Exploring clinician's perspectives of the Female Autism Phenotype in those with intellectual disabilities

Autism Spectrum Condition (ASC) presents differently across populations with an increasing recognition of its unique presentation in women. Research suggests that women are more likely to engage in masking behaviours, which may contribute to delays in diagnosis and barriers to appropriate support. Additionally, individuals with intellectual disabilities (ID) remain underrepresented in autism research, despite a high rate of co-occurrence with ASC. These historical biases and systemic barriers may further obscure the accurate identification and understanding of ASC in these populations. This thesis explores clinicians’ experiences in assessing and supporting women with both ASC and ID. Health professionals working in autism and intellectual disability services participated in semi-structured interviews. Thematic analysis identified five key themes: Diagnostic Challenges, Gendered Manifestations, Intersectional Influences, Education & Awareness and Person-Centred Practices. Clinicians reported observing traits consistent with the Female Autism Phenotype in women with ID, challenging existing assumptions about the cognitive capacity required for masking behaviours. The findings from this thesis highlight the need for greater consideration of intellectual disability in autism research and clinical practice, as well as the importance of an intersectional approach to assessment and intervention. Recommendations include enhanced training for clinicians, the development of tailored diagnostic tools, and increased awareness of gendered and cognitive factors influencing autism presentation. This research contributes to evolving best practices in autism assessment and long-term support for those with ID, emphasizing the importance of individualized, inclusive, and equitable diagnosis and care.