A couple of years ago, a Mum brought her five year old daughter in to see me for an Occupational Therapy assessment due to concerns regarding her ability to learn at school. Her teachers reported that she was having general difficulties “catching on” and “keeping up” and tasks such as handwriting were really difficult and stressful for her.
So they came in for an assessment. The young girl was very sweet and polite. She was well dressed and well mannered. She said hello and asked me my name. She told me her name and complimented me on my “fun” room. I began to interview Mum to get some more information. Mum agreed with the teacher’s report- her daughter was having a great deal of trouble with school work. She spoke of homework always being a struggle and ending in tears, and attempts were only made with an ongoing rewards system that was changing every day. She spoke of seeing an Occupational Therapist in the past for fine motor skills and scissor skills and how those things had improved with lots of practice, only to get to school to discover handwriting was so difficult. She spoke of her daughter’s “poor attention ” and constant need for redirecting.
I then asked about how her daughter was going at home with everyday activities such as eating, dressing, brushing her teeth and sleeping. She told me that her daughter was not motivated to participate in everyday activities required of her and that everything was a struggle, requiring constant nagging. She spoke of her daughter’s avoidance and fear of tasks that she perceived she could not do. She spoke of rigid bedtime routines consisting of lining toys up in a particular order and reading the same three books in the same order every night.
She reported that her daughter had difficulty with social skills, preferring to play on her own and in her ‘own world’ and showing general disinterest in other children. She spoke of her daughter playing the same games in the same way each time. She discussed her daughter’s difficulty initiating and maintaining social interaction. She mentioned her daughter’s “unusual obsession” with animals and said that she would sometimes pretend to be a cat or dog.
Mum spoke of fussy eating and avoidance of foods, her daughter’s aversion to the sensory feeling of grooming activities, particularly hair brushing, hair washing and hair cutting, her dislike of social touch, and her avoidance of textures such as grass, sand and dirt. She told me about her daughter’s distress in response to noisy environments, thunder, the school toilets and specific noises relating to the operations of her mother’s computer. She spoke of her daughter’s reluctance to go to new places and her daughter’s anxiety in unpredictable environments. She spoke of her daughter’s aggressive outbursts and inconsolable meltdowns.
At this point it became very clear- on the surface this was a sweet, little girl, well -mannered and polite, who had learnt the right social etiquette for the occasion. A little girl that was having “some difficulty at school”. But underneath was a girl struggling with Asperger’s syndrome (now known as High Functioning Autism). I (very warily) asked Mum if anyone had brought up the idea of Autism and she replied that she has brought it up. Many times. With many people. With her daughter’s teacher. With her daughter’s GP. With her daughter’s previous Occupational Therapist. Only to be told that her daughter was “just immature”, “was spoilt”, and “will grow out of it”. This was sad but not overly surprising given how differently this little girl presented compared with her Mum’s report. I sent her off to a Paediatrician with my report and she was diagnosed with High Functioning Autism.
I have reflected on this little girl’s story quite a lot over the last few years as it is anchored in my mind as a true example of how girls on the Autism Spectrum present differently to boys and often go undiagnosed for a long time. I don’t mean that they present differently in the core characteristics of Autism, the criteria used for diagnosis, but in terms of how they cope or adjust with being different to their peers.
Professor Tony Attwood wrote a thorough article outlining these fundamental differences, differences which may explain why diagnosis is at a lower rate in girls than in boys. Following is an outline of some of the content in the article, giving my story above some perspective.
- Girls will typically use coping and adjustment strategies to “mask” their social difficulties.
- Girls can often observe, learn and copy other children to determine what to do in specific social situations.
- Alternatively, some girls escape into imagination and create an alternative world. They may prefer to play alone or spend time with pets and animals.
- Girls with an ASD may have the same interests as other girls however may differ in the quality of their interests. For example, the may prefer to “organise toys rather than share them, and not play with toys in conventional ways.
- Many girls have an intense interest in reading, with some being hyper-lexic, developing an amazing vocabulary and escaping into fiction, enjoying a fantasy world, creating a new persona for herself, talking to imaginary friends and writing fiction at an early age.
- Girls with an ASD may escape to nature, preferring to play with animals.
- Many girls with an ASD prefer to play with boys as their play is typically more “constructive and adventurous”, avoiding the emotional interactions that socialising with girls can often attract.
- Girls with an ASD will increasingly “recognise their own social confusion and mistakes and may react by trying to stay on the periphery of social situations”.
- Another strategy is to be extremely well behaved and compliant in class so as not to be noticed or recognised as different by the teacher. At home, the “mask” is removed and a complete opposite “character” will present, often using passive-aggressive ways of controlling her family.
To read the full article, go to:
Check out what these amazing Limpsfield Grange Girls with an ASD have to say on their youtube video……
The more we can understand about girls on the Autism Spectrum, the earlier we can diagnose and get on with supporting these kids in home, at school and in the community.