Welcome to Allied Health Telehealth Virtual Education

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1 Welcome to Allied Health Telehealth Virtual Education Girls on the autism spectrum Rebecca Sutherland Senior Speech Pathologist Child Development Unit Children s Hospital at Westmead Please complete your online evaluation at Girls on the autism spectrum Please complete your online evaluation at 1

2 Understanding of autism over time Possession by devils feral children Holy fools Rain man Autism changelings mental illness Sherlock Holmes Mr Spock From: Autism Spectrum Australia DSM IV criteria Communication Autistic disorder Asperger syndrome PDD NOS Social Interaction Repetitive behaviours/ interests Please complete your online evaluation at 2

3 DSM 5 released May 2013 Two main changes Diagnostic labels Diagnostic criteria Please complete your online evaluation at 3

4 Diagnostic labels DSM IV Autism Spectrum Disorders Autistic Disorder Asperger s Disorder PDD-NOS/ Atypical Autism DSM 5 Requiring very substantial support Autism Spectrum Disorder Requiring substantial support Requiring support Persistent deficits in social communication & social interaction across contexts Restricted, repetitive patterns of behaviour, interests, or activities Autism spectrum disorder Symptoms must be present in early childhood (but may not become apparent until social demands exceed limited capacities) Symptoms together limit and impair everyday functioning Positive Partnerships 2013 Please complete your online evaluation at 4

5 Screening & red flags Wetherby et al. (2004) Screening lack of appropriate eye gaze lack of warm, joyful expressions with gaze e.g. smiling at caregivers lack of seeking to share enjoyment or interest with others lack of response to name lack of coordination of gaze, facial expression, gesture, and vocalisations when communicating with others lack of showing objects of interest to others unusual prosody repetitive movements or posturing of body, arms, hands, or fingers engaging in repetitive play with toys or objects lack of response instructions, even with contextual cues lack of pointing delay in playing with a variety of toys conventionally Wetherby et al. (2004) Please complete your online evaluation at 5

6 Prevalence ASD Stuttering CP Down Syndrome TBI Gender ratios lower IQ higher Please complete your online evaluation at 6

7 Why the difference? Boys and girls may differ in their presentation, potentially making the detection of girls more difficult but research has not found a consistent pattern (Dworzynski, Ronald, Bolton, & Happé, 2012; Kirkovski, Enticott, & Fitzgerald, 2013; Lai et al., 2012). What are the differences? More Similar Similar social and Worse More More repetitive rates communication Similar of core behaviour repetitive skills, differences communication anxiety movements in symptoms? in RRB? in girls? in boys? in behaviours? boys? (Hartley & Sikora, 2009; Kirkovski et al., 2013; Holtmann, Bölte, & Poustka, 2007; Mandy et al., 2012; Van Wijngaarden Cremers et al., 2014; Harrop, Gulsrud, & Kasari, 2015). Please complete your online evaluation at 7

8 It appears there is an on going need to develop awareness and skills among education practitioners to recognise and support the specific needs of female students with ASD. (Baldwin & Costley, 2015) Recent Australian research Please complete your online evaluation at 8

9 171 parents of girls 163 parents of boys 75% primary school age Girls more likely to be in mainstream without support 7% home schooled 77% primary school age Boys more likely to attend a support class Similar numbers of boys and girls in SSPs Please complete your online evaluation at 9

10 Diagnosis Girls are much more likely to be diagnosed by a psychiatrist (8% vs 2%, p= 0.02) There was a trend (p=0.08) towards parents of girls completing the survey when their daughters didn t have a formal diagnosis * Mainstream without support Mainstream with support * * * Support class in mainstream school School type Special school (e.g. SSP, autism school) Home school Boys Girls Please complete your online evaluation at 10

11 Communication Talkative, chatty Good language/ vocabulary Communicates well with familiar people Communicates well if interested in the topic * girls boys Communication Likes talking with others Non verbal To the point girls boys Please complete your online evaluation at 11

12 10% limited verbal skills High literal understanding (71% boys, 68% girls) Boys significantly more likely to prefer to talk about their own interests Girls were blunt or too 50% poor eye contact honest significantly more than boys Social No differences found on any question about social strengths or difficulties Majority of boys and girls were better in 1:1 About half of all boys and girls had 1 or 2 special friends, more than half kind to younger children 10% described as popular Please complete your online evaluation at 12

13 * Interests boys * * * * * * * * 0 Please complete your online evaluation at 13

14 Impact of different interests Girls interests may be overlooked by diagnosticians, because they do not conform to the typical male presentation. There is a need to look at intensity rather than type of interest (Frazier et al., 2014; Solomon, Miller, Taylor, Hinshaw, & Carter, 2012). Please complete your online evaluation at 14

15 No differences in any seeking or sensitivities except: High levels of sensitivity to sound (80+%) and touch (50+%) in both girls and boys Sensory Girls were more sensitive to taste (e.g. preferred bland diet) Low numbers report seeking smell or sound (around 10%) for both girls and boys Smith Myles et al 2000, Asperger Syndrome and sensory issues: Practical solutions for making sense of the world. Shawnee Mission, KS: AAPC Repetitive behaviours Please complete your online evaluation at 15

16 Other observations Both boys and girls frequently described as more comfortable at home More frequent mentions of anxiety for girls than for boys Many more parents describe girls as being conscious of difference and/or showing explicit effort at school to manage (not mentioned for boys) Outside the home she fears her misinterpretations of social communication and in turn avoids it She tries hard at school holds everything together then meltdowns when (she) gets home She has become expert at pretending there is no problem to avoid teachers finding out there is Tries hard not to let people see her difficulties She is worried about not being normal and saying things that make her seem different or strange Please complete your online evaluation at 16

17 Camouflage This observation may give some support to the research findings that females on the spectrum may mask or camouflage their difficulties This possibly makes diagnosis less likely and support services less forthcoming for some girls (Lai, Lombardo, Auyeung, Chakrabarti, & Baron Cohen, 2015; Lehnhardt et al., 2016; Tierney, Burns, & Kilbey, 2016; Baldwin & Costley, 2015). In Summary The similarities in social skills was surprising in this study Communication strengths and difficulties were also similar, with some exceptions Some differences in repetitive behaviour types but not frequencies The interests shown by boys and girls were very different Girls much more frequently described as anxious Girls more often described as trying to manage or hide their ASD Please complete your online evaluation at 17

18 Autism is prevalent Girls can have autism but may seem different to boys on the spectrum Thorough history from the parents is important girls may present differently at home compared with school/clinic Don t dismiss parent (or your own!) concerns contact relevant services and refer on. Take home messages Please complete your online evaluation at 18