If you are a professional who conducts autism assessments, you probably see far more boys and men than you do girls and women. There is a strong belief that more boys have autism than girls, because more are identified. What we often fail to take into account is how autism presents very differently in males as compared to females, and the ways females have learned to mask their characteristics more effectively. Teachers seldom refer quiet, well-behaved girls who seem bashful or socially immature for assessment, while the boys’ behaviors often stand out and are difficult to overlook.
So, how can we ensure that our girls on the spectrum receive the services they will need? What should we look for in evaluating girls and women when Autism Spectrum Disorder (ASD) is suspected? Here are 8 A’s to take into account, although this is by no means a comprehensive list:
Is the teacher already making accommodations to help this girl succeed in the classroom, perhaps without realizing it? A very quiet girl may hesitate before answering until they are given a hint or pointed in the right direction. Many girls simply remain quiet and their teachers tend to make excuses for them based on perceived shyness, rather than suspecting a potentially more significant problem. By providing accommodations without identifying the need, referral for assessment may be postponed for years.
Many typical girls will take an awkward, shy or uncertain girl under their wing and help them navigate socially. These kind-hearted accomplices may speak for the girl and serve as a go-between on the playground and in the classroom. This masks any social deficits.
Take note if a girl demonstrates aversions to typical sensory experiences, such as covering her ears during noisy classroom times, or holding her nose in response to normal smells such as cleansers, popcorn or perfume. Unusual sensory responses are characteristic of ASD. Girls may try to mask their discomfort when sensory overload is a possibility, and pretend that there is nothing wrong even though they are becoming increasingly agitated.
Does she appear overly anxious or fearful when there is a change in the schedule, or when going to a new place such as to the auditorium for an assembly? This is associated with ASD. Girls may just be thought of as “worriers” and it may be attributed to being female rather than seen as a symptom.
Does she often seem to be daydreaming, or lose her place, or seem unaware of what is going on in the classroom? These behaviors are associated with ASD. While boys with Attention Deficit-Hyperactive Disorder (ADHD) are frequently referred for assessment because their excessive movements and hyperactive behaviors disrupt class, many girls have attention deficits without hyperactivity and glide under the radar.
Does she seem overly animated when she talks, gesturing in flowery or fluttering hand movements which are not really communicative? On the other hand, does she lack animation, talking without expression or gestures and keeping her hands and arms down at her sides when walking or running? Some girls were nicknamed “Birdie” as a youngster because of the way the ran with their arms held straight back as if they were flying, or they fluttered their hands like wings. Being overly-animated, and/or lacking affect or animation, can each be associated with ASD.
Most girls have interests they share at various ages, such as a love for horses, or Harry Potter, or other toys, books or television shows. Your girl on the autism spectrum is likely to carry these interests to extremes, even creating imaginary worlds for herself populated with ponies or beloved characters from books. She may retreat to her imaginary world when under stress, and she may continue to be passionate about her personal ardor or special interest long after other girls her age have outgrown it.
8. Another Diagnosis
If a girl already has another diagnosis, such as Obsessive Compulsive Disorder (OCD), anxiety, depression, or ADHD, consider an autism assessment. These other diagnoses share many characteristics and are often comorbid with ASD. Also, take note of her medical records: a history of epileptic seizures has been found to be more prevalent in those with autism as compared to the general population, more so for autistic girls than boys (https://www.ncbi.nlm.nih.gov/pubmed/19454962).
If you’re a teacher or a school psychologist, as you start the new school year, notice the quiet girls in your classroom or on your campus. Think about the 8 A’s: Accommodations, Accomplices, Aversions, Anxiety, Attention, Animation, Ardor, and Another Diagnosis. Girls have a right to receive an appropriate assessment and needed services just the same as boys, even when they present with different symptoms.