Not just for boys Girls on the Autistic
“Not just for boys” Girls on the Autistic Spectrum Rochdale Additional Needs Service
• Temple Grandin
Prevalence • There around 700, 000 people in the UK living with autism - that's more than 1 in 100 • If you include their families, autism touches the lives of 2. 8 million people every day. • Five times as many males as females are diagnosed (NAS January 2017)
History Hans Asperger (1944) • All boys – originally believed no girls were affected but clinical research later caused him to revise this statement. Leo Kanner (1943) • Small group but there were four times as many boys as girls. Lorna Wing (1981) • ‘High-functioning autism' or Asperger syndrome - 15 : 1 • Learning difficulties as well as autism - 2: 1. • Girls are less likely to develop autism but when they do they are more severely impaired? Or , 'high-functioning' girls have been underdiagnosed?
Theories to explain the gender split Wing (1981) • In the general population, women and girls have better verbal skills, while men and boys excel in visuo-spatial tasks. David H Skuse (2000) • • Genes for autism are located on the X chromosome. Girls inherit X chromosomes from both parents, but boys only inherit one, from their mothers. Skuse's hypothesis is that the X chromosome which girls inherit from their fathers contains an imprinted gene which 'protects' the carrier from autism, making girls less likely to develop the condition than boys.
Theories to explain the gender split Kevin Pelphrey (2016) • • • Imaging studies Discovering that girls with autism are indeed different from other girls in how their brain analyzes social information. But they are not like boys with autism. Each girl's brain instead looks like that of a typical boy of the same age, with reduced activity in regions normally associated with socializing.
Girls can be missed “If you were just judging on the basis of external behavior, you might not really notice that there's anything different about this person. It relies much more on getting under the surface and listening to the experiences they're having rather than how they present themselves to the world. ” Simon Baron-Cohen – University of Cambridge
Liane Holliday –Willeys Autobiography “Pretending to be normal” I could take part in the world as an observer. I was enthralled with the nuances of peoples actions. I often found it desirable to become the other person. It became something I did. At times I would copy a persons look and their actions , accents, facial expression, hand movements. It was if I became the person I was emulating.
Limpsfield Grange School • This film was made by the autistic students at Limpsfield Grange School to raise awareness of girls with ASD. • ITV made a documentary shown in July 2015. .
Signs of ASD in girls • Diagnosis of ASD is based on the triad of impairments, identified by Wing and Gould in 1979. Social interaction Sensory differences Social communication Social imagination
Social Interaction • Socially motivated. • History of failure in achieving and maintaining friendships. • Girls gravitate towards older girls, who tend to mother them. • May be socially immature and make a preference to play with much younger children who allow them to dominate play. • May “adopt” a less able peer, perhaps someone with a learning difficulty, who is open to being dominated by the child with ASD. • Don’t do social ‘chit chat’ or meaningless comments to initiate interaction.
Social Interaction • • Dependent on their mother (or other primary carer). See them as their best friend. • • Value friendship and many forge positive relationships. They can also be excessively possessive. • Read fiction (or watch soap operas) to help them learn about inner thoughts, feelings and motivations. • Apologise frequently and want to appease others. • May be on the periphery of social activity. • Parents often organise friendships.
Social Communication • Boys engage in disruptive behaviour. • Girls may be persistently “ill” to gain what they want or control their situation. • Act passively and ignore daily demands, while boys become disruptive in response. • Appear more able to concentrate than boys, who become distracted more easily and can be disruptive. • Learn social behaviour by observation and copying, which can disguise their social deficits.
Social Communication • Find the idea of social hierarchy difficult, so they can respond inappropriately to people in authority. • Need to learn the rules of “small talk”. • Difficulties tend to be masked by their passive behaviours and ability to mimic without understanding. • Look for signs in patterns of behaviour, such as, getting into trouble just before break-time so that they have to stay in.
Social Imagination • Exhibit poor empathic skills and a lack of social interest. • • Seem disinterested in the classroom. Exhibit immature, impulsive and unusual behaviour. • • An inability to “move on”. “Cluttering” behaviour can outline their difficulties with change. • Parents may perceive their daughter as being non-specifically “odd”, but without being able to pinpoint the cause. • Engage in repetitive questioning well beyond the age that those who are not on the spectrum would normally do.
Social Imagination • Special interests are often focused on stereotypical female interests. • The key is the intensity and quality of these special interests. • • Good imagination and engage in pretend play. Can often be intense in nature or they reproduce a real event or a scene from a film or a book. • Many have an elaborate fantasy world with imaginary friends but can struggle to separate reality from fantasy. • Some girls escape into fiction and some live in another world.
Overlooked • It seems that girls on the autistic spectrum may be less noticeable than boys because they are less disruptive and have an ability to mimic behaviours. (Atwood, 2012. ) However. . . • Lack social understanding and any deep knowledge of language. • This becomes increasingly obvious at secondary school. • No younger children to associate with. • Peer groups are more mixed. • • Multiple stimuli such as crowds in corridors or screams in playgrounds. Changes to routines increase anxiety greatly. • Adolescence and puberty heightens anxieties due to lack of control over what is happening.
Mimicking Girls often use their intelligence to mimic and become an actress. However the effort this takes is exhausting. “The fact that girls with undiagnosed autism are painstakingly copying some behaviour is not picked up and therefore any social and communication problems they may be having are also overlooked. This sort of mimicking and repressing their autistic behaviour is exhausting, perhaps resulting in the high statistics of women with mental health problems. ” (Dale Yaull-Smith, 2008)
Jennifer O'Toole channeled her autistic ‘hyperfocus ‘ into dieting and body image. “I used to have a spreadsheet of how many calories, how many grams of this, that and the other “ She became anorexic anorexia and had to be hospitalized when she was 25.
Over to you… Why is it difficult for girls with ASC to develop their social understanding skills despite having greater social abilities than boys?
Overlooked • • Dr Lorna Wing (triad of impairments) Psychiatrist who devoted her career to studying autism. Susie, her daughter, diagnosed with autism. She says girls on the autistic spectrum often appear "normal" at first meeting. "They appear to be more social than boys with autism, but then you notice that their sociability tends to be inappropriate, they might go on and on talking about the things they are interested in, and they fail to notice that you're not remotely interested. They have a poor ability to 'read' people, and that's something that's often very highly developed in females. "
Puberty • It is not until puberty that girls’ social difficulties become more obvious, particularly as they enter secondary school. • Unlike boys, they become withdrawn, depressed and quiet, rather than aggressive. • Some girls become school refusers. • Profound anxieties may be demonstrated in altered behaviours, lower grades at school, poor sleep patterns, low mood/depression and obsessive behaviour.
Sensitive Issues • Menstruation • Physical changes – growing hair, spots, keeping clean, body changes. • Masturbation http: //kidshealth. org/
Talking about puberty • Explain private/public Who they can talk to about any concerns they have? Which rooms are private and which are public?
Talking about puberty • Physical changes Photos of them/family members to understand changes Body outline – how they will change • Menstruation Reassurance Show sanitary products, place to keep them Calendar/App to track periods Social Stories
Talking about puberty • Hygiene
Relationships Social changes • Having a boyfriend/girlfriend • Liking someone differently to how you like a friend • Appropriate touch • Things that should be done in private. Katie Greenhalgh, age 16
Circles Concept can be used to visually demonstrate socially appropriate behaviour in different locations and contexts. This can be adapted to many situations.
The Underwear Rule The NSPCC and The National Autistic Society have joined forces and developed an autism-specific version of the popular resource. With research indicating that disabled children are three times more vulnerable to abuse, both the NSPCC and The National Autistic Society are encouraging parents to talk PANTS with their children to help keep them safe.
An "It is alright to" table lists people and activities, and asks, for example, whether it’s alright for two men to shake hands, whether it’s alright for a man and a woman to shake hands etc. A tick/cross or yes/no can be placed in each box depending on what the person thinks, or what the parent tells them.
The Hidden Curriculum
Strategies Social Skills • • Programs to improve knowledge of facial expressions. Understand the physical signs of feelings and attach names to those emotions. • • Help them make friends. Children with autism don’t pick things up indirectly so you have to break down the incredible complexity of girls’ social interactions and teach them explicitly. • Arrange girl-orientated social skills classes to address the hidden curriculum, the unwritten rules that other girls take for granted.
Develop social skills • Nurture Groups • Friendship groups • Girl groups • Life skills • Art Therapy • Drama clubs
Time to Talk (aged 4 -8) Socially Speaking (KS 1/2) TALKABOUT for Children (aged 4+) TALKABOUT for Teenagers TALKABOUT for Adults TALKABOUT Relationships (KS 2/3/4) SULP Infants SULP Juniors SULP Secondary LEGO Therapy (aged 3+)
Emotions Increasing an individual with an ASD’s awareness of their emotions has been shown to help them change and regulate these emotions (Matson & Sturmey, 2011). • Use situations that arise as opportunities to discuss emotions. For example, if the individual appears to be happy, discuss the emotion of happiness as the way you feel when something good happens or when you feel good inside. • • Practice identifying more common emotions, such as happiness, anger, fear, surprise and tiredness. Progress to more complicated emotions such as excitement, jealousy, trust, disappointment, love, embarrassment, and sympathy.
Rating scales
5 Point Scales
Strategies Regulating Emotions • Take a deep breath and continue to breathe at a slow, steady rate. Explain that this will help their body calm down. • Simple muscle relaxation exercises, such as progressively tensing and relaxing each muscle group in the body can also help them calm down. Explain that “doing these exercises will calm your body down - this will then help your brain calm down and you will feel better”. • Encourage to walk away from the object or situation that is distressing them, or find a quiet place to sit for a little while – this will allow them to escape excessive sensory information (e. g. too much noise, movement, language, etc. ) and the pressure of social interaction, which may cause or worsen their distress. • Doing something they enjoy, such as reading their favourite book, playing on the computer or taking a walk outside may improve their mood. Make a visual list with pictures of the activities your child enjoys – display this list somewhere so that the individual can refer to it when they need to.
Social Stories Be explicit! • • • Visual Predictable Describe an event or situation Other people may have a different opinion Provide strategies or scripts Motivating • Use stories to illustrate situations or events that can cause a particular emotion. For example, to illustrate happiness, create a social story about being happy: When something good happens to me, I feel happy. Some things that make me happy are (enter child’s favourite interests /hobbies/ activities/friends). When I feel happy, I smile and laugh.
Be explicit! Comic Strip Conversations • • Visual Gain the insight of the child Provides insight into how other people think and feel Develop strategies for next time
Strategies • • Buddying with older children in school who can offer social support and advice about social interactions. Appoint a peer mentor for each subject lesson to keep an eye on them in class. Things can so easily go wrong when the teacher isn’t looking. • Structuring breaks and lunchtimes for girls with ASD. • Close liaison with parents to understand if school is causing high anxiety which is being acted out at home (for example, with friendships issues) and discuss behaviours in school. • • Look out for bullying. Female bullying is extremely subtle and it can take girls on the spectrum a very long time to realise what is going on. Distinguishing between caring for friends and suffocating them is another skill that has to be explicitly taught. • •
Strengths • • Play to their strengths Find creative ways of weaving their special interests into the curriculum.
Already discussed: • • • Visual timetables Checklists Workstations Consider the environment Sensory strategies
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