Barbara, a Highly Specialist Clinical Psychologist, with over a decade of experience in the NHS, schools, and private settings, brings a wealth of expertise to her work at CAYP Psychology where she supports children and young people both in the North of England and online. Specialising in neuropsychology, neurodevelopmental disabilities, and behaviours that challenge, Barbara is passionate about addressing the unique presentation of autism in girls. In an interview with Ruby Cole, Assistant Psychologist at CAYP, Barbara shared her insights on this important topic.
How Autism Presents in Girls
Barbara began by sharing how girls who have autism often show distinct signs that set them apart from the stereotypical traits of autism, she went onto explain that one key difference lies in language development. Unlike many children with autism who experience language delays, girls are less likely to have these delays and may even develop language skills that seem advanced for their age.
Barbara noted, “Many parents describe their daughter as a ‘little old lady,’ due to how articulate and mature she seems in her speech.” In some cases, the child may appear to speak fluently overnight, despite initially not attempting much verbal communication. Here, the parents report a sudden shift, where the child goes from being almost silent to speaking as though the words had always been there.
When it comes to play and interests, girls who have autism often have more socially typical interests compared to the more stereotypical interests often seen in children with autism. These interests may seem more typical, but the intensity with which they pursue these activities can be a distinguishing feature!
Barbara further shared that regarding social interactions, girls may form intense one-on-one friendships, often transitioning from one close friendship to another. Where fallouts between friends are common, which contribute to social difficulties that may not be immediately apparent.
Why Autism is Often Underdiagnosed in Girls
When discussing why diagnosis in girls in less common, Barbara noted a few reasons. Firstly, girls can “mask” their difficulties as girls are often more adept at mimicking the behaviours of their peers and adapting to social expectations, making their challenges less visible. Barbara explained, “Girls with autism may engage in socially acceptable activities and adapt their behaviour to fit in, which can delay or prevent a diagnosis.”
Additionally, girls who are shy or who may be perceived as “bossy” can have their social difficulties overlooked. These behaviours are often misinterpreted as personality traits rather than signs of underlying struggles with social interactions.
During the interview, Barbara touched on the biases in neurodiagnostic assessments. Many diagnostic tools used to assess autism are based on male-dominated data, which makes them less sensitive when it comes to detecting autism in girls who mask their difficulties. “Clinicians are now more comfortable relying on their clinical judgment and experience when working with girls,” Barbara stated, recognising that rigid diagnostic tools can fail to capture the nuanced presentation of autism in girls.
Common Misconceptions About Autism in Girls
There is a misconception that autism is more prevalent in boys, with the commonly cited ratio of 4:1. However, this misconception is rooted in the historical under-diagnosis of girls, said Barbara. Due to the ability of girls with autism to mask their difficulties, their struggles often go unnoticed until later in adolescence, when social and academic demands become overwhelming. “Once these demands increase and the masking becomes too exhausting, girls may experience greater distress, which can lead to a breakdown,” Barbara further noted. This can result in a variety of misdiagnoses, with girls receiving labels for anxiety, depression, or other mental health conditions, without the underlying autism being identified.
Supporting Girls Who Have Autism
Barbara emphasised that providing support for girls who have autism requires awareness and understanding. “The first step is ensuring that those around them -including families, teachers, and peers recognise the unique ways autism can manifest in girls,” she explained.
Adapting the environment, particularly in school and work settings, is essential. These adaptations do not have to be unique to girls but should be tailored to the needs of everyone. “It is not about thinking outside the box, “It’s about forgetting the box altogether,” Barbara advised, urging a flexible approach to best support neurodivergent young people.
Encouraging girls to connect with neuro-affirming communities is crucial for reducing isolation and building confidence is key. Finding a supportive community where they feel accepted can have a significant positive impact on their emotional wellbeing. At the same time, it’s important to respect their boundaries and allow them to say “no” to situations that feel overwhelming, while still ensuring opportunities for positive social engagement.
Co-occurring Conditions in Girls with Autism
Barbara further shared that girls who have autism are at higher risk of experiencing co-occurring mental health conditions such as anxiety and mood disorders. This is because these difficulties are often compounded when appropriate adjustments are not made following the autism diagnosis. “If mental health conditions are not considered separately from autism, it can result in a misdiagnosis or misunderstanding of the full scope of an individual’s needs,” Barbara explained.
Barbara emphasised that therapeutic support should be tailored to meet the unique needs of neurodivergent individuals. Conventional therapeutic models may not be as effective with girls who have autism. Models such as Compassion Focused Therapy (CFT) and Acceptance and Commitment Therapy (ACT) offer approaches grounded in scientific understanding and may be more accessible for neurodivergent individuals.
Fostering Strengths and Independence
Lastly, Barbara advised that in supporting girls who have autism, it’s crucial to build on their strengths while also ensuring they feel understood and supported. “Encouraging girls to take pride in their unique abilities and fostering an environment where they feel accepted is key to nurturing their self-worth,” she concluded. With the right understanding, support, and interventions, girls with autism can thrive, feeling empowered to navigate the world in their own way.
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