Marcia Eckerd:
Autism in females is often unrecognized and undiagnosed. This article describes the presentation of autistic traits of females and how they differ from those of males with autism. Screening tools for assessing autism in children, adolescents, and adults are identified and described. The process of clinical assessment of females for possible autism are described, including the disclosure of potential diagnoses to the patient.
Michelle is a self-referred, 24-year-old woman complaining of anxiety. Her anxiety impacts sleep and seems to worsen physi- cal GI symptoms. She is appropriately dressed, having come af- ter class, and she is articulate although she takes long pauses to collect her thoughts. She graduated from an excellent college, and she is attending graduate school in English literature and was working part time until recently. She quit her job because her boss frequently yelled at her about not meeting his expectations. She felt he was never clear and constantly changed what he wanted her to do. She felt anxious every day and dreaded going to work. She had quit a prior job because she found it difficult to work in the constant close “team” environment of the office. The team members regularly went to lunch together or out for drinks after work at a noisy bar, neither of which she enjoyed. She felt that her right to a private life and need for time alone were not understood. Michelle lives in her own apartment. Michelle describes herself as a child “always having her nose in a book” and loving reading. She felt she had not fit in socially through all levels of school. She reports few close friendships, although she had friends in school and had been somewhat friendly with a woman in her last job. Parties and family events made her nervous. She didn’t feel that her parents understood her point of view about attending family events, although they were generally supportive of her. She had not dated until college, and then had one relationship that she broke off. Michelle appears to be a serious young woman of high intelligence. She does not display much emotion, despite being obviously upset by her situation. Her descriptions of her experiences are very detailed. When asked about her feelings, she often does not respond beyond saying she was anxious. Is this social anxiety or something more complex? Should a pos- sible diagnosis of autism spectrum disorder (ASD) be considered? What exactly does ASD look like in female patients?
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