Practitioner experiences in assessing females with autism

Nerelie C. Freeman, Pascale Paradis

Research output: Contribution to conferencePosterpeer-review


Background: The process of obtaining a diagnosis among females is likely to be a different, more protracted process than for males. Several explanations have been suggested to explain this phenomenon, including the social camouflage theory which delays identification, a lack of assessment/screening measures that are sensitive to the female phenotype, and a higher potential for misdiagnosis or missed diagnosis.

Objectives: To explore the training received, assessment practices and diagnostic taxonomies used, and confidence in assessment and diagnosis when assessing autism in females among practitioners in Australia.

Methods: 135 practitioners completed an online survey and seven psychologists participated in a semi-structured interview conducted via Zoom.

Results: Speech pathologists were more likely to report receiving no training in their course around diagnosing autism, but most practitioners reported that diagnosing autism in females specifically was rarely addressed (74.2%). Practitioners said their practice in the assessment of females was most significantly influenced by the current diagnostic criteria (87.9%), the reliability/validity of the assessment tools they use (78.5%), and professional development they have attended in the last 5 years (71.3%). Almost all practitioners used the DSM-5. The most common assessment components used were conducting an interview with the parents and a standardised autism assessment. The ADOS was the most commonly used tool, with only one practitioner saying they would only use the ADOS for assessing males. Psychologists and speech pathologists were more confident than paediatricians in diagnosing adult females, but confidence levels were similar across clinicians for other age groups. In the interviews, the main themes that emerged were: the female phenotype; the assessment process; missed diagnoses and misdiagnoses; applying the diagnostic criteria; and the need for more training.

Conclusions: While the female autism phenotype is gaining traction in research, the theory-practice gap is still evident. While most practitioners reported receiving training in diagnosing autism, the notion that gender differences may exist was often not addressed and subsequently shaped the practices of many practitioners in their early years. While practitioners reported that more recent professional development offerings have influenced their assessment practice, interviewees emphasised that finding relevant training was difficult. The interviewees identified that the current assessment tools available are less sensitive in detecting traits associated with the female phenotype. While the survey identified the ADOS as the most widely used tool, several interviewees described how they modified the protocol when assessing females. While it is positive that practitioners felt fairly confident in their assessment practices, the identified need for more training and more valid assessment tools for females that can be used “as is” (not modified) suggests that there is still scope for improvements in these areas to minimise misdiagnosis and missed diagnoses.
Original languageEnglish
Number of pages1
Publication statusPublished - 5 Aug 2021
EventInternational Society for Autism Research Annual Meeting 2021 - Virtual/Online, Boston, United States of America
Duration: 3 May 20217 May 2021


ConferenceInternational Society for Autism Research Annual Meeting 2021
Abbreviated titleINSAR 2021
Country/TerritoryUnited States of America
Internet address


  • autism
  • females
  • practitioners
  • assessment

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