Abstract
This study aimed to explore the structure of a modified version of the Girls Questionnaire for Autism Spectrum Condition (GQ-ASC; Attwood et al. 2011) to test its utility as an autism screening measure for adult women. We recruited 672 cisgender and trans women aged between 18 and 72 online. The sample contained 350 autistic women (M age = 36.21, standard deviation [SD] = 10.10) and 322 nonautistic women (M age = 34.83, SD = 9.93), screened using the Autism Quotient. A principal component analysis and parallel analysis revealed a five-component solution that accounted for 40.40% of the total variance. The extracted components appear to be consistent with what is known about the way girls and women display their autistic traits and interpreted as (1) Imagination and play: Describes interest in fantasy, fiction, and reflection on the quality and content of imaginative play in childhood. (2) Camouflaging: Describes effortful attempts to reduce the visibility of autistic traits. (3) Sensory sensitivities: Describes sensory processing hyper- and hyposensitivities across various modalities. (4) Socializing: Describes barriers to social understanding and participation. (5) Interests: Describes age-advanced and nonstereotypically feminine interests. We observed significant differences between autistic and nonautistic women across all extracted components, and the total score. A receiver operating characteristic analysis indicated an excellent level of discrimination. When applying a cutoff score of 57, the GQ-ASC correctly identified 80.0% of cases. The modified GQ-ASC is an effective and highly discriminant screening tool for use in adult autistic women. It provides valuable insight into the shared features and experiences of this underrecognized and underrepresented subset of the autistic community.
Lay summary
Why was this study done?
A lot of autistic women do not get an accurate or timely autism diagnosis. We know that when they do receive an autism diagnosis, they often feel stronger in their identity and feel more confident in advocating for their needs. We wanted to find a quick and easy way for professionals to work out which women should be referred for an autism assessment. We also wanted to help autistic women who do not want to have an assessment done feel confident in self-identifying as autistic.
What did the researchers do?
We changed the wording of an autism questionnaire that was designed for younger girls, and had 350 adult autistic cisgender and trans women aged between 18 and 71 years complete it. We looked at answers in a way that told us which questions were most useful for telling apart autistic women and nonautistic women.
What were the results of the study?
We found that a number of questions were grouped together into different areas that were common for autistic women. These areas were as follows:
Imagination and play: Questions about interest in fantasy, fiction, and imaginative play in childhood. Camouflaging: Questions about acting in certain ways to try to hide autistic traits. Sensory sensitivities: Questions about feeling undersensitive or oversensitive to things such as touch, small, taste, and noise. Socializing: Questions about feeling confused in social situations, and finding it difficult to join in. Interests: Questions about interests that are not common for children who are the same age, and interests that are not common for many girls.
What do these findings add to what was already known?
There are a lot of ideas about autism that do not always apply to autistic women. These findings will hopefully help professionals and nonexperts understand autistic women better.
What are potential weaknesses in the study?
We do not know if any of the 350 autistic women who completed the survey have an intellectual disability, and we do not know if having an intellectual disability will change the results of the study. This is something that will be interesting to look into in the future.
How will these findings help autistic adults now and in the future?
The findings of our study can help doctors and mental health professionals work out which women should be assessed for autism. Our findings may also help to change attitudes about who can be autistic, and what autism looks like.
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