How to help autistic girls in a neuro-affirmative way as an Educational Psychologist

Written by
Dr Beth Sheldrake, Child and Educational Psychologist

In my role as an educational psychologist, I am all too aware of the pressure on capacity in the profession to support young female students who have reached crisis point in Secondary School, whilst also aiming to work preventatively in Primary Schools to avoid such issues.

Early intervention can lead to the prevention of mental health difficulties, isolation, trauma, and withdrawal from education for so many young people who internalise the presentation of autism. Training staff and sharing the latest research in Autistic Spectrum and the range of differing presentations that are known about, is a crucial part of the Educational Psychologist’s role. Championing neurodiversity and having schools where young people are comfortable to be themselves rather than believing that they need to camouflage, mask or change their true-self to survive the school system, is the aim that needs promoting.

As an Educational psychologist I aim to explore how the ecosystems of the child’s life inter-relate and shape experiences. Broffenbrenner (1974) proposed the Ecological Systems Theory as a way of viewing multiple aspects that interact with and affect the child. Psychologists regularly hold this theory in mind when exploring the lived experiences of the individual. It is one of our roles to communicate how these dynamic interactions are shaping a child’s experiences and behaviour. When exploring social communication difficulties in girls, this way of working is essential in order to provide a holistic picture of what is important to the young person and how best we can support them.

When working either directly with, or consulting about girls with social communication difficulties, there are two factors that I hold at the forefront of my mind; masking and internalising.

In my experience, the ability to supress certain behaviours and mimic others are behaviours that are synonymous with autistic girls. This means that discussion and consultation with those adults who know the child best, is crucial. I often hear parents talk about the distress that they see in their child before and/or after school, on Sunday evenings, and on the final few days of a school holiday. For some it is a daily battle to get their child to school. It can be frustrating and upsetting for parents when they are told that their child shows no difficulties in school and therefore no support can be offered, or worse – that is it a ‘parenting problem.’ Distress shown by children is often referred to as ‘having a meltdown,’ but it is important to consider that a meltdown can also present as a quiet withdrawal from the world. There may be occasions when a child comes home from school and takes themself away to a quiet space to ‘recover’ after an exhausting day of masking and managing with high levels of anxiety.

When observing as part of an assessment, it is important to note that at first glance, a girl may appear to be sociable and amongst her peer group at playtime. Friendships and relationships require deeper exploration.  Is that girl on the periphery of the group? Is she trying hard to fit in and copy the actions and conversations of her peers? Does she recognise, understand and manage conflict? Does she believe that she has friends? Does she complain about feeling different? Can she play as long as she is controlling that play?

When working directly with a young person, the use of creative tools to assess and explore lived experiences are required and I often use visual cards, such as ‘Next Step,’ ‘Blob Tree People,’ and ‘Human Givens,’ to give a structure and a way into conversation with a young person.

Person centred approaches are also a useful way to elicit what is really important to that young person, for example, what does their perfect day look like? Where would they be? Who would they be with? What would they eat? What would they do? I find asking a young person to draw their bedroom can give me a useful insight into objects that they find important to them, hobbies, interests and the intensity of these. Art and drawing can provide the young person with a way to express some of the feelings and emotions that they find difficult to put into words. Drawing your ideal and your worst school, classroom or teacher, can give so much information about what is important to that person and what things can be adjusted to reduce anxiety.  It also gives a non-threating, more relaxed way to be with you, especially as the psychologist coming in, you are often an unfamiliar person.

When possible, I ask for schools or parents to share my One Page Profile with the young person before I meet with them. This has a photograph of me with my dog and a brief description of my interests. Animals tend to feature regularly (but not always) as an interest for girls with social communication differences. I have several photographs of my dog and house rabbit that I have available to share if appropriate, there are also times when my dog will accompany me on a visit to a school as it supports the young person to engage and provides a focus that is not on them. I have enjoyed many lovely dog walks around school grounds where I have got to know a young person far better than if we had sat at a desk inside.

A large focus of my assessment and information gathering is to try to understand ways that anxiety can be reduced in the young person’s daily life. For a young person, knowing that adults in their life are listening to and understanding what they are battling with on a daily basis, can in itself bring relief. So often, it is changing the small things that can make the biggest difference; always having the same chair in the classroom, eating lunch in a quiet space, not being ‘put on the spot,’ having a discreet way to leave a classroom if it becomes too much, being able to access the art room at lunchtime, not being made to wear a tie… These are all relatively easy things to put in place. There are girls for whom the busy, social, crowded, large environment of the secondary is too much to manage on a daily basis. They may have managed and even thrived at primary with the understanding and nurturing approaches of teachers, but the secondary environment coupled with the hormones of puberty, proves too much. It is crucial at this point that professionals work together to get it right for that young person, before mental health difficulties become inevitable.