Females with autism – From diagnosis to research

Amanda Lyons

18/07/2018 12:11:07 PM

Diagnosed at the age of 30, Pia Bradshaw is an example of how women with autism are often overlooked by the medical establishment. She is now conducting her own research to help educate GPs in identifying others like her.

Pia Bradshaw is conducting research to help GPs be able to more easily identify females who have autism spectrum disorder.
Pia Bradshaw is conducting research to help GPs be able to more easily identify females who have autism spectrum disorder.

Pia Bradshaw grew up knowing she was ‘different’, but not really understanding how. A male friend who had been diagnosed with autism as a child once mentioned to her that she was ‘on the spectrum’, but she hadn’t paid much thought to what that might mean – until years later when she experienced difficulties managing the demands of her new job, a challenge she had really been looking forward to.
Her work difficulties prompted her to seek a diagnosis – but the process proved challenging, and part of the reason for this was Pia’s gender.
‘ASD [autism spectrum disorder] research was primarily based on male subjects and was not only considered rare up until the 1990s, but also considered a male-only condition,’ she told newsGP. ‘We now know this is incorrect and autism and autistic traits are common, and always have been. 
‘Moreover, it has only been recently that autistic females are slowly getting recognition, but many still continue to be un or misdiagnosed because of these incorrect and outdated stigmas.’
This conception of ASD as a ‘male’ disorder even affected Pia’s initial research into the condition prior to seeking a diagnosis.
‘I googled autism and found some of the symptoms resonated with me but not entirely,’ she said.
‘I then searched “autism female”, and that’s what really prompted me to get my diagnosis. I saw myself so clearly in all the information that ‘O Fortuna’ started playing in my head and it was like a thousand pennies dropping. It all made sense.
‘As I continue to research I still have multiple penny  dropping moments almost daily as I learn and understand why I do, say and perceive things differently to others, and how much ASD shapes the way I experience the world in my day-to-day life.’
When she was finally diagnosed with ASD at the age of 30, Pia experienced a range of emotions.
‘It’s like a roller coaster, I went through many different emotional phases whilst coming to terms with my diagnosis,’ she said.
‘Initially I was relieved, but then became angered when questioning why it had taken this long to understand my differences, why didn’t I get the help, understanding and assistance that I needed and how might have my life been different had I received early intervention?
‘Had I been diagnosed when I was younger, I’m sure I would not only have been spared a lot of heartache, it would have assisted both my family and myself in understanding and accepting my differences. There were so many factors where early intervention could have had a huge impact on my life and development. 
Pia also felt that she experienced discrimination after disclosing her diagnosis, ultimately resulting in her leaving her job.

‘It was upsetting, realising the challenges of living in a world which knows so little about autism and the barriers stigma creates for us, whether they are social, environmental, socio-economic or basic access to services and necessary accommodations that other minority groups or those with differing disabilities enjoy.
‘It’s not just a matter of society understanding autism, but actively promoting the acceptance and celebration of neurodiversity and our valuable contributions to the world.’
However, Pia has also experienced positives.
‘I’m learning to embrace my differences and develop a more positive outlook and approach to life by appreciating the strengths my neurodiversity accords me,’ Pia said.
‘But it’s a work in progress. Learning about how my autism impacts the way I experience and see the world in my day-to-day life has been an eye-opening experience. It’s never static, and, given ASD is a lifelong condition, I imagine this will continue to for many years, if not decades, to come.’
One of the issues for females with ASD who are seeking a diagnosis is that women and girls tend to present differently from boys, and are more likely to mimic their peers in an attempt to mask their autistic behaviours. Pia feels this behaviour can result from a blend of innate and socially determined factors.
‘From my personal experience, I think it is a bit of both,’ she said.
‘But the social aspect definitely comes into it, for sure, because if a boy’s loud, rambunctious or naughty, he’s just being a little boy. Whereas females, are socialised to speak, behave and dress a particular way and not question the status quo or say certain things that may disrupt, disgruntle or potentially offend because it’s not considered to be lady-like.
‘So you mimic and try to find ways to fit in to whatever the individual situation may be to avoid standing out or potentially getting into trouble.’
Another important issue affecting Pia’s diagnosis journey was the fact many doctors still seem to perceive ASD as a boy’s disorder.
‘For instance, when I told my GP about my diagnosis, he said something along the lines of, “Really? You’re not like any of my autistic little boy patients that come in”,’ Pia said. ‘I also spoke to a surgeon who has an autistic grandson and when I disclosed my diagnosis, he said, “It’s very rare, though, especially in females”.
‘Autism is not rare, it’s just up until recently, ASD research had primarily focused upon male subjects and diagnostic guidelines were so narrow to begin with that many GPs, teachers, society in general misunderstand ASD, its prevalence and sex differences.
‘Girls and women have been, and continue to be overlooked or often misdiagnosed because of this stigma and lack of knowledge. It’s only now as we understand how autism is perceived differently in females that we’re starting to see an increase in female diagnoses.
‘But, unfortunately, we still have a long way to come. There are many lost generations of women on the autism spectrum that have gone their entire lives not knowing they have ASD and are not receiving their fundamental right to help and support services.’
The time after Pia had gained her diagnosis and resigned from her job was a turbulent one, as she tried to come to terms with everything that had happened, but it also resulted in a silver lining – a new career in medical research.
‘Upon resigning, I thought, what is it that I’m passionate about? What are my strengths?’ she said. ‘Fresh off my diagnosis, I was meticulously researching all things about ASD to try and understand myself and make sense of 30 years of experiences.
‘As an academic researcher, I had always enjoyed learning and studying, so I searched “autism scholarship” and found a PhD scholarship funded by the Cooperative Research Centre for Living with Autism [Autism CRC] at the University of Queensland. Even though the deadline had just closed, I emailed them, applied, interviewed with the team and was fortunate enough to be offered the scholarship.
‘It was an unexpected change of career and an amazing opportunity  to work in a field where I’m constantly learning not only about myself and ASD, but more importantly,  develop research that helps to improve the quality of life of my peers on the spectrum which is incredibly rewarding.’
Pia is now studying towards her PhD in the University of Queensland’s Faculty of Medicine. Although it is early days, the ultimate goal of her research is to help educate GPs and medical students to better understand ASD in their patients so that adult men and women with ASD can receive better quality and more comprehensive healthcare.
‘The aim is to upskill and educate GPs about ASD in adulthood, and within that I will have a separate section dedicated to autistic females,’ she said.
As part of the development of this tool, Pia will be conducting research with GPs to help identify their learning needs and gaps in their education, as well as including people with autism in her research to identify barriers to quality healthcare and inform priority areas of her research project.
‘A lot of the literature shows that when surveyed, GPs feel confident about their knowledge of ASD and their ability to provide care to autistic patients, yet they’re also asking for further training,’ Pia explained.
‘So I want to explore why this is the case and identify the areas in which GPs need further development. Maybe they feel confident with the knowledge they have; but perhaps don’t feel comfortable with knowledge in certain topics, or even how to best deliver healthcare to autistic patients?’
‘So it’s about upskilling and re-educating GPs and medical students which includes information about autistic females.’
The CRC has a focus on actively involving people with autism in research, something about which Pia is very passionate.
‘Community-based participatory research methods involve including autistic individuals in all key areas of the research,’ she said. ‘We will conduct a workshop with autistic individuals, their carers and GPs to identify their experiences, needs, and identify barriers to accessing quality healthcare. This will not only inform and direct our research focus but also direct future research priorities.’
What Pia values most about this type of research is the way it enables people with autism to have a voice in issues and solutions that directly affect them.
‘There is a significant bias towards basic science in autism research which is mostly determined by investors and academics from targeted disciplines. Consequently, this begs the question of whether these research agendas align with the needs and priorities of autism communities?’ she said.
‘I think it’s really important for autistic individuals to be included in research and the subsequent policy it informs because ultimately, it’s our right and through our lived experiences we can pave the way to ensure a better future for not only ourselves but future generations to come.’

ASD autism spectrum disorder females with autism

newsGP weekly poll Would the reintroduction of MBS items for GPs to trace and report on electrocardiogram (ECGs) be beneficial to patients?

newsGP weekly poll Would the reintroduction of MBS items for GPs to trace and report on electrocardiogram (ECGs) be beneficial to patients?



Login to comment

Anne Musgrave   16/12/2018 1:50:13 PM

Only now, aged 78, do I realise I may have autism spectrum disorder. All my life people have scared me. I feel anxious when people are too close to me. I hate being hugged” It makes me feel frightened. Socialising exhausts me. I am a social chameleon. I am always thinking about why I am on this planet. Yes I was a successful feature writer for many years, have been married 50 years and have theee children, two of whom may have this disorde. My father was socially awkward and never showed emotions. Do you think I fit.

Chy   23/03/2019 2:39:23 PM

Thank you for the article. Having recently been diagnosed at 59yrs I'm grateful I did not give up when I had the same issues regarding needing to fit stereo typical parameters many GP's use. It can take a long time with a dedicated professional to get a correct diagnosis. Sadly the cost often proves prohibitive for many, so they will never get the diagnosis. I always knew "I was different" and tried to fit the expected "lady like mold". This can create physical and mental exhaustion.
I could reminisce over the lost opportunities on my education, career, and socialisation, however, I choose to use the opportunity to further my education and hopefully that others for the benefit of future generations. It's laughable to hear after diagnosis "what, no not're too intelligent" from a GP. Lack of intelligence is not a defining symptom. Letting others see it is often affected because we tend to be withdrawn. This often impacts education and career advancements.

JEK   12/04/2019 4:01:59 PM

I was diagnosed a few years ago at age 34. I'm glad to see this article targeted at GPs because in my experience we need more awareness of autism in females and we also urgently need doctors who are able to interact effectively with autistic patients. My own health has suffered because I dread and avoid GP visits. I only bring up my diagnosis when relevant... it frequently is, especially when dealing with comorbid mental health issues. One GP told me I couldn't be autistic because only children are, one said I couldn't be because I'm verbal and can make eye contact, and the list goes on. One recently asked me about my challenges, only to dismiss them straight away, saying "everyone struggles with these things" (no, everyone does not!). I cannot trust a medical professional who knows so little about autism and so I move on and probably look like I'm doctor shopping. It is demeaning and stressful to have these conversations time and time again just to get some appropriate health care.

Sonia Ward   31/05/2019 5:22:58 PM

Being referred to as an introvert and or shy from childhood I now wonder if my new adult label is autistic. My children tell me I show no emotion and although I can read peoples expressions as an outsider I have difficulty doing the same when involved in the conversation myself. Socially awkward or autistic? In a room full of people even ones I've met before, I feel a need to escape. There is a sense that everything is going on around me while I stand isolated in another world. Pursuing a creative pathway has allowed me to blend in as an arty farty person and find a small amount of self-acceptance as a weirdo. I've felt different for as long as I can remember and can recall a sense of peace when imaging and playing alone. The same sense drives me to create continuously and perhaps obsessively. I'm anti labelling people but maybe a sense of understanding would help to make me feel more normal.

Linda   11/06/2019 10:25:50 AM

Hi, I too think I am autistic after reading and watching articles and lectures online. I am basically a misfit. I have never bought up the subject with a go, though I have told a couple of friends my suspicions in that area. My family, well , no, probably because of stigma attached to the disorder, whether that be via my own beliefs or shame. It is good to see that adult female autism is being recognised and becoming known. many things I have read point directly at me , and indeed, explain my memories through life.

Linda   11/06/2019 10:28:41 AM

To Sonia Ward, wow, your comment sound so much like me!

Amy Dudfield   22/07/2019 12:32:55 AM

Sitting here with tears welling up in my eyes. Sonia Ward, you have described how I feel to a T. I had an autistic brother, I had an ADHD partner of 18 years until 3 months ago, my 8yo son is in diagnostic stages of ADHD, Sensory and Spectrum and I am sure my 4yo is ADHD too. Last night, my mother says, I think you might be on the spectrum. I had to hide my shock - I've wondered before but the focus has always been on the boys. Recently I began working as a teachers aide to support children with Sensory Integration needs. Through my research, I have learned I have many sensory issues. I am the first to tell people I work with many ASD girls who fly under the radar and yet here I am reading this as a 35yr old woman, I think I have been flying under the radar my entire life, just "fitting in" and trying not to let my anxieties get in my way. It's like a lightbulb has just switched on and there is hope for me yet. Imagine ASD woman working with ASD

Jes   5/11/2019 3:44:59 AM

At 36, I finally make sense. And so does my poor late mother - if o lay she had known and understood and received the support she needed.

Tracey   31/01/2020 7:54:03 AM

I was diagnosed as being on the spectrum yesterday - age 44! Mixed emotions right now, even though I suspected I was. I have twin boys, 8 years both ASD & ADHD.

Bett   11/03/2020 10:33:37 PM

I would love to know the process of how I go about getting a diagnosis. I have massive anxiety of going to my GP and expressing that I think I am autistic!! Help!!