1. Chester V. Autistic women and girls : increasingly recognised, researched and served. Advances in Autism ;2019 (2019/07/03) ;5(3):141-142.

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2. Zener D. Helping autistic women thrive. Advances in Autism ;2019 (2019/07/03) ;5(3):143-156.

Purpose The purpose of this paper is to outline a clinical framework developed for autistic women. INVEST (Identify Needs, Validate, Educate, Strengthen and Thrive) is a strengths-based neurodiversity therapeutic approach. Autistic individuals are treated with respect and are believed to have the capacity to make meaningful changes in their lives. Design/methodology/approach The author ?s clinical experiences working as an individual, couple and family therapist specializing in girls and women with autism inform this paper. The innovative therapeutic approach will be described including reasons for seeking therapy, the theoretical underpinnings and case examples that bring each component of INVEST to life. Findings Women with autism are very responsive to a therapeutic process that validates their experiences. Helping individuals and their support systems learn more about autism and their unique profile can enhance understanding and self-acceptance. Strategies to increase emotional awareness and reduce victimization are emphasized. Understanding sensory triggers and executive functioning challenges enable individuals to make useful adaptations. Building skills and setting parameters on time and energy help to stave off autistic burnout. Practical implications The impact of the INVEST model goes beyond the therapist ?s office and can be applied to multiple settings. All professionals have the opportunity to treat autistic women with respect, validation and an assumption of competence. Originality/value Clinical program are scarce for individuals with autism, especially women. The INVEST model is the beginning of a discussion of what can help autistic women thrive.

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3. Tromans S, Chester V, Kapugama C, Elliott A, Robertson S, Barrett M. The PAAFID project : exploring the perspectives of autism in adult females among intellectual disability healthcare professionals. Advances in Autism ;2019 (2019/07/03) ;5(3):157-170.

Purpose The purpose of this paper is to explore the perspectives of healthcare professionals on autism in adult females with intellectual disability (ID), including regarding the gender ratio of autism, the clinical manifestation of autism in females, and the recognition, screening and diagnosis of autism. Design/methodology/approach The questionnaire was developed following a review of the relevant literature and distributed to professionals within three healthcare trusts as well as members of two clinical research groups. The questionnaire was completed by 80 ID healthcare professionals. Data were aggregated and analysed using Microsoft Excel. Findings ID healthcare professionals had a lack of recognition of the smaller gender ratio of autism in patients with ID as compared to those without ID. Most respondents reported believing that autism manifests differently in females ; with women demonstrating a greater ability to mask their symptoms. A considerable proportion of participants reported feeling less confident in recognising, screening and diagnosing autism in female patients, with many endorsing a wish for additional training in this area. Practical implications These findings suggest that ID healthcare professionals are keen to improve their skills in providing services for women with autism. Training programmes at all levels should incorporate the specific needs of women with ASD, and individual professionals and services should actively seek to address these training needs in order to promote best practice and better outcomes for women with autism. Originality/value This is the first published questionnaire exploring the perspectives of healthcare professionals regarding autism in adult females with ID.

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4. Allely C. Exploring the female autism phenotype of repetitive behaviours and restricted interests (RBRIs) : a systematic PRISMA review. Advances in Autism ;2019 (2019/07/03) ;5(3):171-186.

Purpose The purpose of this paper is to address the need for increased understanding, awareness and recognition of the autism female phenotype in terms of repetitive behaviours and restricted interests (RBRIs). Design/methodology/approach A systematic PRISMA review was conducted. The main aim of the present systematic review is to identify studies which have investigated RBRIs in females with autism spectrum disorder (ASD) or the differences in RBRIs between males and females with ASD. Findings In sum, 19 relevant articles were identified : 5 studies found no significant evidence to support the notion of sex differences in RRBIs in ASD ; 1 study did not report any differences in RRBIs between males and females with ASD ; 12 studies found evidence that males with ASD had significantly more RRBIs compared to females with ASD ; and, lastly, 1 study found that girls with ASD have features of RRBIs which are exhibited more compared to boys with ASD. Research limitations/implications There is a real lack of in-depth knowledge and understanding of the female phenotype of ASD, and such lack of knowledge has a detrimental impact on the identification of autistic females and a lack of identification can have negative consequence. This is important to address in future research as it is well established that the earlier the diagnosis, the better the outcomes, due to the timely access to appropriate interventions. Practical implications The RBRIs exhibited in autistic females are not sufficiently captured by most currently diagnostic instruments. Clinicians are less likely to identify the RBRIs in females as they tend not to be the typical repetitive behaviours commonly associated with ASD. It has been recommended that clinicians consider ?females as a whole ? in terms of their clinical presentation and look for any indication of RBRIs, even repetitive interests which appear clinically innocuous. Originality/value There is relatively little research investigating RBRIs in autistic women and girls. There is a real need to highlight the importance of understanding and recognising how RBRIs can differ between males and females with ASD.

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5. Nowell SW, Jones DR, Harrop C. Circumscribed interests in autism : are there sex differences ?. Advances in Autism ;2019 (2019/07/03) ;5(3):187-198.

Purpose Sex differences in circumscribed interests (CI) may delay diagnosis for females with autism spectrum disorder (ASD) ; therefore, it is important to characterize sex differences in CI to determine if differential approaches to diagnostic assessment are warranted for females with ASD. The purpose of this paper is to examine sex differences in parent-reported quantity, content and functional impairment of children ?s interests. Design/methodology/approach Parent responses to the Interests Scale were analyzed using descriptive statistics and ANOVAs to determine diagnostic (ASD vs typical development (TD)) and sex differences between four groups of children ages six to ten years : ASD males, ASD females, TD males and TD females. Findings Groups were comparable on the quantity of interests reported on the Interests Scale. Children with ASD demonstrated significantly more nonsocial interests and had greater functional impairment associated with their interests than TD children. A significant diagnosis ?sex effect was found for the number of interests in folk psychology. Descriptively, males with ASD were more likely to have a primary interest in the traditionally male category of physics than females with ASD whose primary interest mainly fell into the categories of TV or the more traditionally female category of psychology. Originality/value These findings strengthen the results of Turner-Brown et al. (2011) by replicating their findings that children with ASD have more nonsocial interests and greater functional impairments related to their interests compared to TD children in a sample that is balanced on biological sex. However, there are distinctions between males and females with ASD in their primary interests that have implications for diagnostic assessment.

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6. Bhullar N. Parental experiences with an adolescent female and male with Autism Spectrum Disorder (ASD) in India. Advances in Autism ;2019 (2019/07/03) ;5(3):199-213.

Purpose The purpose of this paper is to compare experiences of two parents of adolescents with Autism Spectrum Disorder (ASD) differing in gender, including their daily routines at school and at home, challenging behaviour, social support and future plans for their children. Design/methodology/approach The parents of the two adolescents with ASD were interviewed with open-ended questions related to their children as well as their personal experiences, along with getting their individual responses for the established Satisfaction with Life Scale (SWLS). Findings There were similarities and differences in the parents ? experiences with their adolescent children with ASD. Similarities included a limited social support outside their families, hopes for the future of their children, where in they emphasised the need for some ?normality ? for their child, and a lack of plan in terms of legal guardianship and written wills after their own time. Some of the differences were also noted in the parents ? description of symptoms of their children, with the father of the female adolescent reporting more negative experiences both with his child, as well as with his spouse, a lack of social support and, subsequently, more ?dissatisfaction ? on the SWLS than the mother of the male adolescent. Research limitations/implications One of the major limitations of this study is the absence of feedback from the other parent besides the one being interviewed, due to which only one parental perspective was provided here. Social implications There are vital social implications of this study. Both parents reported a limited social support due to which they expressed the need for increasing awareness for ASD in the general society. These findings illustrate the need for a focus on designing interventions for improving outcomes for both parent and child in similar situations. Originality/value This study compared the experiences of two parents of adolescents with ASD, differing in gender and symptomology, but similar in other respects, including the family demographic characteristics and cultural context.

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7. Barnard-Brak L, Richman D, Almekdash MH. How many girls are we missing in ASD ? An examination from a clinic- and community-based sample. Advances in Autism ;2019 (2019/07/03) ;5(3):214-224.

Purpose Research has indicated that males diagnosed with autism spectrum disorder (ASD) outnumber females diagnosed with ASD, which has been attributed to a number of potential biological and genetic risk factors. The purpose of this paper is to estimate how many girls may be missing from ASD via a two-study format, comparing two distinct data sets to Centers for Disease Control and Prevention population estimates for sex distribution of males vs females in ASD. Design/methodology/approach In Study 1, the authors utilized data from the National Database for Autism Research as a clinic-based sample. In Study 2, the authors utilized data from the National Survey of Children ?s Health as a community-based sample. Findings The current study estimates that approximately 39 percent more girls should be diagnosed with ASD. The authors estimate that the sex distribution in ASD should be approximately 28 percent female and 72 percent male based upon current practices. Thus, it appears that more females are being identified as potentially having ASD but were not subsequently being diagnosed with ASD as compared to their male counterparts. Originality/value These results could suggest that a leaky pipeline in the assessment of girls with ASD may exist along one or more points in the ASD diagnostic process, with one potential point at the level of ASD-specific screening (i.e. the SCQ in Study 1) in the clinic setting and another in the community setting as a whole for universal screening (i.e. NSCH data in Study 2).

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