When Did You Know That O Was On The Spectrum?

I'm asked on a fairly regular basis, when did we know that O was on the spectrum?

And the truth is, that we really didn't know. Unlike L, who we knew was a different child from the moment he arrived, there was nothing that stood out with O. Nothing that stood out to us as parents that said O was on the spectrum.

As a baby and toddler, O hit all of her milestones much earlier than most of her peers. She sat by herself at the age of 4 months, she started talking at the ripe old age of 10 months - her first words were Mum, Dad, S%#$ and then Bull#%$@, in a Polish accent! O started walking at 11 months. In most of the developmental areas, O was like any other typically developing baby, toddler and young child. She was constantly on the go and loved to spin. All the time!

The only unusual trait that stood out to us when O was a toddler, and as a young child, was that she appeared to sit back and observe the world around her especially when it came to learning a new skill. We used to say that it was as though O was sitting back and taking everything in, then she'd get up and have mastered the skill immediately. There really wasn't any practicing skills before O mastered them.

O was an overly anxious child from a very young age but we put her anxiety down to separation anxiety. At that point in time, we knew of several other families whose children were also quite anxious. O did have some speech difficulties with the pronunciation of some sounds but as she'd also had numerous ear infections and needed grommets inserted, her speech difficulties were put down to missing key developmental hearing stages.

Her level of intelligence became clear very early on. In Western Australia, children start in Kindergarten at school when they are three. O was certainly more than ready to start school at 3. She was writing her own name and composing the most imaginative stories and she was always asking questions about the world around her. She always wanted to learn new things.

I can vividly recall picking her up after school one day and on our way in tthe car, O piped up with "Mummy, I can count in threes." She then repeated the three times table. When I asked O who taught her to count in threes, O responded with "Oh I taught myself." O was three at the time. By the end of her Kindergarten year, her teacher was extending O's learning in class by giving her Pre-Primary work.

At the age of 5, O was writing short stories of her own. She was reading books years above her age level. O discovered our book of the Complete Works of Shakespeare and she would set herself up in our dining room with this book, the dictionary and her own notebook. She would read a section of the book and if she found a word that she didn't understand (which truthfully, there weren't that many words that she didn't understand) she would look the word up in the dictionary to find the meaning and then she'd write a poem about the word! 

We'd sit back in amazement at this child who always wanted to learn. She was always asking questions about the world around her and she was always so very articulate when speaking. She was like a mini adult. This should have been one of our first clues that O was possibly on the spectrum, but we were told that O was just a very bright child.

O was very particular about how things were done, everything had to be done in a set order. She didn't seem to cope with change all that well. But as we were struggling to get L's health issues seen to, we just put these down to O being affected by what was happening with L. Another ASD trait that we missed.

At the age of 5, O's anxiety worsened to the point that we sought medical advice. From talking to her school teachers and carers at the Outside School Hours Care that she attended, she was a completely different child for them, than she was for us. At school and OSHC, O was a polite, well mannered girl. 

At home, she struggled with her emotions, O would explode with frustration, she'd have over the top emotional reactions to almost everything. When we sought medical advice, we were told that O was just an anxious child, she was diagnosed with an anxiety disorder and our then GP wanted to put her on an anti-anxiety medication. When we took the script into our local pharmacist, she liaised with one of the pediatricians at the Children's Hospital who advised against medicating O as the potential side effects from the medication outweighed the benefits. This should have been yet another sign of O being on the spectrum but at no point was this mentioned by any of the medical professionals that we were seeing on a regular basis.

L was then diagnosed with a provisional diagnosis of ASD in late 2015. Early 2016, we started noticing different ASD traits in O, especially her different stims but we were told that she was just picking them up from watching and interacting with her little brother. We were told that she couldn't possibly be on the spectrum as she made eye contact, she spoke very well and she was very social with other children.

By mid year 2016 we were again struggling with O's anxiety - we had tried mindfulness and essential oils, yoga and numerous other calming strategies but nothing was helping O. We also noticed that O was struggling socially with children who were her age. She got along fabulously with children who were much younger and with adults, but with her peers was another story. We again sought medical advice and were given a GP Mental Health Plan for regular child psychology sessions.

In was during the second psychology session that her then psychologist said to us "You need to get O assessed for ASD as I think she is on the spectrum." Keep in mind that O's psychologist specialized in diagnosing children, especially girls, as being on the spectrum and assisting in managing their anxiety.

Later in that same year, we started the ASD assessment process for O. It was during the speech assessment that it became glaringly obvious to me (and the speech therapist) that O was on the spectrum. Depending on how you look at it, O passed (or failed) the assessment with flying colours. She hit every single ASD red flag during the assessment. Her stims became much more prominent during the assessment. It was a huge eye opener to me as I sat in on the assessment simply observing. 

During the psychology sessions that I participated in, answering questions about O from birth to her then age, she hit every single red flag as well.

All I remember thinking was how on earth did we miss O's traits. How did we not see these traits when she was younger.

It was then that O's psychologist explained that some girls, not all, but some present completely different to that of their male peers. The diagnostic criteria in the DSM-V is very male based as the very first study was based solely on male patients. The psychologist explained that girls in particular can be very good at mimicking the behaviour of others and masking their own ASD traits when they are younger so that they fit into the crowd. This made a lot of sense as to O's behaviour and mannerisms.

She went on to explain that at times, girls are not diagnosed until they are teenagers as this is when the social interactions become harder and more difficult to interpret. Many women aren't diagnosed until they start the diagnostic process for their own children. She explained that many girls are either misdiagnosed at a young age with anxiety or ADHD or another diagnosis or are not diagnosed at all.

We received O's formal ASD diagnosis in June 2017. While we were expecting the diagnosis as both the speech therapist and her psychologist indicated that that is what would be in their respective reports, the level of O's ASD severity shocked us. It was a massive relief knowing that with the reports in our hot little hands we could start therapy and accessing funding but O's level of severity truly shocked us as on paper she is more severe in her Autism then L is. 

The reports also showed us just how well O is at masking her ASD traits so that she blends in with the crowd. Which then told us just how damaging masking is - O struggled at home with her emotions because she was holding it together all day at school. My then eight year old had learnt that if she masked her traits at school and other places outside of home, she was less likely to stand out to her peers as being different. 

During the lead up to O's assessment we did hit a lot of road blocks from well meaning professionals who would tell us that O couldn't possibly be on the spectrum because she made eye contact, her communication skills were above average, she was academically gifted, she was well behaved and well mannered and many other reasons.

When we gave a copy of O's diagnosis report to those professionals, they too were shocked. Many began to realise that Autism can present in many different ways and that perhaps they should be listening to parents when they raised concerns with them about their children.

Almost two years on from O's diagnosis day and we can see the difference that therapy has made for O. She still struggles on a daily basis with her anxiety but having the ASD diagnosis has opened up many doors for us in assisting O.

I know from experience and from talking with families who have just started their Autism journey, that experiences like ours in getting medical professionals to take us seriously about concerns, occur far too often. There are still many medical professionals who believe that if a child, not just girls but boys as well, can make eye contact then they simply can't be on the spectrum, that all individuals present the same when it comes to Autism traits. This is simply not the case.

Autism traits present differently from individual to individual. Hopefully over time, it will be widely accepted in the medical community that Autism can be shown in many different ways but in the meantime if you are finding yourself in this position, please keep pushing on. Keep fighting for your children.

My Favourite Autism Awareness Memes, 2018

This year I have gotten into the swing of creating memes for my blog and for our social media sites. I wanted to share a few of my favourite memes that I have created!

I am very big on spreading a little more Autism Acceptance and Awareness, so here are a few of the memes that I created throughout 2018 which are along this line!

O is strong!

Most days I look at O in absolute amazement and I revel in just how mentally strong she is becoming at the tender age of 8 years.

O is in a constant battle with her anxiety. Anxiety that tells her on a daily basis that she is weak. But each and every day she puts one foot in front of another and strives to prove her anxiety wrong.

Each and every day O finds the strength to ignore her anxiety, she smiles and she tries her very best to be social with her friends at school.

O renews her strength each and every day as she refuses to allow her anxiety to control her every move and thought. 

My gorgeous girl shows just how strong she really is and she strives to be the best version of herself that she can be, despite her ever present anxiety.

Some people rarely venture outside of their comfort zones. I know of adults who will not venture out of the suburb that they live in because that would mean stepping outside of what they know and facing the unknown. O on the other hand, well, she ventures outside of her comfort zone every single day.

O is strong because she finds the courage to speak her mind and speak up for herself and her friends when they need her to. And when she does, she surprises herself, and others around her, with just how brave she really is.

Anxiety is debilitating, it can cause life to grind to a halt. But, as I constantly remind O, anxiety can also makes you stronger. 

Anxiety is causing O to become stronger as she never wants to give up.

Why is support for Autism lacking?

I have often been asked the questions - "why is support for individuals with autism lacking?" and "why do you have to fight so hard for support services?"

There is no hard and fast answer to both of these questions but before I can attempt to answer them, there is a little background information about my little superheroes that you need to know, so bare with me ...........

On the mornings when we are having a rough time at home, I will rarely call the little superheroes school after I have completed the school drop off. I will write in the little superheroes communication books to their teachers prior to school drop off, but I will rarely call.

And the reason is that at school I know that both of my little superheroes will settle, they will conform to what is expected of them and they will both appear to be happy despite the turmoil at home prior to going to school. They both get on with their day despite what had occurred prior to arriving at school. They may need extra sensory breaks or brain breaks as L has taken to calling them, but they do get on with their day.

Prior to gaining L and O's autism diagnosis, we were often accused of providing a lack of discipline and a lack of structure at home. We were often told that L's behaviour was a result of our parenting style. We were regularly asked "are you sure that is how they are behaving?" We were accused of lying or of over exaggerating the behaviours. All of the behaviour was put back onto us as parents - it was all our fault.

I have had to resort to recording videos of my little superheroes when they are at their most vulnerable at home to PROVE what I am describing to professionals. I should not have had to do this and yet, at least once or twice a year, I have to.

And then when we received the final diagnostic reports for both L and O, we had to start proving that the behaviour was occurring all over again. This time to funding bodies.

According to the medical and education professionals that we spoke to, the common denominator for L's poor behaviour was us, his parents. When it comes to a child's poor behaviour it appears to be quite easy for professionals to jump to conclusions and place the blame directly on "poor parenting decisions."

Unfortunately for us, the poor behaviour was rarely seen outside of our home.  

The act of behaving one way at home and another outside the home has a name. It is known as Autism Masking or autism camouflaging and it is more common than you'd think among individuals with autism.

When a child acts differently at school, when they put on the mask, this makes it incredibly difficult to access the support that they desperately need. They are denied access to inclusion services due to their presentation outside of the family home.

Autism is a very complex and confusing (at times) disorder, and yet many individuals learn when they can and can't explode. O is a master of this! O knows that standing out in the crowd is not a great thing to do and L is slowly picking this habit up. They both know that they can show their vulnerable sides at home as there is no judgement from us. They will both internalise their anxieties and frustrations throughout the school day and explode when they walk through the door at home in the afternoon.

Many medical and education professionals have the mistaken assumptions that if a child truly had challenges, the challenges would manifest in all settings in exactly the same way. 

And as a result the consequence of these assumptions is that children are left with little support as they are unable to access the support services that they need and families are left to struggle.

So what needs to change so that our children can access the support services that they need? What needs to change so that the support is more readily available?

In my mind there are two areas in which changes need to be made and the changes more have to do with the thought processes of medical and education professionals than anything else.

The first change that needs to be made is that medical and education professionals need to be more understanding and be willing to listen to a parent when they are describing the way in which a child behaves at home. 

Just because you don't see the behaviour on a daily basis, does not mean that the behaviour doesn't occur.

I am yet to meet an adult who doesn't go home and moan to others to let off steam after a rough day at work. While adults generally don't arrive home and immediately enter into meltdown mode, there are days at work where I am sure that we all put on a mask and pretend that life is great. When we are put into a different environment than what we are used to, we will all change to suit the environment. When we are all put under stress, our coping mechanisms come into play.

Children are no different.

There are many stresses in the classroom that teachers, at times, are not aware of. There are sensory issues that will affect some students more than others. There are the stresses of needing or wanting to conform to the expected norm so that they blend in with the crowd. Then there are the academic pressures that are placed upon students throughout the school year.

All of these stresses alone are enough to cause anxiety to bubble to the surface in any child. If all of these stresses are combined, then you have a recipe for internalising anxiety and a behavioural explosion at home.

The second change that needs to occur is that medical and education professionals need to be much more aware of the many different ways in which autism can present. The saying "so you've met one person with autism" can not be more appropriate when it comes to support for individuals with autism.

When a child does not present autism traits in the manner in which professionals are familiar with, this causes confusion. It can't possibly be autism, can it?

Traits can be seen just as "quirky features" of a child and a parents concerns are dismissed.

A child who makes eye contact, they can't possibly have autism, can they?

Children with autism aren't social, are they?

Every individual with autism presents differently - no two individuals are alike. There are traits that are similar between all individuals and then there are traits that can present as though they are on opposite ends of the spectrum.

Girls will often present autism traits quite differently to that of their male counterparts and this in itself causes difficulty for students to access services and funding.

Girls are fantastic at copying or mimicking their peers and as such girls, generally speaking, are not diagnosed until after the age of 6 or 7 or until they hit their teenage years. Obtaining an autism diagnosis for a girl can be a very challenging process due to their innate ability to copy the behaviour of others.

All professionals need to remember that the autism is a spectrum - a very wide spectrum.

I have two children and both present completely differently to each other. They are alike in some ways but completely different in others.

If these two changes alone occurred then parents would begin to feel less alone and not belittled by the professionals who are meant to be there to support them.

If these changes occurred, then perhaps the support for individuals with autism would increase or be easier to access.

How can Autism present in girls?

After we'd been through the ASD diagnosis process with L and had received his official diagnosis, we began to notice that O was presenting with quite a few ASD traits. We weren't sure if we were noticing O's traits because we were more aware of them due to L's diagnosis or if she had in fact been presenting with the traits the entire time.

O has always been an anxious child, she has always found something to worry about. In the past we have tried numerous techniques to try and assist O with her anxiety but all to no avail. In the second half of last year we came to the point that we needed to seek the assistance of a child psychologist. During O's second session, the psychologist took me aside and suggested that we should look at getting O assessed as she strongly believed that O was on the spectrum.

And wouldn't you know it, O now has a provisional diagnosis of High Functioning ASD, not that medical professionals diagnose children with High or Low Functioning ASD anymore. However the scale of 1 to 3 that a child receives reflects High to Low Functioning.

During O's diagnosis process I began to ask questions of the medical professionals that we were visiting frequently and also began to do some research of my own.

How on earth had I missed O's ASD traits? They were there the entire time and I had missed them. Why? How?

Well.......

For a start, girls are generally brilliant at masking their traits by either copying or mimicking their peers. It is only when the social and emotional side comes more into play as girls grow older, that girls with ASD begin to struggle. It becomes more difficult to understand and mimic others emotions and social interactions as these become more complicated.

O has always been a little copy cat. I used to regularly comment when she was a baby and toddler that it was as though she was watching the other children around her before she practiced a new skill. And when she did "practice" a new skill, she often succeeded on the first try.

Last year O really struggled to understand the girls in her class and others that were older than her. She would often tell us that she didn't understand the way that they talked or acted. It was becoming harder for her to blend in.

Girls, ASD or not, often know that standing out in the crowd is generally not a great thing to do. They will have enough skills to be able to blend in with their peers. They watch and observe and then use their intelligence to join in on social situations. Girls will learn socially appropriate and acceptable behaviours such as maintaining eye contact, memorising phrases that are commonly used and imitating the facial expressions of others.

O is variable when it comes to maintain eye contact. She usually finds eye contact difficult however occasionally she will maintain eye contact but the catch is that she is in fact staring at you. It can become very uncomfortable.

It's often known as Autism camouflaging and as a consequence of being able to camouflage their traits, girls generally stay off the radar and are diagnosed at an older age, compared to boys with ASD. Girls are usually diagnosed after the age of 6 or 7 or even older as a teenager.

There are numerous females that have gone through their life undiagnosed until they begin the diagnosis process with their own children. It is during that process that they begin to relate to the criteria being used to assess their children. I am one such adult - I can see a lot of myself as a child in O. I have also been able to relate my teenage years and how I was feeling to the diagnostic criteria.

This is not to say that girls are not diagnosed before the age of 6 or 7, numerous girls are diagnosed younger than that and it is most likely due to the fact that their ASD traits were obvious. Children present ASD traits in many different ways, there is no typical way of presenting. But what Autism researchers are finding is that more and more girls and women are coming forward to be diagnosed.

The original DSM criteria was very much male biased. In fact ASD used to be thought of as a male disorder as females were rarely diagnosed. In the past girls may been misdiagnosed or missed altogether simply because at times they do present differently to what the criteria is suggesting. Or the traits simply didn't stand out to those adults around them.

When Dr Hans Asperger originally reported about Autism in 1944, he initially only found it in boys and he stated that "in the autistic individual the male pattern is exaggerated to the extreme.....it could be that the autistic traits in the female only become evident after puberty. We just don't know." (Firth, 1991, pg 85.)

In fact for every four boys who are diagnosed with ASD, only one girl will be diagnosed. Obtaining a diagnosis for a female can be a very challenging process. The idea that girls can present ASD traits differently to that of boys is a relatively new concept and as such not all medical professionals are in agreeance.

Neurotypical boys and girls differ in terms of how they socialize, how they communicate and in their behaviour. It is safe to stay that ASD children are no different.

In saying that, I do need to add that boys and girls with ASD are also similar in many ways - they all have difficulty relating to and communicating with other people, they may have repetitive behaviours, they may be fixated on a special topic or interest and so on.

But those similar characteristics which both girls and boys both experience difficulties with may present differently between the sexes.

Boys will generally act out their frustration behaviourally when they are unable to understand social situations. Girls however tend to internalize their frustration and are less disruptive at school. At school they are well behaved and generally fly under the radar. They are quiet, helpful and kind and may appear to be shy or sensitive. This in itself makes it very difficult to convince educational and medical professionals that something is not right.

O worked out very early on in her schooling that acting out at school was not a good thing, she did not want to get into trouble so she would internalize all her frustration and then release it all when she arrived home. Her teachers have never seen this other side of her.

This is the downside of camouflaging - it takes a considerable amount of mental effort to be constantly on the ball when in social situations. This leads to mental exhaustion and it does take an emotional toll on the individual and their family.

Constantly camouflaging leads to high anxiety which, for girls, rarely presents at school or in social situations. Boys may become disruptive when in an anxious state, girls tend to internalize their anxiety and let their emotions explode when they arrive home to their safe place. This is O to a tee......

Other ASD traits that girls may present with include:

At times girls with ASD will possess the ability to read above their developmental level, however their comprehension does not always match their reading skills. They may have an average or slightly above average IQ, will receive good grades and not appear to struggle academically which leads to confusion among educational and medical professionals during the diagnosis process.

Girls may be book worms or love to write creative stories and they often have the most amazing imaginations. The stories and poems that O composes are simply amazing. We have been told recently that girls with ASD do not have an imagination, however I beg to differ.

Girls with ASD will often prefer the company of much older or much younger children. They generally like to play the same game and play the same role every time! O played a game when she was younger called Mummies and Darlings. She was the Mummy and I was the darling. She would fall into the Mummy role and would not break character. This game could go on for days, we'd go to sleep at night and when we awoke the following morning, the game would continue. And if I broke character, hooley dooley, O would completely lose it!

Girls with ASD may go to a speech therapist for their speech when they are quite young but this initial speech issue is initially unrelated to Autism. As a baby and toddler, O suffered from numerous ENT issues to the point that between the ages of 2 and 2 and a half she could not hear. Missing 6 months of hearing affected how she learnt new sounds and as such when she entered Kindy she was unable to pronounce certain sounds. O attended speech therapy for approximately 18 months to correct her speech pattern.

Girls with ASD may have repetitive behaviours and special interests like their male counterparts however these can look different as well. L has an obsession with anything and everything to do with superheros - clothing, toys, books, bedding, facts, comic books, TV shows ...... O has special interests, Monster High Dolls and Shopkins are some of her interests, but these are very similar to those interests of typically developing girls. O has collections of objects, one being tiny bits of paper. This type of collection is generally not common amongst neurotypical children!

At school and in other social situations, girls with ASD may spend a considerable amount of time either alone or looking for opportunities to help out other children or their teachers. We're constantly told that O is always helping other children at school and that she likes to help the teachers during recess and lunch. Mmmmm....

Having now completed the diagnosis process with O and having to look closer at her traits, I can see that her traits were there all along but other than her anxiety, none of her other ASD traits stood out like L's did. O's stimming didn't stand out as being odd, her collections and obsessions were similar to those of other children her age, being first time parents we put her favouring of certain foods down to being slightly fussy. O has a variable pain tolerance. I could go on but hopefully you get the picture.

What I can tell you is that we have had several years of feeling like we were banging our heads against a brick wall when trying to explain her emotional outbursts and we now know why. O was simply presenting her ASD traits differently to other children.

One important lesson that I have taken from O's diagnosis process is that it is paramount that parents are listened to by educational and medical professionals when they are desperately seeking answers for their children's behaviour.

I'm not in any way dismissing how other children present with ASD, there is no typical way. As the saying goes, if you've met one person with autism, you've met one person with autism. Some children present with autism traits at a younger age than others.

What does need to happen is more awareness of the difference in autism traits. The more awareness that there is in the educational and medical system, the easier it will become to get our children the help that they desperately need.

Reference:

Firth, U. (Ed). (1991) Autism and Asperger Syndrome. London: Jessica Kingsley Publisher.

What does Autism look like?

Just lately I've heard of and read quite a few posts on Facebook and other sites where people have stated certain individuals can't be autistic because "they don't look Autistic" and other similar comments. Comments along these lines really get under my skin as I feel they undermine what families have gone through to obtain a diagnosis and it just makes it harder for those with Autism to be accepted for who they are.

I was having this conversation with O's psychologist a few weeks ago, that people have certain ideas of what Autism should look like and then when they meet someone who doesn't fit that description, they struggle to comprehend that Autism can present differently. If an individual is physically disabled, people accept that, you can see the disability as it is there in full view, no questions are asked, society accepts them. When the disability is hidden as Autism often is, society seems to struggle to accept it.

We've been told by quite a few people, including medical professionals, that L can't be Autistic because he doesn't look Autistic. He doesn't fit the typical stereotype that many people have of Autism. People have said to us "but he can talk" or "he doesn't flap his arms all the time" or "he looks normal."

My response to them is: "tell me what you think Autism looks like and I'll show you what Autism can look like."

Dr Judith Gould, a Consultant Clinical Psychologist and Director at the Lorna Wing Centre for Autism has said that "Autism is more diverse than originally thought, with new ideas being put forward every day. In fact, it's a case of 'the more we know, the less we know', particularly in how gender affects individuals with autism."

Autism can present in many ways. Autism is generally characterised by difficulties in behaviour, social interactions, communication and sensory sensitivities. While these characteristics are common amoung those diagnosed as being on the spectrum, they are not necessarily exhibited by all people on the autism spectrum. It's why it is called Autism Spectrum Disorder - it's a spectrum and a very broad spectrum at that.

I have worked with many children who are on the spectrum, and I have not yet come across a child who is the same as another, they have all presented differently. I've worked with a child who was completely non-verbal and needed substantial assistance in all areas. I've worked with a delightful girl who was incredibly social and had difficulties with communication but when she sang, you could understand every word. I've worked with a child, that unless you had been told that he was on the spectrum, you would never know. I could go on, but you get the picture.

Some children are diagnosed early in life, others are not diagnosed until later in life. L was a different baby to O. He was different from other children his age and we just knew that there was something about him that was concerning. It took 3 and a half years for someone to take us seriously. He was late to hit all his milestones, he did things that were unusual, he's always had sensory sensitivities, he's always lined things up, he's always had sleep issues and the list goes on.

O on the other hand was no different from other children the same age as her. It is only in the last year or so, that we've begun to suspect that maybe she could be on the spectrum. At first we just thought that perhaps it was because we were more aware of Autism due to L's diagnosis that we were now picking up traits in O. But in talking to our pediatrician and O's psychologist, the traits were always there but they didn't stand out as being "odd" so we didn't suspect anything.

Medical professionals are now beginning to realise that Autism traits in girls often present differently to that of the traits in boys. In some cases the traits don't start presenting until girls reach the age of 6 or 7 or often in their teenage years. At times, females aren't diagnosed until adulthood when they go through the diagnosis process with their own children and realise "hang on, I think I may be on the spectrum."

It is thought that women and girls who have been diagnosed as being on the spectrum are better at masking their difficulties as young children in order to fit in better with their peers. Girls are just better at covering up the more obvious characteristics of the disorder. In Asperger's and girls, Tony Attwood states that "girls are more able to follow social actions by delayed imitation because they observe other children and copy them, perhaps masking the symptoms." Girls may pick someone in their class and they copy everything about that person: how they dress, how they act, how they talk, so that they fit in.

The social difficulties may therefore be less obvious and as such a diagnosis is not made because they haven't met the criteria or they are misdiagnosed. This masking behaviour generally isn't seen in boys diagnosed with autism.

Girls are generally more aware of the need to be social, many feel the need to interact socially and while they will be involved in social play, they may be led by their peers rather than initiating the social contact. (Gould & Ashton-Smith, 2011)

As girls become older, they may find it more difficult to copy their peers and they may struggle to understand social situations or start struggling emotionally, and that is when the traits start to show themselves.

Other studies have suggested that features often associated with autism such as attention and socialisation, as well as concerns about depression, higher levels of emotion and anxiety are often reported more in girls than in boys (Holtmann, Bolte & Poustkaet, 2007.)

This year, O has started saying that she doesn't understand how some girls at school act or why they talk the way they do. O has always been an anxious child, but in the last year, her anxiety has gone through the roof. With these traits now emerging, we've begun the diagnosis process for O. While she doesn't struggle academically, she does need help socially and emotionally. And now we can see that girls, at times, do present differently. O is presenting completely different to how L presented.

I definitely don't profess to being an expert on Autism. The one thing that I do to profess to knowing is that every individual with Autism is different from the next. We're experiencing it first hand with our little superheroes.

So the next time you hear someone say "they can't be autistic, they don't look like it" what is your answer going to be?

Holtmann, M., Bolte, S. & Poustkaet, F. (2007) Autism Spectrum Disorders: Sex differences in autistic behaviour domains and coexisting psychopathology.

Gould, J. & Ashton-Smith, J. (2011) Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum.