Psychologists' Diagnostic Experiences with Girls on the Autistic Spectrum

The issue of the challenges of assessing autism spectrum disorders (ASD) in females is a recurring theme in the ASD research literature. Differing presentations of ASD in females, lower prevalence ratios due to unknown reasons, as well as limitations of standardised assessment instruments used, are some of the reasons described as causing or contributing to these challenges. However, clinicians are rarely asked about their experiences of assessing ASD and, to date, the experiences of psychologists in assessing ASD in girls has yet to be explored. Based on the findings of a Republic of Ireland-wide survey, the experiences of 91 psychologists working in children’s services who were clinically active in autism assessments were explored. Quantitative data was primarily gathered, but qualitative data was also gathered via open-ended questions. Findings indicated that psychologists accessed different training opportunities during professional training and post-qualification. Psychologists had more experience assessing ASD in boys, and psychologists who had completed more assessments with girls, indicated higher levels of confidence in assessing ASD in girls. Findings also indicated that psychologists’ confidence in using clinical judgement during ASD assessments was positively correlated with the number of years’ experience assessing ASD, which has significant implications for assessing ASD in girls. Psychologists also reported that girls were more likely than boys to be sub-threshold on screening instruments and diagnostic assessment measures. Psychologists indicated that there were specific challenges related to assessing autism in girls, and they also identified particular ‘red flags’ for identifying autism in girls, as well as specific assessment practices for over-coming such challenges. Finally, survey data was used to compile information and guidelines that could be used by psychologists to inform assessment practices when assessing ASD in girls, as the majority of psychologists indicated that they would welcome the publication of best practice guidelines in this area.