Girls typically present with more subtle traits of Autistic Spectrum Disorder (ASD), less associated with the traditional asocial model, but still presenting challenges to their development and interaction.
In recent years, there has been a rise in the number of girls diagnosed with ASD. The most recent estimate is 1:3, and a growing awareness of the unique needs of autistic girls.
Historically, it was thought that autism was largely a condition of boys, indeed it has been called, ‘the extreme male brain’ but in recent years there is a greater recognition of the prevalence of autism in girls. Girls typically present with more subtle traits, less associated with the traditional asocial model, but still presenting challenges to their development and interaction.
How does autism differ in girls?
Quite simply, it looks really different. Boys with ASD tend to be less social than their peers and display prominent and obvious areas of obsessive interests and compulsions. Girls with autism, however, are more able to follow or imitate social actions. When they are younger they can mimic socially appropriate behaviour, without understanding what they are doing or why they are doing it. This can have the effect of masking their difficulties.
Girls with autism are often aware of and feel the need to socially interact. They can join in play but are often led by their peers. They may not initiate social contact but will react to it and can appear socially passive or socially odd. They feel that they would like to have friends but do not understand how to make friends. This can cause lots of unhappiness and can create feelings of isolation.
Social communication can be difficult, with girls not understanding why we would want to communicate with other people.
Recognising facial expressions and what emotions they show can be challenging for girls with autism, making it hard for them to read a situation. This can mean that people’s responses to them are surprising and bewildering. Appropriate social communication can be difficult, with the girls having little or no understanding about social hierarchies. This can result in them speaking to adults as though they were their friends, and not changing their language to suit the social situation they are in. This can cause problems at school, and in wider society.
Often girls on the spectrum have a good imagination, and compared to boys with autism are relatively good at pretend play. They can spend a long time indulging in elaborate fantasy worlds, which can be complex and full of detail, and can be sustained over long periods of time. Their fantasy world can dominate play; the girls might be able to talk about their world in depth, and often the line between fantasy and reality can become blurred.
Girls with autism often have special interests. When they are young these interests can include age appropriate topics such as horses or animals, boy bands or certain books or films. This in itself it not unusual. It is the intensity of their interest and how long the special interest lasts that will be different.
As other girls move on to other areas of interest, girls with autism often do not. This causes gaps to appear between their social development and that of their peers, often resulting in them becoming increasingly socially isolated as areas of common ground disappear.
Sensory needs can also add to an already complicated picture.
Autistic girls may be particularly sensitive to loud noises, bright lights or touch; may hate wearing tight clothing or particular fabrics; or conversely, may love to be tucked in super tight clothes, or need to have their hair tied back in a tight ponytail.
Eating can be a battleground, with girls only prepared to try certain foods and textures. Not eating or controlling their food intake is another characteristic, and there is ongoing research into the prevalence of anorexia amongst women and girls on the autistic spectrum. There is also growing evidence to support a link between gender dysphoria and autism in girls.
A high level of anxiety is common among girls with autism. The world can be a confusing and unpredictable place. To minimize this, they may need to exert a high level of control on their environment and the people in it. This can result in quite ritualised behaviour, inflexible routines and meltdowns when unplanned events occur.
Autistic girls often want to please and will spend all day at school trying very hard to do the right thing. As a result, home life often suffers as they vent their frustration and anxiety for hours at the end of every school day.
- Clear routines and structure at home can be a great help. A timetable of what is happening, with pictures, can help to make a girl feel less anxious.
- Communication is key. Make everything explicit. Explain why you are doing something, or why you talk to someone in a certain way.
- Use egg timers or sand clocks to count down at the end of an activity, so that changing activity or focus does not come as a surprise.
- Try to identify triggers for crisis points. Create a calm box in your home, and if it looks as if anxiety or anger is building, use it to avoid meltdown moments. Fill it with items such as stress balls, toys that light up or reflect light; tactile toys – anything that will help.
- Display clear visual rules in your home and refer to them.
- Talk about emotions as they happen and name them, to help her understand how she feels physically and the label for the emotion she is experiencing.
- Explain, explain, check understanding and explain again!
With the right support and guidance, girls with autism can become successful, self-aware, happy and independent young people, able to live and study independently and pursue a variety of careers.
With thanks to Sarah Wild, headteacher at Limpsfield Grange