Autism and Girls

Background

Historically many girls with autism have not been recognized/diagnosed due to:

• More subtle presentation
• Clinicians not recognising girls
• Other diagnoses being used to explain difficulties – autism not being considered as an explanation

Mental health problems have often been the primary diagnosis which may have masked the underlying autism. This can result in lack of appropriate support which in turn can result in loneliness, depression, and social isolation, increased vulnerability in terms of emotional well-being, i.e. self-harm, eating disorders; lowered grades and reduced opportunities in the future.

How difficulties may present

• Girls may not come across as having social impairments and might be: passive, compliant, shy, coy, embarrassed, innocent, unassuming, appease and apologise. They may avoid eye contact, but may also be able to provide very good eye contact and appear confident / talkative.
• Tendency to camouflage / ‘mask’ their difficulties – don’t disrupt and draw attention to themselves (as some boys do).  They can be very adept at following and imitating social interactions by observing and copying others. Whilst they are compliant and passive in school, crisis behaviour at home can occur as a result of worries ‘carried home’.
• Manifestation of significant anxiety at home – may catastrophise.  Need to avoid social pressures / demands can lead to school refusal.
• Boys externalise their problems while girls tend to be more resilient and ‘suffer in silence’.
• Special interests tend to be the same as peers though maybe more intense.
• Escape into fiction, have imaginary friends. Can create rich and elaborate fantasy worlds – escape from the pressures of the real world. Potential to be mistaken for psychosis?
• Role play social scenarios with dolls – events from fiction and / or school.
• Avid observers –by mirroring others, develop a superficial social competence (social echolalia). May care what their peers think and worry – may be acutely aware of their differences and know that they are surrounded by people who don’t really ‘get them’ resulting in increased isolation/anxiety.
• Lack reciprocity in social play and can be very controlling. May become very reliant on a particular peer who becomes their ‘social interpreter’.
• Alternatively, some girls will form casual relationships, but not stick to one group or have close friends – difficulty recognising and managing conflict and this impacts on their ability to repair and maintain friendships (also socially exhausting).
• Possibility of demand avoidance.
• Are often able to eventually answer questions about social situations, friendships, etc. but need longer processing time – this can be difficult, i.e. chatty teenage girls!
• Difficulties with self-identity, i.e. appeasement, over apologetic, follow others, etc
• Very vulnerable to bullying and social isolation; possibly put themselves at risk through abusive relationships, i.e. promiscuity – ‘at least I’ll be popular.’
• Vulnerability: how to cope with developing body, managing dating, safe sex, menstruation, fertility.
• Difficulties may become more pronounced / obvious at secondary where social relationships become more complicated and the gap between themselves and their peers widen. Much harder to keep up, fit in and cope.

Strategies

• Similar to boys in the need for structure, use of visual cues and a low arousal environment.
• Regular checking in by staff as girls may not seek help and may not vocalise their anxiety.
• Development of a personalised ‘help’ system, i.e. green pencil for ok, red pencil for help.
• Pre-teaching of lesson content will improve understanding and confidence.
• Develop a clear avenue to help a pupil to develop their confidence to raise and discuss worries, i.e. mentoring opportunities. Development of a ‘thought book’; social stories and comic strips; flow charts and emotional scaling.
• Opportunities to develop self-awareness / self-esteem: develop a success portfolio.
• May need direct support re: organisation, particularly with homework.
• Opportunities for social skills work re: peer interactions and ‘digging beneath the surface’ to unpick understanding of social contexts / hidden rules. Work should include exploring different levels of relationships, making and maintaining friendships, being alone and dealing with bullying (what is and is not acceptable in typical peer interactions) and programmes of SRE.
• Possible development of a girls group.
• Use common interests as a basis for developing friendship skills and incorporate into learning opportunities.
• Developing support strategies which do not make CYP stand out from her peers.
• Scaffolding support structures to increase independence while reducing vulnerability.
• CYP’s have a structure of safe places / clubs to go to during unstructured times in the school day.
• Opportunities for appropriate sex and relationships education, particularly exploring issues re: assertiveness, resilience / vulnerability and the safe use of ICT.
• Careers information, advice and guidance specificity: girls who are systematisers may prefer male-dominated occupations, where the need to follow rules is high. Girls may need to: see the big picture of career pathway options, celebrate the right to choose their own path.

Useful resources, links and further reading

• ‘Girls and Autism’: Carpenter, Happe et al, 2019
• ‘The Spectrum Girl’s Survival Guide: How to Grow Up Awesome and Autistic’: Castellon and Grandin, 2020
• NASEN: ‘Flying Under the Radar’
• The National Autistic Society
• Limpsfield Grange
• Jacqui Ashton-Smith and Judith Gould: ‘The Diagnosis and Education of Girls and Women with Autism’
• Tony Attwood and Temple Grandin: ‘Asperger’s and Girls’
• The Girls of Limpsfield Grange
• Rosie King Ted Talk
• Safeguarding autistic girls at school (autism.org.uk)

• Download a printable version of this guide