Girls who have Asperger’s Syndrome (AS) are primarily different—not regarding the core characteristics of autism spectrum disorder (ASD) but rather in their reaction to being different. Girls often use constructive coping and adjustment strategies to effectively camouflage their confusion in social situations and may achieve superficial social success by imitating others or avoiding engagement in interpersonal situations. A girl with AS can become an avid observer of other children and intellectually determine what to do in social situations: learning to imitate other girls, adopting an alternative persona, and acting as someone who can succeed in social situations (in effect becoming a social chameleon). On the other hand, some girls escape into a world of imagination. They constructively avoid social interactions with other children, choosing instead to engage in creative solitary play, read fiction, or spend time with animals.
These coping and camouflaging mechanisms may mask the characteristics of AS for some time, such that the girl slips through the diagnostic net during the elementary school years. However, there is a psychological cost that may become apparent only in adolescence. It is emotionally exhausting to be constantly observing and analyzing social behavior, trying not to make a social error; adopting an alternative persona can lead to confusion with self-identity and low self-esteem. The stress, strain, and exhaustion of intellectually analyzing social situations and acting normalbut being rejected, bullied, and teased can result in the development of depression, an anxiety disorder, eating disorder, or borderline personality disorder. The clinician diagnosing or treating these secondary mood or personality disorders can then identify the characteristics of AS when exploring the developmental history of the girl. Psychologists and psychiatrists therefore need a paradigm shift in their recognition of the female presentation of AS to ensure earlier diagnosis and access to effective understanding and support for girls with AS.