By Dr Michelle Garnett & Professor Tony Attwood
I think my student is autistic, what do I do?
For some students’ autism can present in subtle ways that only start to become clear when you begin to get to know the child or teenager. Whilst many autistic students are picked up in early primary school, others “fly below the radar” and are missed in the early years. Globally, the average age of diagnosis for boys is 8 years and 12 years old for girls. If you think your student has autism but they have not been diagnosed and there is no IEP there are several steps you can take to advocate for your student, including collecting data, communicating with the parents or carers, and providing quality information to inform the diagnostic process. This blog describes each of these three steps to assist teachers or teacher’s aides who are concerned that their student may be autistic.
Why is formal recognition of autism important?
There has been some debate as to whether seeking a formal diagnosis of autism is helpful for a student or not. One of the main reasons not to is fear of stigmatising the child. For this reason, some parents may be reluctant to seek a diagnosis. However typically the child is aware that they are different, their peers are aware, and in the absence of an accurate and informed reason for the differences, it is common for both the child and their peers to use unhelpful explanations that become their self-identity, such as “I am or s/he is weird/psycho/bad/defective etc.” Sadly, in our combined clinical experience of 80 years in autism, we have seen this scenario play out far too often with the consequence that the child is bullied and rejected by peers, their self-esteem suffers, and they experience high levels of anxiety and depression, often starting in childhood.
When a diagnosis, or as we prefer to say, a discovery of autism is made, there is an explanation of the child’s differences that is neurological, not a character defect, and a clear signpost to evidence based research on support and therapy, types of school accommodations and teaching methods. Recognition of autism assists the child, their family, teachers and peers to recognise who they are in terms of their strengths, abilities and challenges, leading not only to the right kind of support, but also paving the way to a healthy self-esteem based on an authentic sense of self and acceptance of that self.
If you suspect that your student may have autism there is information that you can collect. Observe your student during interaction with their peers in unstructured and in group activities in the classroom. Notice how often they initiate interactions with peers, and their use of body language, including facial expression. How “tuned in” do they seem to their peers? There are several screening questionnaires that would be helpful to complete. We have devised two and include them here for your use:
Complete this questionnaire about your student aged 5-19 years old
Complete this questionnaire about your student aged XX years old. This questionnaire was standardised on an almost equal number of males and females, to discern differences in between the genders on autistic traits, in addition to differences between autistic children and non-autistic children. Often girls will mask and camouflage their autism by observing their peers and copying them. For more information about recognising autistic girls in the classroom, and what to look for, read our blog on How to Recognise Autism in Girls.
There are no cut-off scores for these questionnaires, but norms are provided with the questionnaire and your student’s scores compared to non-autistic students will give valuable information about whether there are red flags for autism.
2. Communicate with Parents
The step of starting a conversation with parents about the possibility that their child has autism can be one of the most difficult steps to take. In our teacher training on autism, this is one of the most common questions. Having insight into the natural fears’ parents can hold about having their child being discovered as having autism creates the possibility of having the conversation with compassion and sensitivity. We recommend meeting the parents before or after school in a private place and being direct and solution focussed. Consider this example, “The reason I wished to discuss Madeleine with you today is because I have noticed that she is often quiet at group time and tends to sit to the side of groups at lunch without getting involved. I am concerned that she is struggling to socialise with her peers and may feel lonely. I am interested in your own thoughts.” It is helpful to be upfront with your reason for requesting a discussion, giving some examples of the behaviour that concerns you, and to communicate care and openness to their opinion.
Sometimes having several conversations, both formal and informal, with parents may be needed to establish a trusting relationship before flagging the possibility of autism, and a referral to a specialist diagnostician who understands the subtle ways that autism can present. At this stage you may share the results of the screening questionnaire you have completed. Be clear that you cannot diagnose, but that you have recognised signs and you think it would be worth exploring.
Before deciding to take the step of commencing a diagnostic process parents may wish to discuss with you the Pros and Cons of having a diagnosis, including what being recognised in the education system would mean for their child, in terms of who would know, what are the potential benefits, and what are the risks.
Be prepared for the parents to disagree with you. They likely do not see what you see at school, and their fears may be too great. It is still possible to work together for the child’s benefit, by keeping open and respectful communication with the parents and understanding the child’s needs together. Some options may be closed due to lack of funding or the possibility of making accommodations, but it is within the parents’ rights to choose not to proceed. Often when autism is present anxiety is also present, and a referral for anxiety may be more acceptable for parents. Assisting the student with their anxiety will assist their autism and may be a step toward autism discovery.
3. Contribute to the Diagnostic Process
If your student’s parents choose to have a diagnostic assessment, be prepared for potentially long delays. However, it is worth waiting for a diagnostician who knows autism. Supporting parents and the student during the wait is an important and valuable process. Depending on your location, parents may choose a paediatrician, paediatric psychiatrist, clinical psychologist, or GP with specialist autism knowledge. It can be helpful for the school to compile a list of known experienced diagnosticians in autism to be able to guide parents. Be aware that autism is a specialist area, and not all health professionals have been trained in the recognition of autism beyond the most classic and conspicuous presentation.
Give your completed questionnaires to the parents for the diagnostic interview and be prepared for a follow-up phone call with the diagnostician. These are some of the questions you may be asked:
- Does the child have an age-appropriate understanding of what a friend is and do they have friends?
- Can they maintain their friendships?
- Do they stand out from peers, if so, how?
- How well do they read facial expressions, gestures and social context and cues?
- Do they understand personal space?
- What is their reaction to gentle and/or firm touch? What is their reaction to unexpected touch?
- Do they distressed and/or irritated by noises?
- Are they distressed by certain light intensities?
Routines and Resistance to Change
- Does s/he have any routines or rituals that s/he insists on doing?
- Does s/he talk about specific topics of interest, irrespective of the needs of the listener, or is the content of what s/he talks about reciprocal and varied?
- Does s/he use an age-appropriate range of gestures in a conversation?
As a teacher you can be a very valuable part of the social and academic success of your student if you suspect that they have autism. Collecting data, communication with the parents and contributing to the diagnostic process are three key steps you can take to assist. Equipped with knowledge about what is happening, your student, their family and school staff have much to gain.
We have been training teachers in recognising and supporting autistic students for the majority of our combined 80 years specialised in autism. To learn more about this increasingly important area we encourage you to watch our recording, Autism in School.