AFAB Autism Assessment: Common Questions Answered
Dr. Jessica Myszak, who provides autism assessments for late-diagnosed, high masking women answers the following questions: How does autism present differently in women? Is self-diagnosis valid? Why haven’t the lived experiences of women been included in the diagnostic criteria? What might social differences, repetitive and stimming behaviors look like in someone who is AFAB? We explore thoughts about HSP vs. autism? What is Pathological Demand Avoidance PDA (also known as Pervasive Drive for Autonomy)?
Dr. Jessica Myszak, Licensed Psychologist
Questions asked in this episode
- Why are so many assigned female at birth AFAB being diagnosed with autism?
- Is it a fad? People say you watch Tik Tok and think you’re autistic
- Is self-diagnosis valid?
- Why haven’t women and their experience and presentation of autism been included in the DSM criteria?
- How does autism present differently for women?
- Why is there a gap between the written criteria for autism and the lived experience for those who are AFAB?
- If someone is an internalizer, what might stimming and repetitive behaviors look like?
- What are your thoughts about HSP vs. autisim?
- Do you think that HSP is a subtype of autism, or is there a profile of autism where deep feeling, deep thinking and empathy are present?
- What is Pathological Demand Avoidance PDA, also knows as Persistent/Pervasive Drive for Autonomy?
Common misconceptions about autism in females
- The assumption that autistic females are not interested in socializing, when in fact they may be on the fringes of social groups but never feel like they truly belong. –
- The assumption that autistics do not have feelings, nor do they have empathy is grossly false. Many autistics feel so much, that it is overwhelming
- The assumption that autistics don’t or can’t make eye-contact.
- The assumption that autistics will stim in apparent ways like rocking, hand-flapping etc. vs. thinking/processing, hair twirling, sucking cheeks in, using thumb to gently stroke hand, rubbing feet together, counting things.
- The assumption that autism only affects males, and as a result, assessment tools and education are often skewed towards recognizing autism in males. –
- Many psychologists and neurologists still rely on outdated information about autism that was learned many years ago in graduate school, which can lead to misdiagnosis or missed diagnosis in females. –
- There is a gap between healthcare professionals who are following updated information about autism in females and those who are not.
Some characteristics of autistic females
- Autistic females may be on the fringes of social groups but never feel like they truly belong. –
- Autistic females may have a strong desire to socialize and make friends, but may struggle with social cues and maintaining friendships. –
- Autistic females may have a tendency to mask their symptoms in social situations, which can lead to exhaustion and burnout. –
- Autistic females may have a strong interest in certain topics or activities, but these interests may be more socially acceptable than stereotypical “male” interests like trains or vacuum cleaners. –Interests may include relationships, personal growth, hobbies and crafts, medical information, being an avid reader, parenting, etc.
- Autistic females may be more likely to experience anxiety or depression than their neurotypical peers. –
- Autistic females may be more likely to receive a misdiagnosis or missed diagnosis due to the fact that assessment tools and education are often skewed towards recognizing autism in males.
Examples of repetitive or stimming behavior in women
- Deep thinking and processing. –
- Using weighted blankets or heavy blankets for comfort. –
- Hair twirling, pursing lips, having tongue against the roof of the mouth, sucking on the inside of cheeks.
- Rubbing fingers or toes together, using fidget toys, doing cricket feet (rubbing feet together). –
- Doing a figure eight or pattern with fingers or thumbs on clothes. –
- Watching shows on repeat, listening to music on repeat, rereading books.
- It’s worth noting that these are just a few examples, and that repetitive or stimming behavior can take many different forms and vary widely between individuals.
Ways healthcare professionals can better recognize and diagnose autism in females: –
- Healthcare professionals should be aware that autism looks different in autistic females than it does in males, and should not rely solely on assessment tools and education that are skewed towards recognizing autism in males. –
- Healthcare professionals should be aware of the common misconceptions about autism in autistic females, such as the assumption that they are not interested in socializing or that autism only affects males. –
- Healthcare professionals should be aware that autistic females may mask their symptoms in social situations, which can make it more difficult to recognize their autism. –
- Healthcare professionals should ask questions about the individual’s social experiences and interests, and should not assume that their interests are stereotypical “male” interests. –
- Healthcare professionals should be aware that autistic females may be more likely to experience anxiety or depression than their neurotypical peers, and should take this into account when making a diagnosis. –
- Healthcare professionals should stay up-to-date on the latest research about autism in autistic females, and should seek out training and education on how to recognize and diagnose autism in this population.
Patricia was a Licensed Clinical Social Worker, but is now exclusively providing coaching. She knows what it’s like to feel like an outcast, misfit, and truthteller. Learning about the trait of being a Highly Sensitive Person (HSP), then learning she is autistic helped Patricia rewrite her history with a deeper understanding, appreciation, and a sense of self-compassion. She created the podcast Unapologetically Sensitive to help other neurodivergent folks know that they aren’t alone, and that having a brain that is wired differently comes with amazing gifts, and some challenges. Patricia works online globally working individually with clients, therapists, and she teaches Online Courses for HSPs that focus on understanding what it means to be an HSP, self-care, self-compassion, boundaries, perfectionism, mindfulness, communication, and creating a lifestyle that honors you
Dr. Jessica Myszak is a Chicago-area psychologist who specializes in autism assessment for both children and adults. Doing both in-person and telehealth evaluations in many states across the US, she has developed a niche in less-typical presentations of autism–autism in women, high-masking adults, and pathological demand avoidance (PDA). She also provides educational content on Tiktok about these topics. She is also the founder of the Autistic Support Network, a free private online community for members to share information and connect with other autistic adults.
Dr. Myszak’s Links
Autistic Support Network– https://autisticsupportnetwork.com/
HSP Online Course–https://unapologeticallysensitive.com/hsp-online-groups/
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