Development of a Narrative-Based Assessment for Autism in Adult Females

Abstract

This paper introduces an autistic-led and developed narrative-based assessment protocol addressing the paradigmatic and systematic underdiagnosis of autism in adult females. Traditional diagnostic instruments, validated primarily on male cohorts, fail to capture the Female Autism Phenotype characterized by sophisticated masking, internalized traits, and distinct cognitive styles. Through analysis of 988 written narratives from autistic women worldwide, eight thematic domains emerged: observational detachment, social navigation challenges, masking/identity fragmentation, sensory-perceptual differences, relational patterns, distinctive cognitive styles, characteristic developmental trajectories, and ethical rigidity. In opposition to an often-accepted paradigm of autism, where the subject is a male child, often with accompanying intellectual disability, 70.7% of this study's participants held college degrees, challenging deficit-based stereotypes. The narrative methodology circumvents masking behaviors triggered by face-to-face assessments, with 76% of participants expressing experiences in writing they couldn’t verbalize. Drawing on Critical Autism Studies and Husserlian phenomenology, bridging the gap between Social/Behavioral Sciences and the Arts and Humanities, the Wilderwood Reflective Assessment and Diagnostic Indicator of Autistic and Neurodivergent Cognitive Expression (WRADIANCE) shifts diagnostic power from clinician observation to client self-report, honoring autistic women's capacity for self-knowledge. This neurodivergent-affirming approach represents a fundamental paradigm shift in autism assessment, offering a pathway to identification that validates rather than pathologizes female autistic experience.