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Hiding in the shadows, ASD and Girls

March 20th, 2018

World Autism Awareness Day has become an important date in the calendar, especially for those living with the condition in some capacity in their lives. For charities like the National Autistic Society, just one day is not enough. From 26 March to the 2 April they will be running various fundraising campaigns, asking the public to get involved in whichever way they can.

Whilst we have come a long way as a society in recognising and understanding Autism, there is still a long way to go. For example, it is not well known that ASD shows itself differently in boys and girls. The majority of the signs and symptoms we associate with ASD are often representative of boys, not necessarily girls. Octavo Educational Psychologist Nicola Tallis, who has extensive experience working with children and young people with ASD, discusses the matter.  

The statistics tell us about the higher prevalence of boys with an autistic spectrum disorder (ASD) than girls. However, there is a growing body of research that girls may be under represented in this field. Girls with ASD may be less noticeable than boys in schools as they tend to be less disruptive and have an ability to either mimic behaviours or hide in the shadows, hoping not to be noticed. (Attwood, 2012.)

Why are girls with ASD not being identified at school?

Girls with ASD often present with positive, compliant personalities and difficulties which can be missed as  they often do not come across as having any marked social impairments. These girls tend not to be disruptive and try not to draw attention to themselves. They tend to camouflage their difficulties. Boys on the spectrum tend to externalise their problems whereas, girls will often suffer in silence. Challenging behaviours often manifest themselves at home as opposed to school.

Mental health issues for girls

It is often not until puberty that girls’ social difficulties become more obvious, particularly as they enter secondary school and may become the subject of bullying. Difficulties and difference become increasingly obvious at secondary school level, when there are no younger children to associate with, when peer groups are more mixed and any “protection” from long known peers may have dissolved. Additionally, multiple stimuli (such as crowds in corridors or screams in playgrounds) and changes to routines which occur at secondary education can increase individual anxiety greatly. Adolescence, involving changes, such as menstruation and the growth of breasts and body hair, can profoundly affect girls with ASD, heightening anxieties due to lack of control over what is happening. Unlike boys, girls often become withdrawn, depressed and quiet, rather than aggressive. Profound anxieties may be demonstrated in altered behaviours, lower performance at school, poor sleep patterns, low mood/depression and obsessive behaviour. Research from 2011 found that many women who were later diagnosed as being on the autistic spectrum initially were thought to have learning difficulties, personality disorders, obsessive compulsive disorder or eating disorders (Rivet and Matson, 2011). This differential diagnosis could be related to lack of awareness of how ASD presents in females.

Checklist for teachers in identifying girls with ASD

  • Social Immaturity
  • Special interests (intensity of these interests)
  • Different eye contact
  • Poor handwriting
  • Poor gross motor co-ordination
  • Isolation or teasing by peers
  • Lower grades
  • Viewed as ‘odd’ by teachers
  • Disorganised
  • Passive – lack of interest in class activities
  • Lack of empathy
  • Repetitive questioning

(Attwood, 1999, Kopp and Gilberg, Cord et al 1982, Smith 1997)

Intervention

Observation of girls in the social setting of school, paying close attention to friendships is vital for diagnosis. Seeing how girls manage during unstructured times can be telling. In order to support these girls the following is essential in any setting;

  • Use of visual timetables, or other visual aids to underpin communication and increase predictability
  • Emphasis on a visual and sensory play for young children
  • Social programmes involving exercise and language games
  • Buddying between individual children with ASD and other volunteer children in school. They could offer support and advice around social interactions
  • Structuring breaks and lunchtimes
  • Increasing awareness amongst school staff
  • Highly structured lessons – support for unstructured time
  • Careful positioning of children in class – away from more distracting children
  • Warning of sensory stimuli that is to be introduced to the class

To support and enhance the lives of girls with possible ASD and social communication difficulties, it is therefore up to us as educators to spot these symptoms earlier and intervene to change the lives and perceptions of these girls.

Octavo run a range of CPD courses for those working with pupils who may have SEMH issues, including qualifications such as the National Award for SEN Coordination and shorter sessions such as ASD and Behaviour. To view our full CPD programme visit octavopartnership.org/courses/

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