ASD in girls

[Sara2000]

Can anyone tell me if developmental markers in girls are the same as boys for ASD?

My DD aged 15 has many signs of ASD to my untrained eye; high anxiety levels (under tier 3 CAMHS), social anxiety, plays roblox obsessively and finds online friends much easier , socially isolated in primary school in the last few years but had friends intermittently in the earlier years , sensory issues with clothes. Hates crowds and noise.

She is currently not able to attend school due to her high anxiety.

CAMHs did an ADOS assessment and she came back as 'traits'. She apparently met the diagnostic threshold based on her and the schools input. But when they interviewed is there were of questions about how she played when she was young. Quite apart from the fact it was a decade ago so our memory wasnt great, but we dont recall anything unusual or issue with making friends at a pre school level. She also walked and talked when she should have. I just wondered if it was because girls dont show the same developmental markers such as late talker , late walker and using your hand as a tool etc.

I dont mind if DD has ASD or not, but I would like to understand why she is so anxious she doesnt want to leave the house unless she knows where we are going. Why she hates being touched on her arm and feels the need to rub the feeling away after you touch her, who she finds it hard to understand inferred language and sarcasm.

Boys can and do present very differently to girls especially with Aspergers. Girls often appear calm and compliant and have trouble organising themselves. It means that they slip under the radar. My daugher is 11 and has Aspergers.

Thank you. Do you remember what she was like ar 4/5? Did she play with toys 'normally' and interact with other children as expected? I dont remember that being an issue for DD but looking at her now she is like the stereotype of Aspergers.

Can anyone tell me if developmental markers in girls are the same as boys for ASD?
All the tests are unhelpfully based on the male presentation which is why so many girls get missed.

Read up and watch youtube vids on autism in girls and women, Lorna Wing and Judith Gould, Sarah Hendrickx, Alis Rowe, Iris and more.

Why she hates being touched on her arm and feels the need to rub the feeling away after you touch her
That's called Sensory Processing, I'd lay odds she does other things that are in this booklet that you've never realised were traits.
www.falkirk.gov.uk/services/social-care/disabilities/docs/young-people/Making%20Sense%20of%20Sensory%20Behaviour.pdf?

she finds it hard to understand inferred language and sarcasm
Read up on semantic pragmatic language disorder, it's a dx in its own right but if there are enough other traits present, an autism dx can be given.

Anxiety is a driver for autism, the more you can lessen the anxiety, or the more the autistic person masks, the less their autistic presentation will be obvious to other people.

Many girls and women are treated only for anxiety and other MH issues when they are in fact autistic. Read some of the neurodiversity support threads and see how common it is for women to be overlooked and misdiagnosed. www.mumsnet.com/Talk/mumsnetters_with_sn

No-one online can diagnose autism, but if you look at all of the information available, you may find you have some observations which so far you'd not mentioned, (because you'd not realised they were relevant) which would provide more evidence for a diagnosis.

My daughter at 4/5 would tend to ignore the cues around her. She has always been able to make friends with one or two people but she not keen to branch out to anyone not on her wave length. School reported that all the kids would be getting ready for PE whilst my dd sat smiling to herself. She also takes everything very literally - doesn’t understand idioms even now. At this age she also disliked the singing of certain songs in assembly.

Thank you thats very helpful.

Another thing to look out for is echolalia. My Aspie girl did not have a language delay as such but her use of language is a bit unusual. As a younger child, she would lift phrases from TV shows ie, ‘I am not sleepy and I will not go to bed’ if I told her it’s bed time. I have Aspergers too and catch myself using an exact phrase that I’ve read in a book or heard somewhere. It’s one of those things that you can be unaware of.

The reason play is so important is that it shows flexibility or otherwise. But tbh in a girl with Aspergers the differences are quite subtle. It’s the bigger picture of a number of different things. Imagination is quite important. In my own case, I can’t make up a story - I don’t have the imagination for it. But I can read a book with emotion because, then I’m provided with the structure. My daughter always struggled to play imaginatively alone but if another child was there she was fine. Whereas my only NT child could easily play by herself using her own storyline.

Thank you this is all so useful. Dd did lots of role play and writing plays when she was young but not much imaginative play on her own. It's hard to remember though.

I've just read the DSM-5 definition of how ASD is diagnosed and I can honestly say DD had very few of the early developmental signs.

Have you looked at one of the online checklists for ASD markers in females to see how many apply?

I’m not sure how up to date DSM-5 is on current specialist views of ASD presentation in girls which can be very different, though not always of course.

Good grief. Thank you @openupmyeagereyes. I just did one at DD ticked almost every box. So, its possible she has it even if she wouldn't fulfill the DSM5 diagnosis as that has so much on the developmental stuff that she didnt have. But she did have the early years markers in the checklist like being an early reader and having 1 friendship at a time.

My DD didn't really show any signs of ASD until she started school. The only noticeable thing before then was the number and intensity of her tantrums (in hindsight i can see they were meltdowns) and her stubbornness. Her nursery certainly had no concerns. She was diagnosed with ASD aged 8 after she had problems at school. She is now in a specialist school after her secondary school transition went tits up.

I also have a DS with ASD and he was diagnosed aged 3 because it was bloody obvious. I wouldn't say he was any more autistic than DD, he just presented more typically when he was young.

I wouldn't have realised DD was autistic at all (partly as she talked right on time - although she was a late walker, but she was hypermobile too so there seemed a clear "physical" explanation for that, though I now realise it was sensory too). Partly it was because she was a bit of a mini-me and I have a lot of traits too, so it was harder for me to spot things: so much of it seems totally "normal" to me.

She has been less social than other children. Even now she has friends but sometimes complains they are not interested in playing her games (she has very intense interests which are not always the same as theirs!) so I suspect that will be a bit of a challenge, as your daughter found. Honestly though I needed a lot of help to see how her traits translated to anything you would read in the DSM (even though her Dx/ADOS score was not borderline, as I was expecting).

I believe the DISCO assessment is supposed to be good for older autistic girls (and indeed boys with a more "internalised" presentation). But I think that is mainly done at the Lorna Wing centre, and not necessarily that easy to access.

What does your DD think? She might like to watch some videos (like the Iris one mentioned above (link below), or YoSamdySam, Purple Ella, Autistic Tyla, invisible i, Stephanie Bethany, Sew Many Books, all on YouTube) and see what resonates.

For you as a parent I really found these books useful, even though my DD is still young:
www.amazon.co.uk/Girls-Autism-Educational-Personal-Perspectives-ebook/dp/B07NHTDV6T?tag=mumsnetforu03-21
www.amazon.co.uk/Spectrum-Women-Walking-Beat-Autism-ebook/dp/B07BDQYZZQ/ref=sr_1_1?dchild=1&s=digital-text&keywords=spectrum+women&tag=mumsnetforu03-21&qid=1602258673&sr=1-1
www.amazon.co.uk/Stim-Autistic-Anthology-Lizzie-Huxley-Jones-ebook/dp/B086XGTDVY/ref=sr_1_1?dchild=1&s=digital-text&keywords=stim+lizzie+huxley&tag=mumsnetforu03-21&qid=1602258883&sr=1-1

Also there are some good novels with autistic female protagonists - like "A Kind of Spark" (Elle McNiccol), "The State of Grace" (Rachel Lucas) - both by autistic authors.

Good luck and take your time - it's a lot to take in!