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      Autistic women and girls: increasingly recognised, researched and served

      Advances in Autism

      Emerald Publishing

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          Understanding and recognising the female phenotype of autism spectrum disorder and the “camouflage” hypothesis: a systematic PRISMA review

           Clare Sarah Allely (corresponding) (2019)
          Females with autism spectrum disorder (ASD) may display superficial social skills which may mask their ASD symptomology impacting on the identification of the disorder – known as the “camouflage” hypothesis. Compared to males with ASD, it is increasingly recognised that females with ASD have a stronger ability to imitate behaviour which is socially acceptable, particularly those females who have higher cognitive abilities (i.e. intelligence considered to be within the normal range) ( Ehlers and Gillberg, 1993 ). The paper aims to discuss this issue. This paper will explore the literature on camouflaging or masking behaviour in females with ASD. A systematic PRISMA review was conducted. The capacity to “camouflage” social difficulties in social situations is considered to be one of the main features of the female phenotype of ASD (e.g. Kenyon, 2014 ). Social imitation or camouflaging enables some level of success and coping, which results in some females never receiving a diagnosis of ASD. They typically may not exhibit any observable functional impairments. However, under the surface of the camouflage, females may experience high levels of subjective stress, anxiety and exhaustion and a need to re-charge or recuperate by withdrawing from any social interaction. There is relatively little understanding and knowledge of the female phenotype of ASD. This lack of understanding and knowledge impacts significantly on the ability to identify females with ASD (Lai et al. , 2015; Bargiela et al. , 2016), which can have a number of negative consequence (Adamou et al. , 2018; National Collaborating Centre for Mental Health (UK), 2012). There is a need for the development of a camouflaging measure. There is a real need for further research exploring the positive and negative impact of the phenomenon of “camouflaging”, or “pretending to be normal” in females with ASD.
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            Journey to diagnosis for women with autism

             Dori Zener (corresponding) (2019)
            The purpose of this paper is to review the barriers that girls and women face in receiving an accurate and timely autism diagnosis. The journey to late-in-life diagnosis will be explored with a focus on mental health and well-being. The aim is to improve the awareness of the female autism phenotype to provide access to early identification and appropriate supports and services. The author’s clinical experience as an individual, couple and family therapist specializing in girls and women with autism informs the paper. Research on co-occurring mental health experience and diagnoses are reviewed and combined with case examples to outline the themes leading to and obscuring autism diagnosis. Females with autism are less likely to be diagnosed or are identified much later than their male counterparts. Living with unidentified autism places significant mental strain on adults, particularly females. Achieving a late-in-life diagnosis is very valuable for adults and can improve self-awareness and access to limited support. Mental health professionals will develop a better understanding of the overlap between autism and psychiatric conditions and should consider autism in females who are seeking intervention. This paper provides a clinical approach to working with autistic girls and women. This knowledge can complement the existing research literature and help build the foundation for a greater understanding of the female autism phenotype.
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              Diagnosis and treatment of ASD in women in secure and forensic hospitals

               Sarah Markham (corresponding) (2019)
              The purpose of this paper is to explore the experience and possibilities for misdiagnosis of women with ASD in secure and forensic hospitals, via the medium of a lived experience case study. To consider the clinical value of the patient perspective of and insight into their disorder. The case study is supplemented by relevant associations to the MHA Code of Practice, the CQC report, Monitoring the Mental Health Act (MHA) 2016–2017, published on 27 February 2018 and current research findings in the fields of service provision, quality of care and treatment of female patients with a diagnosis of ASD. A review and commentary of the author’s lived experience of a formal diagnostic assessment for ASD as a female patient in a secure and forensic hospital. In reviewing aspects of the author’s clinical assessment, the author has made contextual reference to the MHA Code of Practice, the CQC report, Monitoring the MHA 2016–2017, published on 27 February 2018, and current research findings. The account focuses on aspects of the author’s recent experience assessment and treatment for ASD which the author believes may be of use in informing clinical practice. Open-ended exploration of a lived experience account/case study of a diagnostic assessment of an adult female patient for ASD, demonstrating the possible ambiguity of responses to questionnaire-based assessment tools and other deficiencies inherent to the assessment process and care and treatment of adult female ASD sufferers in secure and forensic hospitals. The author uses the lived experience as a patient to review and provide commentary on the clinical assessment for ASD. This review is, therefore, informed by an authentic patient perspective and not clinical perspectives. This paper highlights the need for further research into the diagnostic assessment of females for ASD in a secure and forensic hospitals. First, to encourage practitioners to extend their range of thinking to be more inclusive of the patient perspective when performing a diagnostic assessment. Second, to increase practitioner awareness of the deficiencies in the current service provision for adult female patients diagnosed with ASD in secure and forensic hospitals. To improve patient experience of diagnostic assessment for ASD and the quality of the assessment and patient outcomes in secure and forensic hospitals. The paper is original in concept in that it considers the inclusion of patient experience/views in assessment and formulation and links them to wider social policy and practice guidance. The case study is an authentic patient account informed by the author’s experience of secure and forensic psychiatric hospitals. The value of the paper may be determined by the extent to which the paper encourages practitioners to consider the patient perspective and experience of the diagnostic assessment and how this and subsequent care and treatment may affect the adult female patient in secure and forensic hospitals.
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                Author and article information

                Contributors
                Journal
                AIA
                10.1108/AIA
                Advances in Autism
                AIA
                Emerald Publishing
                2056-3868
                03 July 2019
                : 5
                Issue : 3 Issue title : Women, girls, and autism spectrum disorders: part II Issue title : Women, girls, and autism: part I
                : 141-142
                Affiliations
                Partnerships in Care Learning Disability Services, Norfolk, UK
                Article
                629210 AIA-07-2019-052.pdf AIA-07-2019-052
                10.1108/AIA-07-2019-052
                © Emerald Publishing Limited
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 7, Pages: 2, Words: 784
                Product
                Categories
                back-matter, Non-article
                cat-HSC, Health & social care
                cat-LID, Learning & intellectual disabilities
                Custom metadata
                no
                yes
                JOURNAL
                included

                Health & Social care

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