Knowledge Bank - Inclusion

Autism and how it manifests in girls

The gender split within autism often leaves girls underdiagnosed. How can schools help to address the condition in girls?

Autistic disorder is a lifelong developmental disability, which affects the way a person interacts with, and responds to, the world around them. Since autism is a spectrum condition, it manifests in a variety of ways according to individual circumstances. These differences are seen both within and across genders.

In particular, there is a significant gender split within autism diagnoses. In Brugha’s 2009 survey of adults living in households throughout England, it was discovered that 1.8% of men and boys surveyed had a diagnosis of autism, compared to 0.2% of women and girls. This split is also seen in the ration of men to women who used the National Autistic Society’s adult services in 2015, which was approximately 2:1. Notably, girls appear to be underrepresented by these diagnostic figures. It therefore appears that girls with autism have been under diagnosed, in comparison to the figures for boys. Growing speculation suggests that girls with the condition are not referred for diagnosis. Resultantly, they are missing statistics, which are often undiagnosed until adulthood, or not at all.

The invisibile nature of autism in many girls is a result of the existing diagnostic system. Currently, the diagnostic criteria is based on the characteristics of boys with the condition. However, girls may present themselves differently than boys do. Therefore, the procedure which is used for diagnosis should be altered according to gender differences. It is crucial that the method of diagnosis recognises the wider perspective of the condition. In order to address both boys and girls with autism, professionals must ask the right questions, assess the child’s developmental history and observe the individual in a number of different settings. It is a case of understanding whether their social role is based on intellect, rather than social intuition. A much more subtle analysis is needed for girls with the condition.

Spotting the behavioural markers for autism in girls is only achieved through close observation. Girls with autism are often able to mask their symptoms, especially in social situations. In a classroom environment, girls are more able to concentrate than boys, who often become disruptive and easily distracted. Therefore their behaviour appears in line with the other girls in the class. In wider social situations, by using a process of observation and imitation, girls are able to compensate for the developmental disability. Whereas autism in boys manifests in a lack of social understanding, girls appear to have a greater desire to connect with the world around them. However, although girls with autism are seen to be interacting socially more often, a key marker is allowing themselves to be led by peers, rather than initiating social contact. Taking the lead from others allows the child to learn the ropes of interaction, which can later be mimicked in order to appear in control of the situation.

Whereas boys with the condition experience extremely restrictive interests (which are often the key for diagnosis on the less severe end of the spectrum), girls show fewer signs of such behaviours. Instead, girls with autism will often observe similar interests to other girls their own age. However, their interests are often intense and obsessive, such as a fascination with a particular celebrity or TV show. Alongside this, girls often experience an intense involvement in pretend play. Especially in younger girls with the condition, the imagination appears to be particularly active. This intensity also manifests in repetitive behaviours and sensory differences. Reactions to loud noises and certain textures can lead to social awkwardness and anxiety in autistic girls. Specifically, recent research has shown a correlation between autism and eating disorders. A number of the behavioural tendencies of those with conditions such as anorexia are closely linked to the way in which autism manifests in girls.

In contrast to the vivid interests and imaginative processes, passivity in response to daily tasks is another indicator of the condition in girls. Whereas boys become disruptive in response to daily demands, girls act passively and often ignore responsibility. This can lead to issues in education, such as adhering to the school timetable. Furthermore, within the school setting, girls often respond inappropriately to figures of authority, since the conception of social hierarchy is not fully developed.

In order to address the evidently prominent issue of autism in girls, procedures need to be put in place to help increase independence, and to aid the understanding of language and social situations. Meeting the needs of all children is a key part of a school’s commitment to a culture of inclusion. This can be achieved in a number of ways:

Across the school

  • Creating an “autistic curriculum”, which is able to include not only the individual learning needs of the child, but also addresses the wider social, emotional and communication needs. By doing so, the child is able to develop their own sense of independence and their well-being is closely monitored.
  • Being interested in hearing the pupil’s own voice about their learning and experience of school life. Having high ambitions and aspirations for pupils with autism is essential, but understanding the individual circumstances of the child in question is key for development.
  • Realising that the education of children with autism is broader than for children without the condition. One way of addressing this is by monitoring progress through alternative methods than the standard assessment requirements. This will help educational leaders to assess social and behavioural developments, as well as their educational progress.
  • Training staff so that the condition is understood across the school. This enables leaders to step in to provide support for the child, regardless of the situation. This is especially important during unstructured time, such as breaks and lunches, when anxiety levels tend to be higher than during structured time.
  • Working alongside specialist health practitioners, with a particular focus on speech and language therapy, occupational therapy, mental health and social care. Involving children in programmes to improve the knowledge of facial expressions and to understand the physical signs of feelings will nurture their sense of social integration.

In the classroom

  • In order to aid the understanding of verbal communication, teachers should speak as clearly as possible. Through the use of direct language, the child is able to process the information much more effectively. By slowing communication down, extra time is provided to understand the information. The child is therefore much more likely to engage with the lesson, rather than passively listening.

  • Providing the child with visual aids can help with the daily demands of school life, which can often appear overwhelming to children with autism. For example, a visual timetable with simple drawings and times will enable the child to process and act on the information in a way that previously seemed daunting.

  • Integrating individual children with autism and older volunteer children in the school. A buddy system provides the child with social support and the opportunity to ask for advice. Girls with autism  often have a history of failure in achieving and maintaining friendships. By providing the child with a secure figure, a sense of permanent inclusion is adopted.

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