Supporting autistic girls in schools

Autism has traditionally been viewed as a condition predominantly affecting boys, and therefore autistic girls are not being sufficiently identified. Gould and Ashton-Smith (2011) recognise that autistic girls are broadly misdiagnosed and underdiagnosed, and although the male-to-female ratio has narrowed significantly over the years (currently 3:1), a recent meta-analysisA quantitative study design used to systematically assess the results of multiple studies in order to draw conclusions about that body of research of prevalence studies by Loomes et al. (2017) found that ‘There appears to be a diagnostic gender bias, meaning that girls who meet the criteria for ASD are at disproportionate risk of not receiving a clinical diagnosis’ (p. 466).

Identifying autistic girls can sometimes be difficult, and where teachers have concerns it is important to work with professionals to identify and design strategies as part of whole-class teaching. It may be particularly challenging to recognise autistic girls, who often display more subtle signs of autism and can camouflage their difficulties to fit in with peers. Headteacher Sarah Wild reiterates this, stating that ‘when unhappy, girls will implode emotionally’ (Neustatter, 2015).

Autistic girls, whether diagnosed or non-diagnosed, can face many barriers to gaining a suitable education. But with greater understanding of these issues, professionals can have a positive impact on the experiences of this minority group, helping them to achieve greater success academically. Some of the barriers that autistic girls experience in educational settings include:

• having to process language (which depletes energy levels and can affect sleep)
• speech and language differences
• having to navigate social situations
• having to adapt own behaviour (camouflage) to fit in with peers
• being expected to be sociable by others (during structured and unstructured times)
• coping with the impact of environmental stressors, which can lead to overload
• not being taught certain concepts explicitly
• problems relating to social understanding
• difficulties coping with change and transition
• not understanding how to self-regulate
• not being able to understand or express feelings
• being misunderstood by peers and staff.

Many autistic girls experience mental health issues. Van Steensel et al. (2011) highlight that autistic children and adolescents are at ‘increased risk of anxiety and anxiety disorders’ (p. 302). One source of anxiety is change, as it brings uncertainty. We know that all autistic girls are unique and that their ability to cope with different kinds of change and transition will vary. But some girls will need additional support to understand the physical changes taking place in their bodies as they develop during puberty. Some may have sensory issues or phobias that can exacerbate their difficulties. Students can learn that change is a gradual process and this can be taught using visual aids, helping to allay fears.

Professionals can help their autistic students to experience reduced anxiety, and ultimately help them to learn, by:

• using visual timetables and lesson schedules to provide them with routine and predictability throughout the school day
• using photos and itineraries in preparing students for enrichment days or school trips
• being concise by minimising the amount of language used
• breaking up work into smaller chunks so that students do not feel pressurised
• considering the impact of factors within the learning environment such as noise, lighting, smells
• providing structure to the learning environment through an organised classroom with areas designated for specific tasks
• displaying a positive, non-judgemental attitude, as many autistic students will worry about making mistakes and may not attempt tasks for fear of doing something wrong
• being flexible in their approaches, respecting that autistic students may have different needs from their non-autistic peers
• presenting concepts visually or through demonstrations
• providing lists with visuals
• using Comic Strip Conversations and Social Stories (Gray, 1994, 2015) to aid understanding, of social situations in particular
• using humour
• helping students to recognise factors that lead to overload
• exploring personalised strategies to help students to regulate themselves, whether under- or over-stimulated
• allowing students to work independently if they prefer.

There are many self-regulation strategies and resources that can be implemented in schools. The Alert Program (Williams and Shellenberger, 1996) and The Zones of Regulation (Kuypers, 2011) are two programmes that some schools use. Specialist advice can also be offered by occupational therapists.

Each student is unique, so it’s often useful to seek the views of the individual, who might be able to suggest which approaches may work best for them. Others will require a greater level of support to explore self-regulation strategies, and working with students to help them understand and express feelings can be beneficial.

Story-writing, poetry, diaries, drawing, exercise, sport, music and drama are just some of the successful outlets for self-expression used by many of the autistic girls that I’ve worked with. Having time to pursue intense interests will allow girls to self-regulate, enabling them to focus on learning.

During unstructured times, some autistic girls will benefit from taking part in activities alongside others that require minimal social communication, such as learning a musical instrument or taking part in a sport. Activities such as these help girls to gain a sense of belonging, leading to increased wellbeing (Relojo-Howell, 2017). Structured break and lunchtime activities provide routine and sameness, helping students to feel calm. Some girls will prefer to be alone and others will enjoy pursuing their own interests independently, as this allows them to ‘recover’ from social interaction or sensory overload.

Although teaching self-regulation strategies can help autistic girls to feel more comfortable in the school environment, educators can further support autistic girls by reflecting on their own practice and by viewing the school environment from the perspective of the student. Professionals can consider, for example, whether their instructions are clear and concise, whether students have routine and predictability in their lessons and how the learning environment might impact on learning. A review of whether the current curriculum is meeting the needs of a diverse range of learners can also be beneficial for autistic students, especially for autistic girls, who can often lack skills in being assertive. What autistic students need to be taught can differ from that of their non-autistic peers. Some skills need to be taught explicitly, and this can be achieved through a life skills curriculum. One of the most important lessons that autistic girls can learn is how to keep themselves safe.

Research by Sedgewick et al. (2018) highlights how autistic people can be more vulnerable to abuse than neurotypical people. Therefore, we must adapt many aspects of the curriculum, including relationship education, relationship and sex education, and health education, giving consideration to what we teach and how we teach it, and enabling schools to effectively safeguard this group of learners.

Autistic girls may be at risk of exploitation and abuse because they:

• may have difficulty reading between the lines
• might understand language in a literal way
• may not understand the intentions of others
• can sometimes be socially isolated
• may find it difficult to generalise across situations
• may be unaware of risk or danger because they lack the ability to predict what might happen.

As autism affects social communication and interaction, girls can benefit from learning how to manage a range of social situations, and be explicitly taught topics such as consent, healthy and unhealthy relationships, appropriate touch and feelings. Some autistic girls may also find it difficult to understand gesture, read facial expressions or body language, or understand the physical sensations that occur when experiencing emotions. In contrast to the stereotype of the autistic person who does not have feelings, there are many autistic girls who experience intense emotions, often drawn in by the plight of others, making them more vulnerable to exploitation. Where possible, we should teach these girls to be assertive and to question the actions of others.

Schools can help autistic girls to develop a strong sense of identity by providing opportunities to explore how autism affects them, thereby supporting them in becoming more self-aware of their strengths and challenges. We must have high expectations for these girls but provide the adjustments in their learning environments to ensure that they succeed.

Autistic girls are often in the minority, so it’s important to make these students aware that they are not alone by celebrating autistic female role models in society. Involving autistic girls in research can also help to address the gender data gap that currently exists. Where schools actively promote the value of diversityThe recognition of individual differences in terms of race, ethnicity, gender, sexual orientation, socio-economic status, physical ability, religious beliefs and other differences, autistic girls will feel able to be themselves and will thrive.

References

Gould J and Ashton-Smith J (2011) Misdiagnosis or missed diagnosis: Girls and women on the autism spectrum. Good Autism Practice 12(1): 34–41.

Gray C (1994) Comic Strip Conversations. Texas, USA: Future Horizons Inc.

Gray C (2015) The New Social Story Book. Texas, USA: Future Horizons Inc.

Kuypers L (2011) The Zones of Regulation: A Curriculum Designed toFoster Self-Regulation and Emotional Control. London: Think Social Publishing.

Loomes R, Hull L and Mandy WPL (2017) What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry 56(6): 466–474.

Neustatter A (2015) Autism is seen as a male thing – but girls implode emotionally. The Guardian, 14 July, 15. Available at: theguardian.com/education/2015/jul/14/autism-girls-emotion-self-harm-school (accessed 20 November 2019).

Relojo-Howell D (2017) Low sense of belonging at school causes young people to self-harm. Available at: www.psychreg.org/low-sense-of-belonging-school-self-harm (accessed 24 October 2019).

Sedgewick F, Crane L, Hill V et al. (2018) Friends and lovers: the relationships of autistic and neurotypical women. Available at: researchgate.net/publication/328555805_Friends_and_Lovers_The_Relationships_of_Autistic_and_Neurotypical_Women (accessed 10 January 2020).

Van Steensel FJ, Bögels SM and Perrin (2011) Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review 14(3): 302–317.

Williams MS and Shellenberger S (1996) How Does Your Engine Run? A Leader’s Guide to the Alert Program for Self-Regulation. Albuquerque: TherapyWorks