“An Art, Not a Science” : 
how do experienced clinicians differentiate autism from psychiatric conditions in adult women?
Introduction. Autistic women present with greater social motivation and more typical language abilities than their male counterparts, leaving them vulnerable to misdiagnosis or late diagnosis. Paradoxically, there is concern about potential overdiagnosis of autism in psychiatric populations presenting with social difficulties, as diagnostic criteria remain relatively vague and autism less stigmatizing than many psychiatric conditions. Little guidance exists to guide clinicians when deciding whether to attribute adaptative difficulties in adult women to (1) autism, (2) a psychiatric condition, or (3) both.  Research suggests that autism is best reliably identified by expert clinicians having been exposed to a high number of autism cases, who notice qualitative aspects of the condition not included in diagnostic manuals. Thus, we aimed to better characterize the difficulties faced by clinicians in assessing adult women for autism, and the traits, behaviors and tools used to differentiate between autism and psychiatric conditions.  Methods. Semi-structured interviews were conducted with 20 psychiatrists and psychologists from 7 different countries, experienced in autism diagnosis of adult women. The Framework Method was used to reveal themes relevant to our research goals.  Results. According to participants, autistic women had learned certain social contingencies allowing them to appear more typical, which made differential diagnosis a frequent question. Clinicians recommended long, flexible assessments, and validating the information volunteered by the person. Many traits cited as indicative of autism reflected a clinical knowledge of autism. Trauma and Borderline Personality Disorder were cited as particularly difficult to differentiate from autism. Conclusion. Evaluating for autism in adult women presents with singular challenges which clinicians address using individual toolboxes. In this population, it may be crucial to have the capacity to offer alternative avenues for non-autistic people having self-identified with the spectrum.
autism women differential diagnosis adult diagnostic