Understanding Girls on the Spectrum
Girls on the spectrum often go unnoticed at school. They can appear well-behaved and compliant, not admitting to difficulties in understanding work so as not to be noticed or recognised as a different.
Autism is a lifelong neuro-developmental condition. It affects how a person communicates with, and relates to, other people and the world around them, but historically far fewer females have been diagnosed with autism than males, with the ratio standing at approximately one female for every four males since the early 1990s.
One of the reasons, is that primarily our understanding of autism spectrum disorder (ASD) is based on the profile and abilities and developmental history of boys and men on the spectrum.
Girls and women with ASD are different, not in their core characteristics but in terms of their reaction to being different – girls and women have so often successfully camouflaged their autism. Recently, a fascinating research study conducted in Scotland (Rutherford et al, 2016) showed prevalence rates across the genders and the findings indicate not only that the true prevalence of ASD in women is far higher than once thought, but also underlines that females are being diagnosed much later.
For adolescent girls, an initial diagnosis of a different condition is often made; particularly, social anxiety, ADHD, selective mutism, depression including bipolar disorder, gender dysphoria, obsessive-compulsive disorder, or anorexia nervosa (Attwood and Garnett, 2016)
When looking fine isn’t the same as being fine
Girls on the spectrum often go unnoticed at school. They can appear well-behaved and compliant, not admitting to difficulties in understanding work so as not to be noticed or recognised as a different. They are more likely to apologise and appease when making a social error and peers and adults may then forgive and forget, without realising that a pattern is emerging. They often suffer social confusion in silence and isolation in the classroom or playground. Girls develop specific coping and adjustment strategies by camouflaging or masking, but may be a different character at home.
‘I would rather be alone, but I can’t stand the loneliness.’
Professor Tony Attwood, a pioneer in the research of girls and women on the spectrum, speaks about how camouflaging can delay the diagnosis of autism. A delay in confirming the diagnosis will delay access to appropriate support networks and services for those who have autism. Research has also confirmed that camouflaging is associated with poorer mental health outcomes and is not associated with wellbeing (Hull et al. 2019). Camouflaging may contribute to high levels of anxiety and the development of clinical depression (Attwood and Garnett 2016). Psychotherapy needs to focus on the negative consequences of camouflaging, encourage self-acceptance, and facilitate ways to explain the characteristics of autism to friends and colleagues so that others can accommodate and appreciate those characteristics
Is a diagnosis really helpful?
- The damaging labels: Prior to receiving a diagnosis, many people project into the confusion of who they’ve been perceived as by others, including “weird,” “defective” and “psycho.” Each representing in loud clashing tones, “something is wrong with me.” Therefore, a diagnosis, can come as an enormous relief to discover that there is nothing “wrong,” much that is very right, and a lot that is different and beautiful.
- The missing piece of the jigsaw puzzle: The diagnosis can end the seeking and the confusion to the question of “Who am I?” There is suddenly a literature-base, research findings and fascinating facts to answer lifelong questions.
- Finding your Tribe: Embracing neurodiversity provides acceptance and understanding, especially amongst those who intimately know the reality of living with neurological difference. Once a person identifies with being on the spectrum, they can learn from others in their tribe about how to cope with other people’s ignorance, sensory issues and emotional dysregulation amongst other things.
“Being aware of the diagnosis can assist the whole family, so that true understanding, non-judgmental acceptance, accommodations and empathic attunement can occur.”
As Professor Tony Attwood says: “It is my experience that our young girls on the autism spectrum need to know about their difference as early as possible in a factual, celebratory and empathic way to allow them to grow into and appreciate who they are, instead of living by their own and others’ ignorant judgments”. For more information, visit www.bellavista.org.za
References
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington, DC: American Psychiatric Association.
Attwood and Garnett (2016) Exploring Depression, and Beating the Blues: A CBT Self-Help Guide to Understanding and Coping With Depression in Asperger’s Syndrome. London: Jessica Kingsley Publishers.
Rutherford, M., McKenzie, K. and Johnson, T. (2016) “Gender ratio in a clinical population sample, age of diagnosis and duration of assessment in children and adults with autism spectrum disorder.” Autism 20(5), 628-634.
https://attwoodandgarnettevents.com/2019/12/12/understanding-girls-on-the-spectrum-by-prof-tony-attwood-and-dr-michelle-garnett/. Accessed on 21/09/2021
