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I’m back with the second part of our mini-series on autism. Today I’m really trying to parse out why we’re seeing such a gap in how often we diagnose males versus females. We’re also diving into the social communication paradox (how someone can look really skilled on the surface while still struggling with the same underlying neurological hurdles), and the way restricted interests look different when they’re focused on things like animals or art instead of train schedules. It’s a lot to wrestle with, especially when the DSM hasn’t quite caught up to what we’re seeing in our offices every day, but I’m hoping this helps clear up some of that diagnostic fog.

Main Topics

00:01: Discussion of the four-to-one male-to-female prevalence ratio and the evidence for under diagnosis in females
01:45: The timing of diagnosis and how delays in assessment compound over time for female patients
02:28: The intellectual disability paradox and how impairment levels influence diagnostic rates
03:20: Research on social communication differences and the distinction between observable skills and underlying understanding
04:55: Issues with measurement bias in the ADOS and the problem of diagnostic overshadowing with co-occurring conditions
07:10: Quantitative and qualitative differences in restricted interests and repetitive behaviors across sexes
10:21: Statistics on psychiatric comorbidities and why autistic females face higher rates of anxiety and depression
12:50: Developmental trajectories from early childhood through adulthood and the adolescence inflection point
14:30: A preliminary look at camouflaging and the CAT-Q subscales in the female phenotype

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About Dr. Jeremy Sharp

I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

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568. Autism Mini-Series: The Female Autism Phenotype