with autism: do they really suffer less than men? New
Statesman. Retrieved from http://www.newstatesman.com/politics/health/2016/02/women-
autism-do-they-really-suffer-less-men
Szalavitz, M. (2013, November 16). Theory finds that individuals with Asperger’s Syndrome don’t lack
empathy – in fact if anything they empathize too much. Retrieved from
https://seventhvoice.wordpress.com/2013/11/16/new-study-finds-that-individuals-with-
aspergers-syndrome-dont-lack-empathy-in-fact-if-anything-they-empathize-too-much/
Szalavitz, M. (2016). The Invisible Girls. Scientific American MIND, (March/April 2016).
Wallwork, E. (2016, March 25). How Gender Stereotypes Prevent Women With Autism From
Unmasking Their True Selves. Huffington Post. Retrieved from
http://www.huffingtonpost.co.uk/entry/women-with-autism-spectrum-
disorder_uk_56e9744de4b096ed3adcaef7
Willey, L. H. (2011). Safety Skills for Asperger Women: How to Save a Perfectly Good Female Life.
Jessica Kingsley Publishers.
Willingham, E. (2015, September 4). Autistic Girls Are Undiagnosed, Underserved And Misunderstood.
Forbes. Retrieved from http://www.forbes.com/sites/emilywillingham/2015/09/04/autistic-girls-
are-undiagnosed-underserved-and-misunderstood/