ASD and Girls

In the TV comedy programme The Big Bang Theory, two of the main characters portray a man and woman, both who have Aspergers Syndrome.

The main male character, Sheldon, is a highly intelligent university physicist with a girl friend called Amy, who is a brilliant neurobiologist.

The big difference between the characters however is how they interpret their relationship.

Sheldon sees Amy as a special friend who happens to be a woman. While Amy refers to Sheldon as her boyfriend and would like to introduce the emotional and physical elements associated with such a relationship. Unfortunately, Amy lacks the necessary social skills to communicate this effectively to Sheldon, thus leaving them in a state of friends “without” benefits.

Aspergers Syndrome is part of the Autistic Spectrum Disorder (ASD) in which the key traits are usually described as difficulties in Social Interaction, Social Communication and Social Imagination.

This article aims to highlight a crucial issue in that due to the different tactics used specifically in terms of social relationships many girls with ASD are not identified unlike their boy counter parts.

Due to their ability to mask some of these traits many girls slip through the net especially at primary school.  Thiscan result in major consequences both in terms of diagnosing the condition and the negating the prospect for early interventionto prepare girls for the more complex social challenges in the teenage years.

Research by Lorna Wing in 1981 showed a ratio of 15 to 1 in the diagnosis of Aspergers syndrome between boys and girls. This suggests the tendency for both teachers and other professionals working with children and young peopleto mistake or overlook some of the signs and symptoms in girls.

Holtman et al (2007) outlinesclearly that girls present differently from boys with ASD in the 3 key areas of of Social Interaction, Social Communication and Social Imagination.

Social Interaction

• Boys with ASD tend not to appear motivated to be socially interactive, but by contrast girls are generally more motivated to be socially interactive.  However, girls tend have a history of failure in achieving and maintaining friendships.
• Girls often gravitate towards older girls, who tend to mother them and act as a form of social “protection”.
• Girls may be socially immature and make a preference to play with much younger children who are not challenging and would therefore allow the child with ASD to dominate play, giving them the predictability and control that children with autism crave.
• Girls with ASD may “adopt” a less able peer, perhaps someone with a learning difficulty, who may themselves be marginalized, so they are open to being dominated by the child with ASD.
• Girls with ASD may be unnecessarily dependent on their mother, or other primary carer, who they regard as their best friend and confidante in a social world which they find challenging and frightening.

Social Communication

• Boys engage in disruptive behaviours, whereas girls may be persistently “ill” to gain what they want or to better control their situation.
• Girls with ASD tend to act passively and ignore daily demands, while boys become disruptive in response.
• Girls appear more able to concentrate than boys, who become distracted more easily and can be disruptive.
• Girls tend to learn social behaviours by observation and copying, which can disguise their social deficits.
• Girls may find the idea of social hierarchy difficult, so they can respond inappropriately to people in authority, such as teachers.
• Children with ASD of both sexes need to learn the rules of “small talk” which they often find incomprehensible as a pastime. Girls’ difficulties tend to be masked by their passive behaviours and ability to mimic without understanding.
• Parents may perceive their daughter with ASD as being non-specifically “odd”, but without being able to pinpoint the cause.

Social Imagination

• Imaginative play does exist, but it is intense in nature, often focused on stereotypical female interests, such as dolls, make-up, animals and celebrities, which is why girls with ASD may not seem that different to females who are not on the spectrum. The key is the intensity and quality of these special interests, which are exclusive, all-consuming and experienced in detail.
• Children with ASD can engage in repetitive questioning well beyond the age that those who are not on the spectrum. They can exhibit poor empathic skills and a lack of social interest.
• They can also seem disinterested in the classroom and exhibit immature, impulsive and unusual behaviours. An inability to “move on”, even with basic matters, can be common.  An example of this could be the child not being happy to throw away old toys or clothes which the child has long since grown out of. This “cluttering” behaviour can outline their difficulties with change per se. While such types of behaviour may be common to both sexes, the ways in which they present can be different for boys and girls.

In addition,there are the following issues to be considered:

• Girls on the autistic spectrum may be less noticeable than boys because they are less disruptive and have an ability to mimic behaviours.(Attwood, 2012)
• They lack social understanding and any deep knowledge of language and this becomes increasingly obvious at secondary school level, when there are no younger children to associate with and when peer groups are more mixed ensuring thatany “protection” has dissolved.
• Additionally, multiple stimuli (crowds in corridors or screams in playgrounds) and changes to routineswhich occur at secondary education levels can increase individual anxiety greatly, however, the best cbd oil companies are producing the best treatments to deal with anxiety.
• Adolescence, including menstruation and the growth of breasts and body hair, can profoundly affect girls with ASD leading to heightened anxieties due to lack of control over what is happening.

Anorexia nervosa has been referred to as “female Asperger’s” because around one fifth of girls who present with anorexia have traits which are consistent with features on the autistic spectrum. Approximately 20 to 30 per cent of anorexic patients are perfectionists and demonstrate rigid modes of thinking and behaviour, which are common autistic traits.
It is not until puberty that girls’ social difficulties become more obvious, particularly as they enter secondary school when they can become the subject of bullying or can be generally marginalised and perceived as strange. Unlike boys, they become withdrawn, depressed and quiet, rather than aggressive.

Profound anxieties may be demonstrated in altered behaviours such as lower grades at school, poor sleep patterns, low mood/depression and obsessive behaviour.

Recent research found that many women who were later diagnosed as being on the autistic spectrum were initially thought to have learning difficulties, personality disorders, obsessive compulsive disorder or eating disorders (Rivet and Matson, 2011). This differential diagnosis could be related to a lack of awareness of how ASD presents in females.

In summary more research is essential to identify features of ASD in girls and to train health and teaching staff about presentations in females. Diagnostic tools must be adapted to incorporate gender differences and ensure that scores attributed to behaviours include the range of symptoms in girls. Observation of girls in the social setting of school, paying close attention to friendships, is vital for diagnosis. Seeing how girls manage during unstructured time is also telling, since those with Asperger’s have difficulty identifying how to fill the time and do not enjoy the freedom but are lost and anxious.

As a result some options for support may include

• Use of visual timetables or other visual aids to underpin communication and increase predictability
• Emphasis on visual and sensory play for younger children
• Occupational therapy input to address any sensory issues and enhance coordination and muscular-skeletal abilities
• Programs to improve knowledge of facial expressions and understand the physical signs of feelings and attach names to those emotions
• Social programs, involving exercises and language games, performed by small groups of children with ASD
• Buddying between individual children with ASD and older volunteer children in school, who can offer social support and advice about social interactions

There is one episode of the Big Bang Theory  where Sheldon tries to explain to Amy that other people find her a little strange while completely not realising he is explaining many of his own traits to her. Amy for once does exhibit an accurate social expression of incredulity before slamming the door in Sheldon’s face.

Sheldon walks away and says to himself,”Poor kid she just doesn’t get it”.

In terms of girls with ASD, I am not sure “we get it” ….we need to do better.

Fin O’Regan
www.fintanoregan.com