In the clinic we do a lot of assessments of autism spectrum disorder and many of those are for girls. As you may know, autism occurs less in girls than boys – however, I sometimes wonder if ASD is less frequent in girls or just less diagnosed because of the difficulties in identification. Not only is most information on the internet more representative of boys, but the assessment tools that we use as professionals to diagnose autism, are also more geared towards boys, which makes the whole process even more challenging! 

Autism often looks very different in girls when compared to boys and this can result in either a misdiagnosis or missed diagnosis. Girls can be misdiagnosed with difficulties such as Attention Deficit Hyperactivity Disorder, OCD or social anxiety when in fact, they are on the autism spectrum. Due to this, we at The Insight Centre decided to do a blog series about autism and girls. This post will be focused on communication and a list of up comings posts can be found below.

Just a quick note first – No two girls with ASD are the same, and the following information is not trying to over generalise and may not represent all girls however, we hope it is helpful.

Communication

Intellectually able girls with ASD often integrate better than boys with ASD. Girls can be very capable in that they can often imitate social behaviours and follow scripts, and it is these skills can camouflage their difficulties. Challenges in communication may only become apparent as a girl gets older. This is in part due to relationships becoming more complex and difficult to read. Also, the content of conversations change and become more focused on interpersonal topics, which can be a challenge.

The style of communication of girls with ASD may not be obviously unusual or different. However, there can be subtle differences. Often girls can sound more wise or mature than would be expected when considering their emotional regulation skills, social understanding and behaviour. This can be due to advanced language skills or in part due to the difficulties that they experience instinctively knowing how to have conversations and interactions. To manage same, intellectually able girls can watch others and rote learn or mimic phrases that then allow them to engage. These can be from adults, their parents, the TV or their peers and can lead to girls using phrases that would not be in line with their general style of communication or their overall maturity, and it is this that makes them stand out. 

 

Many of the parents I’ve met described their daughters as being socially vulnerable, naive and trusting.  This often stems from a difficulty in foreseeing the consequences of their own and others actions in social and practical terms. This then impacts their ability to know how to act appropriately and to know when others are not acting appropriately. This difficulty, and challenges reading social rules and norms can also result in a reduced awareness of social hierarchy. As a result, girls and boys with ASD may not change their style of communication when talking to people such as; their teachers or parents. So this is another subtle difference that may be present. However, always remember that this is not because the young person is being rude or “bold” but instead, because they do not fully understand the expectation or need to change their style of communication.  

Non-Verbal Communication

Girls with ASD often have strengths in terms of their non-verbal communicative behaviours and imagination. For example; for a lot of girls, they use a higher level of gesture and eye contact. This can go against what people expect from a child with ASD and again, can mask their challenges. However, while they may use many gestures and eye contact, the quality of these can be impacted. For example; gestures can be exaggerated (i.e. “dramatic” or “over the top”) or stilted. In relation to eye contact, subtler difficulties can, but may not always, be present for example; gaze may not be sustained or is held for too long. Eye contact may be delivered on an inconsistent basis, or children can look just past your eyes or at shoulder level. Such challenges can be tricky to pick up on, unless you look for them. 

There is also a myth that all children with ASD speak with an accent (for example; British or American) and while this can sometimes be true, it’s not always.  For some girls, it is not an accent that stands them apart from others but instead it’s, the rise and fall or modulation of their tone for example; speaking in a childlike tone, or speaking very quiet or very loud.  Again, such difficulties can be subtle and may be missed.  

Conversation

An area of difficulty for some children is their ability or desire to make ‘chit-chat’ or meaningless exchanges. This is not to be confused with making chat about things of interest (which can often be strength), this instead, relates to talking about mundane topics due to a desire to be involved in a chat with another person. As adults, we tend to ask children lots of questions; for example, “How was your day? What did you play in yard? Did you have fun at the party?” etc. Sometimes, we don’t expect children to give more than a short answer, so we accept answers such as “I dunno”, “Fine”, “Yeah”, “No.” Thus, a girl’s (or boy’s) difficulty with expanding in conversation or offering more information may not be apparent in day-to-day exchanges with children, but still may be present. 

The ability to engage in chit-chat can be leant  however, for girls (and boys) with ASD, these skills are not naturally acquired and so, their ‘chit-chat’ may seem disjointed and / or unnatural. Also, despite having some skills in this regard, they are not always used. Conversations may not be maintained unless it’s a topic of interest. A child recently said to me “I know I should [talk about a persons experiences or interests], and I really try but I’m just not interested, so I can’t stay focused when they speak”. This can represent a challenge for girls (and boys) especially when they get older as the focus of interactions can involve more chit chat. However, worry not as these skills can be taught and a blog post will follow about how you can help on a day-to-day basis. 

Another difficulty can be topic maintenance – that is keeping with the flow of the conversation. Girls and boys with ASD can find it hard to go along when others are leading a conversation. You may notice that they appear disinterested or that conversations don’t go on for as long, as they do when the young person is talking about an interest of theirs e.g. animals, princesses, anime, pop stars, political figures or just a specific friend. Girls (and boys) with ASD may not seek information from the listener during the conversation and so it can feel one-sided. This may not be apparent during conversations with adults as we tend to allow children to lead. When such challenges are present (which is often) if is not due to them being rude, it is actually most likely that the young person does not fully understand the need for give and take in conversation, and so it needs to be explicitly taught. 

 

Often, girls (and boys) with ASD do not want to spend lengthy amounts of time discussing serious topics or feelings. Instead, they prefer to spend shorter periods discussing or doing things of common interests, which can result in interactions not being consistent or sustained. The young person may approach and remain with a group for small amounts of time, having small chats before leaving and spending time on their own. Again, this can represent difficulties in children being identified as needing assessment. Myths that children with ASD don’t interact or do not desire friendships or interactions can act as a barrier in detection, as this is often not the case. 

Often, the difficulties that girls with ASD experience can be hard to get a sense of and this is due to their ability to mask their challenges. Sometimes the best way to know is to talk to the young person directly about how they find interactions with others. The important thing to get a sense of is how the young person is acquiring their social communication skills – is it natural for them or it is something that they really have to work at? Are they literal and do they understand the subtle differences in communication for example; when someone is being sarcastic or serious? 

However, always remember that difficulties in communication in isolation does not mean autism spectrum disorder! More information about the other difficulties inherent in ASD will be provided in this series but if you are concerned, contact the clinic or your local psychological service.  

I hope you found this helpful and below is a list of upcoming blog posts. If there is something else you would like covered just let us know – we are always looking for feedback! 

Coming Soon … 

·       Friendships and Relationships in girls with ASD

·       How to help social understanding and development of friendships in girls who have a diagnosis of autism spectrum disorder

·       Autism, Girls and Play Development

·       Emotional Regulation and Autism Spectrum Disorder

·       What to do to help develop emotional regulation and emotional literacy in children with ASD

·       Looking at how restricted interests, repetitive patterns of behaviour, interests or activities manifest in girls who have a diagnosis of autism spectrum disorder. 

 

Written by Dr Stacey Ball, Clinical Psychologist and Laura Patterson, Assistant Psychologist, The Insight Centre