Miss Asd; A New Screening Instrument for Girls and Women with ASD

Background: The diagnosis for ASD is mainly based on the male ASD phenotype. Consequently, women with ASD are often misdiagnosed or diagnosed much later in life. A screening instrument taking into account the female ASD phenotype could aid in the identification of women who may have undiagnosed ASD. The Autism-spectrum Quotient (AQ, Baron-Cohen et al., 2001), an often-used ASD screening instrument, does not take into account the female ASD phenotype. Typical for a female ASD phenotype is a higher social motivation, better camouflaging techniques, gender specific preoccupations, and vulnerability for emotional problems.

We developed the M-ASD (Miss-ASD), an ASD screening instrument taking into account this phenotype. It includes 120 items derived from extensive literature search on female ASD expressions, clinical impressions of the authors, and data analysis aimed at sex differences in adults with ASD on other questionnaires (N=200 AQ, N=90 SRS-A, N=250 BRIEF-A). The M-ASD has 6 subscales: 1) Social interaction and communication, 2) Rigidity, 3) Coping, compensation and camouflaging behavior, 4) Sensory issues, 5) Information processing, and 6) Miscellaneous.

Objectives: Development, validation and standardization of a new screening instrument, M-ASD, which takes into account the female ASD-phenotype.

Methods: There were 31 participants with ASD (14 men, 17 women; M = 33.31, SD = 12.56 year), diagnosed by trained clinicians. Their estimated intelligence, based on education, is average to superior. All participants completed the AQ and the M-ASD. A cut-off score of 26 is used for the AQ. There are yet no norm scores available for the M-ASD, therefore, in semi-accordance with the AQ, the cut-off is set at >60% of ASD confirmatory answers.

Results: Women have higher M-ASD mean scores (more reported problems) than men, on both total score and all sub-scores (6-14% higher), with the highest mean difference on the subscales ‘Sensory issues’ and ‘Coping, compensation and camouflaging behavior’. T-tests showed a significant difference for ‘Sensory issues’ and a trend for ‘Coping, compensation and camouflaging behavior’: women report more problems than men (p = .04, p = 08, respectively). The correlation between AQ and M-ASD was high (r = .72, p = .010).

Conclusions: The M-ASD seems to be suitable in measuring ASD characteristics; the correlation with another ASD questionnaire (AQ) is high. Women diagnosed with ASD score higher on M-ASD subscales that seem to be more characteristic for women. Women have higher M-ASD scores than men, on both the total score and all sub-scores. This might be linked with a higher self-knowledge in women and/or the fact that this tool is more focused on the proposed female ASD phenotype. Coming months, we will continue to collect data. Our ultimate plan is to shorten the M-ASD and focus on validation and standardization of this new screening tool.