“Girls with Autism: Social Perception, Language, and Camouflaging” presented by Julia Parish-Morris, Ph.D., was first on the roster of yesterday’s morning and afternoon workshops.

Dr. Parish-Morris’s professional and dynamic style made for an engaging 3 hours. Well-organized and animated, with a good sense of humor throughout, Dr. Parish-Morris also handled questions very well, providing thorough answers. The occasional question that was off topic, was answered briefly with a smooth transition back to the topic. A rare gift for any presenter.

Dr. Parish-Morris’s goals for participants in this workshop included:
• Understand the diagnostic criteria for ASD
• Identify weaknesses in prior research on ASD
• Gain a deeper understanding of how ASD manifests in girls

All goals were met. The workshop provided a brief, but very good understanding of the history and diagnostic criteria for Autism. She made it clear that she was a Developmental Psychologist and a researcher. While she did not do clinical work, Dr. Parish-Morris told several anecdotes, relevant to her presentation, from her clinical colleagues.

As presented in the workshop, Autism Spectrum Disorders (ASD) are neurodevelopmental disorders that are behaviorally defined, with symptoms on a continuum from mild to severe impairment. The DSM-V Diagnostic Criteria include:

Impaired social communication
• Atypical or reduced eye contact
• Trouble understanding thoughts and feelings of others
• Difficulty Connecting with Peers
• Impaired nonverbal Communication

Repetitive behaviors and restricted interests
• Insistence on sameness
• Lining toys up, rather than playing imaginatively,
• Rocking, tapping, self-stimulation
• Sensory abnormalities

The above symptoms have been present since early childhood and interfere with everyday functioning.

Although challenged in recent studies, Dr. Parish-Morris said that the research suggests that the prevalence of ASD is much higher in boys than girls. She said that the recent increase in the Occurrence of ASD can be explained best by:

• Broadened diagnostic criteria
• Replacing other diagnoses
• Better ascertainment of symptoms
• Legitimate increase

Dr. Parish-Morris explained that ASD in children was originally thought to be associated with schizophrenia until about 60 years ago. She apologized on behalf of the mental health field, for the brief period of belief in the 1960’s, that ASD was caused by poor parenting, especially unemotional (refrigerator) mothers. (While Dr. Parish-Morris is too young to remember, it made me think of the popular book, “In Search of Dibs,” by Virginia Axline.) Dr. Parish-Morris emphasized that mothers are not to blame for Children with Autism. Dr. Parish-Morris said that the ASD field returned to science in the 1960’s with biological research showing that ASD had a genetic base as a cause, with environmental correlation. Recent research has also shown anatomical and functional differences in the brain.

Dr. Parish-Morris mentioned that ASD can occur in all societies, all races, all genders, and all cognitive levels. She suggested that the “Savant” often associated with ASD is not a superior cognitive ability, but a result of extensive practice due to hyper focus on a particular area of interest. Dr. Parish-Morris also Said that ASD often occurs with co-morbid symptoms including
• Seizures
• Anxiety
• ADHD
• Tics
• OCD
• Tourette Syndrome
• Language Disorders
• Learning Disorders
• Intellectual Disability

ASD has a wide variety of outcomes as described by Dr. Parish-Morris. She said that those who are diagnosed early are most likely to achieve a positive outcome. Those with later diagnosis will have less access to services, problems with transition as adults and a loss of social network.

Dr. Parish-Morris stated that girls are often diagnosed later than boys.

During her presentation, Dr. Parish-Morris discussed the reason for differences in ASD in rates and timing of ASD diagnosis between boys and girls. She said that most of the ASD research was based on studies with boys, and the criteria for diagnosis was developed with these studies. Dr. Parish-Morris suggests that a diagnostic gender bias has led to a lower diagnosis of ASD for girls, despite comparable levels of impairment. Dr. Parish-Morris presented a meta analytic study in 2017 of 13 million children that showed a diagnosis of ASD with “male-like” symptoms are more likely to be diagnosed with ASD.

During her presentation, Dr. Parish-Morris presented research that suggests that girls with ASD are more sensitive to social expectations and able to mimic, or camouflage ASD symptoms with learned superficial behavior. Girls with ASD who are verbally fluent may demonstrate superficial understanding of appropriate social etiquette to mask the ASD symptoms. Dr. Parish-Morris explained that girls with ASD may also learn to stay near other girls, or weave in and out of social activities to appear involved. Dr. Parish-Morris summarized the problem with diagnosis for girls with ASD:

• May appear less impaired in everyday life due to camouflage or masking symptoms
• Are less likely to be referred, have later diagnosis and no early intervention
• May have greater subsequent internalizing disorders (depression anxiety)

Dr. Parish-Morris concluded her workshop with three studies showing that girls with ASD are more likely to show some language and social behavior compared to typical boys, rather than typical girls. She suggested that girls with ASD should be compared with typical girls, rather than typical boys.

What a breath of fresh air! In her workshop today, Dr. Parish-Morris did not present another “cook-book” of treatment steps. Her presentation was well balanced with a description of Autism, and palatable amount of research with a focus on girls with Autism. She presented a clear case that the body of research with girls on the ASD spectrum needs to be improved. During the break, there were a few comments that disagreed with some of her statements. Dr. Parish-Morris suggested that typical women may have better friendships than men, and typical girls are often less aggressive than boys. One person said that men’s relationships may be different but are just as good. Another person argued that girls can be as aggressive as boys, but in a different way. Regardless of the different points of view, all participants appeared eager to return for the second half, and very satisfied at the end of the workshop.

Any other thoughts?