Recognizing and Understanding Autistic Girls at School

Most children referred for a diagnostic assessment for autism are males. Autistic males with fluent speech will likely be diagnosed, on average, by the time they are eight years old. Autistic girls, on the other hand, "fly under the radar" and tend to be diagnosed during their teenage or adult years. A recent research study found that the male-to-female ratio of autism was 1:4 in four- to ten-year-olds, and jumped to 1:2 in adult women. The clinical records for diagnostic assessments that we have carried out show the same pattern. Since young autistic girls and teenagers are not being identified as having autism, they are missing out on valuable, accurate, and timely understanding and support. This article looks at how to recognise their profile at school.

Why Autistic Girls Are Not Diagnosed

Many autistic girls remain undiagnosed because the signs of autism are less obvious than they are with boys. It is worth asking why this is the case. An understanding of the social world does not happen innately or intuitively for those with autism. Autistic children and adolescents cope with this difficulty in different ways. One strategy is to use "camouflaging" to hide autistic characteristics. To successfully camouflage, people watch others closely to understand how to act and what to say in social situations. They imitate others, develop scripts, practise at home, and adopt masks and personas to be able to manage social situations. Research suggests that autistic females camouflage more than males and that they engage in that practice to fit in socially at school and avoid being bullied.

Some autistic girls can also be more motivated than autistic boys to conform and fit in socially at school. They tend to be well-behaved and less disruptive, and are thus less likely to be noticed. They may have learned that they will be left alone if they are good, and no one will see them if they are quiet. This makes it less likely that they will come to the attention of their teachers. While informed parents may believe that their daughter is autistic, she is unlikely to be diagnosed as such if the profile is not apparent either in the clinic during the diagnostic assessment or at school. In addition, teachers will not approach parents with concerns that a girl may be autistic if they do not pick up the profile in the classroom. Research shows that autistic women often receive mental health diagnoses prior to a diagnosis of autism.

Autism Profile – Autistic Girls

Since each autistic girl is unique, her needs will be reflected differently. School staff should be cautious not to overgeneralise since autistic students can be as different from each other as any other students. However, there is a recognisable profile of autism in girls that we will outline below. Our hope is that increased recognition will lead to earlier support and understanding.

Unlike most autistic boys, girls tend to be able to accurately interpret and answer questions about social interactions, social situations, and friendships. However, their responses may not come naturally or as quickly, which can make it difficult for them to keep up in group settings or with the conversation of many non-autistic girls. They may discover that boys can be more like-minded as friends since their friendship dynamics may be perceived as easier to understand.

Rule-Driven

Autistic girls are likely to adhere strictly to classroom rules and routines, regardless of whether they are established by others or by themselves. As autistic girls apply their cognitive skills to analyse social interactions from an early age, they are typically more likely than autistic boys to discuss the inconsistencies of social conventions and to be enforcers of social justice or fairness. If they are strongly motivated to abide by classroom rules and tend to be shy, naïve, and unassuming, they can easily be missed in a classroom of boisterous children. They can also be very hesitant to ask for help for fear of drawing attention to themselves, and reticent to act due to a sense of perfectionism that creates a fear of getting things wrong or being seen as "silly" by teachers or peers.

Strong Interests

Autistic girls may focus much of their intellectual energy on learning about their social world. As such, their interests often centre on social topics, including animals such as cats and horses, psychology, friends, a particular person or celebrity, literature, and fantasy. While the topics may not differ much from those of interest to non-autistic girls, what is different is the intensity of the interest. Autistic girls often have a rich imaginary world where they engage in elaborate doll play using a script to re-enact real events, a practice that may help decode social situations. Their tendency to follow scripts and to struggle with social reciprocity can put them at odds with peers who may not want to follow their script and find them too controlling. Girls with autism will not easily read social cues to know what to do or how to predict people's behaviour. Thus, autistic girls may have trouble recognising and managing conflict, which can affect their ability to repair and maintain friendships.

High Levels of Anxiety

Despite often having better coping mechanisms and an ability to camouflage their social difficulties, autistic girls face social difficulties that are very real and cause considerable stress and confusion. Their social challenges and sensory difficulties can have a significant impact on their well-being, leading to high levels of anxiety in the classroom and playground. Some of the signs of high anxiety at school include:

• School avoidance and refusal, and choosing to visit the school health centre frequently.
• Becoming overwhelmed, or going quiet, in social situations and appearing shy.
• Being reluctant to participate in class activities.
• Being unable to communicate verbally, or situational mutism.
• A constant feeling of being judged negatively by peers.
• Withdrawing from social interaction and choosing to be alone at lunchtime.
• Somatic complaints, including low energy, headache, stomachache, chest pain, and fatigue.

Dr. Jekyll and Mr. Hyde

Successful camouflaging allows an autistic girl's socialising to appear normative to non-autistic girls and teachers. She appears to successfully "keep it together" at school. She may be able to do such a great job at wearing the mask and fitting in that nobody, apart from her parents, would believe she is autistic. However, this effort takes a toll on her energy levels and emotions. Such girls will often come home feeling exhausted, irritable, and very emotional. She can have a meltdown or shut down the moment she is out of the school situation. Parents may be at a loss as to how to assist their daughter when afternoons after school are characterised by tears, tantrums, "rude behaviour," social avoidance, and arguments. In fact, parents may even be blamed by professionals because the visible challenges occur only in the home setting.

Autistic Girls in the Classroom

A wide range of difficulties are common for autistic girls in the classroom. The following list of challenges may help teachers recognise the autism profile at school:

• Autistic girls may process social and emotional information slower than their neurotypical peers, resulting in a time delay in their responses.
• They may have difficulty putting their thoughts and feelings into words, and struggle to express their wants and needs.
• They may have executive function challenges, such as difficulties with planning and organising their time, belongings, and behaviour.
• They may have sensory issues related to bright lights, certain noises, or odours such as perfume, which may not be overtly apparent due to masking.
• Social difficulties appear in subtle ways. For example, they dislike group projects, will not ask for help, go to the library at lunchtime, do not have a best friend or only have one friend and are lost if that friend is not at school. They move between groups of friends but don't seem to belong to one group and may prefer boys as friends.
• Autistic girls seem more stressed during transitions between classes and at the start and end of the day.
• They are overreactive to seemingly small things, such as a change in familiar classroom routines.
• Autistic girls are very good at art, singing, languages, and/or reading.
• While perfectionistic, they are also disorganised when it comes to some tasks.
• They have a strong sense of social justice.
• They tend toward black-and-white thinking.
• They may be gender fluid or dysphoric.
• Autistic girls may appear to be tomboys.
• They may appear shy, rude, lazy, or "odd."
• They tend to interpret language literally.
• They are extremely empathetic and sensitive.

Next Steps

Teachers may find it challenging to talk to parents about the possibility of their children having autism. Unfortunately, there is still stigma around being different in our society. Also, since teachers are not qualified to diagnose autism, they may feel uncomfortable mentioning it in case they've got it wrong. We urge educators to discuss with parents or caregivers any concerns they may have about their daughters. Share what you have observed at school. It may be helpful to give them a copy of this article as a reference point. Remember that parents and teachers share the same goal: the best outcome for the young girl.