Autistic little girl

Autism in girls: Symptoms and diagnosis

Due to a variety of factors, doctors may overlook or misdiagnose autism in girls. Older girls with milder forms of autism may hide their symptoms or work harder to “fit in” with their peers. Early diagnosis can help autistic girls access support, so it is important to recognize the symptoms.

Autism is a developmental condition that can affect a person’s ability to communicate and interact with others. However, symptoms can vary widely among individuals.

The Centers for Disease Control and Prevention (CDC) estimate that about 1 in 44 8-year-old children have been identified as being on the autism spectrum.

The CDC also estimates that boys are four times more likely to be identified as being on the autism spectrum than girls. Doctors may underdiagnose autism in girls because they may not exhibit the “common” behaviors associated with autism or are better at hiding their symptoms.

The symptoms of autism tend to be the same for boys and girls, but every person is different, and symptoms can vary.

Since autism involves such a wide range of symptoms, many people prefer the term autism spectrum disorder (ASD).

Many autistic children have difficulty with social interaction and communication. Some examples of common symptoms include:

not responding to their name by the time they are 12 months old
preferring not to be held or cuddled
having difficulty following instructions
not looking at something when another person points to it
losing certain skills, such as no longer saying a word they could use before
having difficulty explaining what they want or need
having difficulty understanding how other people are feeling
avoiding eye contact

Other key characteristics of autistic behavior are strict routines and repeated actions. Some common examples include:

having difficulty adapting to a change in routine
being unusually attached to objects or toys
rocking from side to side
spending lots of time organizing items
repeating certain words, phrases, or sounds
having an unusual response to certain smells, tastes, or sounds
having movement issues, including impairments in balance or fine and gross motor skills

Most of these symptoms tend to appear in infancy or early childhood, though people may not always recognize them at the time. Other symptoms may not become obvious until a child is older.

Doctors more commonly diagnose autism in boys than in girls. This can mean that parents, caregivers, and healthcare professionals may be less likely to look for symptoms of autism in girls.

Stereotypes about typical male and female behaviors may cause some people to miss symptoms. Many people think of girls as naturally quieter or more content to play alone than boys. However, speaking less and preferring to spend time alone can both be symptoms of autism.

There is some evidence to suggest that certain symptoms of autism are more common in boys than in girls. For example, repetitive behaviors and difficulty with impulse control may appear more often in autistic boys than autistic girls. These symptoms can be easier to spot than difficulties with communicating or socializing.

Girls and boys may deal with the symptoms of autism differently. Girls may hide their symptoms or put more time and energy into learning social norms. Autistic girls are also more likely to be able to form friendships than autistic boys. This can mask autism because many people see difficulty socializing as one of the key symptoms.

A common misdiagnosis of autism is a mental health issue. Mental health issues can also occur alongside autism. Anxiety, depression, and personality disorders can all share some symptoms with autism, which may cause a doctor to misdiagnose it.

Autism can cause stress for some people. This can lead to different behaviors in girls and boys. Girls are more likely to react to stress in ways that people may not notice immediately, such as self-harm. Boys may be more likely to react to stress outwardly — for example, by becoming angry or misbehaving. This behavior is more visible and may flag autism sooner.

Girls may have more self-awareness and be more conscious of “fitting in” socially. This can mean that they are able to hide the symptoms of autism in childhood.

However, as girls get older and social norms and friendships become more complex, they may find it harder to relate to others. This can mean they may not receive a diagnosis of autism until their teenage years.

A general lack of understanding about autism may lead healthcare professionals, teachers, parents, or caregivers to miss the symptoms in girls.

Research from 2016 suggests that stereotypes about autism can result in a later diagnosis for some autistic girls. Such stereotypes include assumptions that all autistic people have a keen interest in math and science, and that autistic people are unable to form friendships.

However, this research used a cohort containing only 14 women, so this experience may not be a common one.

It is also important to note that healthcare professionals developed screening tests for autism mostly using male case studies. This could mean that these tests miss the symptoms that are more common in girls.

More research into how the symptoms of autism can differ between the sexes could help improve diagnosis methods.

ASD covers a wide range of symptoms and behaviors. Some autistic people have learning difficulties and need additional care. However, many autistic people have low support needs, which means they can participate fully in everyday society.

An autistic child with low support needs has typical intelligence and social skills for their age. This type of autism is more difficult to diagnose, and some doctors may overlook it in girls.

There are links between certain health conditions and an increased risk of autism. These conditions include fragile X syndrome, tuberous sclerosis, and epilepsy.

At a routine healthcare visit, a doctor should be able to find early symptoms of autism before a child reaches the age of 2 years.

They will ask questions about certain milestones, such as smiling for the first time, crawling, and making sounds, to check the child’s development. The CDC has a list of key milestones for different ages.

Early diagnosis can help children and their families access support and better understand certain behaviors.

In some cases, symptoms may be less obvious, and a doctor may not be able to diagnose autism in a toddler.

Older children may have a referral for ASD screening. Screening usually involves a series of simple tests to check a child’s speech, learning, and behavior. An appointment with a professional who specializes in autism may follow.

A child may show one or more symptoms associated with autism but not be autistic. For example, avoiding eye contact and being attached to routines are common personality traits.

Autistic children may have multiple symptoms that impact their daily lives. They may be able to mask these symptoms, but this can cause stress. Autistic children can also be more vulnerable to bullying or abuse. Parents, caregivers, and teachers should be aware of this so they can be ready to educate other children on the condition and provide support to those who have it.

Although doctors diagnose autism less frequently in girls, the symptoms are usually similar, if not the same, for both sexes. Some symptoms may be less obvious or less likely to occur in girls.

Due to the way autism screenings have been developed, autistic girls may not fit the commonly accepted profile of an autistic person. This can mean that they receive a diagnosis later in life.

Understanding the symptoms and standard milestones for child development can help a person spot autism in girls.

People who believe their child may be showing signs of ASD should speak with a doctor.

Autism in girls: Symptoms and diagnosis

Autism is a developmental condition that can affect a person’s ability to communicate and interact with others. However, symptoms can vary widely among individuals.

The Centers for Disease Control and Prevention (CDC) estimate that about 1 in 44 8-year-old children have been identified as being on the autism spectrum.

The symptoms of autism tend to be the same for boys and girls, but every person is different, and symptoms can vary.

Since autism involves such a wide range of symptoms, many people prefer the term autism spectrum disorder (ASD).

Many autistic children have difficulty with social interaction and communication. Some examples of common symptoms include:

not responding to their name by the time they are 12 months old
preferring not to be held or cuddled
having difficulty following instructions
not looking at something when another person points to it
losing certain skills, such as no longer saying a word they could use before
having difficulty explaining what they want or need
having difficulty understanding how other people are feeling
avoiding eye contact

Other key characteristics of autistic behavior are strict routines and repeated actions. Some common examples include:

having difficulty adapting to a change in routine
being unusually attached to objects or toys
rocking from side to side
spending lots of time organizing items
repeating certain words, phrases, or sounds
having an unusual response to certain smells, tastes, or sounds
having movement issues, including impairments in balance or fine and gross motor skills

Most of these symptoms tend to appear in infancy or early childhood, though people may not always recognize them at the time. Other symptoms may not become obvious until a child is older.

Doctors more commonly diagnose autism in boys than in girls. This can mean that parents, caregivers, and healthcare professionals may be less likely to look for symptoms of autism in girls.

Girls may have more self-awareness and be more conscious of “fitting in” socially. This can mean that they are able to hide the symptoms of autism in childhood.

A general lack of understanding about autism may lead healthcare professionals, teachers, parents, or caregivers to miss the symptoms in girls.

However, this research used a cohort containing only 14 women, so this experience may not be a common one.

More research into how the symptoms of autism can differ between the sexes could help improve diagnosis methods.

An autistic child with low support needs has typical intelligence and social skills for their age. This type of autism is more difficult to diagnose, and some doctors may overlook it in girls.

There are links between certain health conditions and an increased risk of autism. These conditions include fragile X syndrome, tuberous sclerosis, and epilepsy.

At a routine healthcare visit, a doctor should be able to find early symptoms of autism before a child reaches the age of 2 years.

Early diagnosis can help children and their families access support and better understand certain behaviors.

In some cases, symptoms may be less obvious, and a doctor may not be able to diagnose autism in a toddler.

A child may show one or more symptoms associated with autism but not be autistic. For example, avoiding eye contact and being attached to routines are common personality traits.

Although doctors diagnose autism less frequently in girls, the symptoms are usually similar, if not the same, for both sexes. Some symptoms may be less obvious or less likely to occur in girls.

Due to the way autism screenings have been developed, autistic girls may not fit the commonly accepted profile of an autistic person. This can mean that they receive a diagnosis later in life.

Understanding the symptoms and standard milestones for child development can help a person spot autism in girls.

People who believe their child may be showing signs of ASD should speak with a doctor.

How Autism Affects Sibling Relationships

7/25/20

Sibling autism is associated with problems, but it can also make children more patient, empathetic and resilient

Source: Spectrum News 9002

At the end of March, Michelle Byamugisha emailed a local celebrity with the subject line "Message to your biggest fan, my autistic brother." The coronavirus lockdown had been going on for two weeks, and her 34-year-old brother, who has a severe speech impediment and likes to be called Mark B, was desperate. He could no longer attend cooking classes, go bowling and other public places, and he was so depressed that he hardly got out of bed. nine0003

The family discussed what to do about it, and Byamugishi had an idea. Her brother was very into all things weather, and for many years he listened to meteorologist Steve Rudin's Washington weather reports every night. What if Mark B hears Rudin's message directly? It might bring him out of his blues, Byamugisha thought.

In her e-mail, she explained Mark B's experience, noting that the loss of a daily routine is "particularly difficult for someone on the autism spectrum." She then made a request, “If you can spare some time, it would be great if you could record a video message for my brother. It will definitely give him strength." She didn't really expect an answer, but she thought that if it could help her brother, then it might be worth a try. nine0003

Siblings like Byamugisha often play a huge role in supporting an autistic person throughout life. However, in a sense, they are the forgotten family members in autism research. Although younger siblings of children with autism may be of interest to scientists because of their increased risk of autism to themselves, research into the experiences of siblings of autistic people is extremely limited. Twenty years ago, all the few studies on this topic were based on the assumption that autism was a default problem for other children in the family. nine0003

However, over the past ten years, researchers have begun to study the real experiences of siblings, and gradually they are realizing that the impact of autism on these relationships is very multifaceted. “Disability is not some external force. Disability is part of family relationships, says Ariella Meltzer, researcher at the Center for Social Impact at the University of New South Wales, Australia. “This is part of the very essence of the relationship, part of the communication and feelings between brothers and sisters.” nine0003

This relationship can be beneficial for both neurotypical and autistic children in the family. For a neurotypical child, they can help develop qualities such as maturity, patience, resilience, and empathy. And for a child with autism who has difficulty communicating, chatting and squabbling with a sibling provides a meaningful experience of friendship.

Although autism in another child in the family may be difficult, many NT children feel a strong need to protect the autistic sibling and are very interested in the success of the autistic child. They can act as "translators" if the sibling's speech is incomprehensible to strangers, in some cases they understand the sibling's abilities and needs even better than their parents. nine0003

“For many siblings, tolerance training starts before breakfast and goes on 365 days a year, and it starts at a very, very young age,” says Emily Hall, director of the Sibling Support Project, a non-profit organization in Washington.

Supporting relationships between siblings when one of them has autism is associated with practical benefits for families. As parents age, they lose the ability to care for adult children with autism, and siblings often become primary caregivers. Research suggests that they are more likely to volunteer for such responsibilities if they have a close relationship with a sibling. nine0003

Michelle Byamugisha is 27 years old and works in public relations and lives in Washington DC. Her other brother, Jeremy, had Mark B's needs in mind first as he planned his adult life. Jeremy Byamugisha, 32, is an accountant and still lives with Mark B and his parents in Maryland, where he helps with Mark B's care.

“It made me patient,” says Jeremy. “Mark was a big influence on that.” For her part, Michelle never invites her friends home unless she's sure about their relationship, because Mark B will ask about them (and remember their birthdays) forever. “Jeremy and I have these shared commitments, our decision to bring only peace and stability to the family,” she says. nine0003

Mark B, for his part, adores them. “That's the first thing he says when he meets new people. He says: "I'm Mark B, I have a sister, I have a brother." And he immediately shares with them the latest details about my life with Jeremy, - says Michel. “A brother who is so happy to see me and is so excited about any of my success – it’s like I have a personal fan who will always support me.”

Just one hug

Relationships with brothers and sisters are one of the longest and most important relationships in a person's life. Children learn with their brothers and sisters how to play, argue, share and negotiate. Research suggests that close relationships with siblings are associated with better mental health later in life. nine0003

However, the nature of autism can make this closeness difficult. People with autism often find it difficult to identify and express their emotions, as well as to understand how other people feel. They may be uncomfortable with the manifestation of feelings. “Just one hug,” Mark B politely reminds others. Many studies suggest that if a sibling has autism, then the relationship will be less intimate than if the sibling has another developmental disorder that does not affect contact with other people, such as Down syndrome. “It takes two for social interaction, right? It's like dancing,” says psychologist Theodore Tomeni from the University of Alabama, USA. If a brother or sister has autism, then the dancers may move out of sync. nine0003

An analysis of 69 studies published in 2019 found that neurotypical siblings of autistic children were, on average, more prone to anxiety and depression than their peers. They also, on average, have more difficulty establishing positive relationships with others and have more negative beliefs, which can take the form of low self-esteem, negative perceptions of disability, and a general lack of optimism, notes Carolyn Shivers, study author and psychologist at the Polytechnic University Center for Autism Research. Virginia. nine0003

Relationships can be especially problematic if an autistic child shows resentment and aggression towards a sibling, such as fighting, hitting or yelling at them. In a long-term study published in 2007, psychologist Richard Hastings, now at the University of Warwick, UK, interviewed 75 mothers who had two children, one of whom had a developmental disability. If a child with a disability had a high level of behavioral problems at baseline, a neurotypical sibling was more likely to become withdrawn, angry, or hyperactive two years later. “If you grow up in a situation that involves unique challenges and possibly threats to personal safety, and in some cases real trauma, you can feel tremendous loneliness,” says Hall. nine0003

Living in poverty, increased stress or depression in parents also increase the risk of mental health problems for siblings. Raising a child with a disability, who may need special activities and constant supervision, requires a lot of time and money that many families lack, and these needs can be an additional source of stress for siblings.

Despite this, research shows that most people with an autistic sibling are psychologically healthy, well-adjusted people. “Many of these children are fine. They are fine. They are no different from brothers and sisters in other families,” says Tomeni. nine0003

Because they have been exposed to a disability since early childhood and were the same age as the autistic sibling, non-autistic siblings have a unique perspective that their parents don't, Meltzer notes. Brett Aurin is 15 years old and lives in the US state of California. His twin brother Kyle has autism and the experience led him to acceptance. “Sometimes he has more complexities, but he is not some other species,” says Brett. “I just consider it part of his personality. He's just my brother. I even forget that he has autism.” nine0003

Compared to other children and adolescents, siblings of autistic children may be more mature and have a more developed form of empathy called perspective empathy, the ability to take another's point of view. A brother or sister with autism also helps develop the ability to be grateful. Abigail Diaz, 29, says her brother Daniel, now 20, calls her up to 100 times a day to say "I miss you" or chat - too many incoming calls for someone working full-time day. “It's hard,” says Diaz, director of education and government programs at the Wisconsin Maritime Museum, “but I still remember a time when he couldn't speak. So for me it's always better than not being able to talk to him." nine0003

A study was published in 2019 titled "I don't live with autism, I live with my sister". The researchers interviewed nine girls aged 10 to 14 who had autistic siblings who were unable to speak. Many girls complained of being tired and expressed concern about the future. At the same time, they were sympathetic to the sensory differences of a brother or sister (two girls called it "superpowers"), were able to prevent tantrums, and also expressed acceptance, love, and hope. nine0003

According to a meta-analysis published earlier this year, many siblings express similar acceptance of the autistic child. "It's a recurring theme of love, empathy and empathy," said lead author Alexandra Leadham, a clinical psychologist at the Royal Chesterfield Hospital, USA. “Some people definitely feel that this experience has made them stronger.”

Stop being a dad

Some autistic children require so much attention that their siblings are left behind. “Their needs can be ignored, or they are always put on the back burner,” Leadham says. For example, in one study published earlier this year, one girl complained that her parents ignored her learning difficulties because they seemed minor compared to her brother's. As a result, she was only diagnosed with dyslexia at the age of 12. nine0003

Brothers and sisters of children with autism are much better equipped if they have people in their lives (parents, relatives, coaches, teachers or friends) who listen to their problems and appreciate them, whom they can always turn to for support. Tomeny and colleagues found that children with autistic siblings who seek and receive support are relatively less likely to have emotional and behavioral problems. In contrast, children who said they weren't getting the support they needed had more problems, such as having more tantrums, fears, or anxiety. nine0003

Adults can help typically developing children by explaining to them that the problem behavior of an autistic child is a result of their brain. “When I was about 6 years old, my mother explained everything about autism to me,” says Luciana Geresi, an 11-year-old girl whose 13-year-old brother was diagnosed with autism. Her mother showed her videos and explained that some people with autism talk about their special interests all the time. “When I was younger, I was like, ‘He already told me about it, he already told me about it. I thought he was deliberately trying to annoy me,” recalls Luciana. “But now I know everything, and I'm like, 'OK, I understand.' Like, I can handle it because I know he has autism." nine0003

Experts say that siblings should be allowed to calibrate their relationships naturally, rather than requiring them to default to being tutors, nannies and caregivers for an autistic child, for example. Brett Aurin says he watches over his twin brother at times, but his parents try not to rely on him too much. Sometimes they even tease him and say, "Stop being a dad."

If siblings choose to take responsibility for an autistic person, experts say, they are less likely to feel dissatisfied than if they are encouraged to do so by their parents. In high school, Diaz followed Daniel's prescriptions and took him to the doctor instead of hanging out at the mall. “I didn’t do a lot of the things that kids usually do, but I don’t feel like I missed out on anything because I was there for every big Daniel success,” Diaz says. “Something about our connection seems magical. My name was his first word. His first steps were towards me." nine0003

Specialized support programs can also reduce siblings' emotional and behavioral problems. For example, the Sibling Support Project supports groups for children aged 8 to 13 who have a sibling with a disability. "It's a way to let out the accumulated emotions," says Hall. “You can feel very lonely if you don’t know other people who have been through the same situations.”

The experience of siblings of children with autism can be very challenging. The child may feel angry at the brother's behavior that causes their family to forgo vacation trips, but he may also feel pride because his brother learned to tie his shoelaces at 13 years old. “It's all mixed up in the sibling experience,” Hall says. Everything is not great, everything is not terrible. At every moment of time, it's all at once." Experts emphasize that no one should feel guilty about relationship problems with an autistic sibling. “Some stories are great, others are not. But every story is valuable,” says Shivers. nine0003

In both close and problematic relationships, children usually know the vulnerabilities and strengths of a sibling. In a 2019 sister survey, one little girl complained that her parents constantly forced her autistic brother to eat food he didn't like, each time ending in tantrums. And Hall recalls that once during a Sunday seminar full of sleepy teenagers, everyone suddenly woke up when it came to the disparity in expectations. Many joked that their parents underestimate the abilities of a brother or sister. “I know that he can unload the dishwasher,” said one boy, “because when my parents are not at home, I always entrust him with it. He really likes it!" nine0003

Over the past few years, experts have begun to look at these relationships in a different way, by examining the point of view of autistic siblings. A new study has found that people with autism often see nothing out of the ordinary in relationships with their siblings. The problems of neurotypical siblings may not be obvious to siblings with autism. “Siblings with and without disabilities don't always agree on what's going on in their relationship,” says Meltzer, who led the study. “And we didn’t know about it until we started talking to both.” nine0003

A similar disagreement happened to brothers Ajay and Jarrett Link. Their parents divorced when they were young, and AJ, who was diagnosed with autism as an adult, helped raise Jarrett, who was four years his junior. Jarrett remembers that his brother's awkwardness and long silence caused him confusion as a child. After AJ, now 30, was diagnosed, everything fell into place. “It explained a lot,” says Jarrett, who now accepts his brother's need for solitude with ease. nine0003

For his part, Ajay doesn't recall any awkwardness. “It’s strange to think about it, because from my point of view it was a normal experience,” he says. “But for Jarrett, the experience was different and he didn’t quite understand what was going on. ” The brothers value each other's strengths. AJ admires Jarrett's ability to provide emotional support, while Jarrett says that AJ, who graduated from law school this year, is the smartest person he knows: "If I could do any of what he does it on an intellectual level, I'd be rich by now." nine0003

The same dedication inspired Michelle Byamugishu to contact weather forecaster Rudin during the pandemic. Less than an hour later, she received the edited video. “Hi Mark B, this is Steve. I was happy to know that you have been watching my weather forecasts for over ten years. I know things have changed now because things are changing around the world right now, but we can all get through this together.” After these words of encouragement, Rudin said: “I hope one day, when everything gets better, you and your sister will come to visit me at the station. I would really like that." nine0003

When Mark B looked at the message on his mom's smartphone, his brother Jeremy filmed his reaction. Michelle posted the video to Twitter, where it has been viewed over 64,000 times.

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Relatives of people with ASD, Scientific research

How violence affects the lives of autistic people

02.02.20

Many people with autism experience a “triad” of psychological trauma: brutal circulation in childhood, abuse of specialists and persecution at school or at

Source: Spectrum News

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The bullying started early. Cassian Asasumasu remembers that when she was 5 years old, the children took her things and lied about it because they knew that she could not distinguish people by their faces and would not be able to complain about them. When she was 10 years old at a sleepover, the girls poked her fingers, froze her pajamas and decided to see how many times they could make her cry. Her nervous breakdown from that sleepover lasted 48 hours. The following year, her classmates locked her in a clothes locker, and then she was punished for kicking the door in from the inside. nine0003

“Most of my childhood memories are of other kids bullying me,” says Asasumasu, who was diagnosed with autism at age 3. “I cried every day in elementary school.” Sometimes she cried so hard that she vomited. Even if she held back her tears, the insults hurt her.

In middle school, teachers told her mother that they thought she was at risk of suicide, but apart from that she did not feel any support from adults. Her teachers told her to ignore those who bullied her, but that was impossible for her. She had seven brothers and sisters, who, according to her, often threw their tricks on her, and her parents punished her instead of them. “You get in trouble no matter what you do,” says Asasumasu, now 37, “for everything others do.” nine0003

This experience is a terrible reality for many autistic people. Research suggests that children on the autism spectrum are three times more likely to be bullied, physically and sexually abused compared to their neurotypical peers. Bullying and violence can lead to extreme stress and psychological trauma while being rarely recognized and often left untreated.

Trauma therapy in this group is mostly experiential, so people often have to deal with their own safety and health issues. “Children with autism who have experienced abuse or any form of violence are a very vulnerable population, not only because they are more likely to have similar experiences, but also because we know very little about how it is best to help them,” says Christina McDonnell, professor of clinical psychology at Virginia Tech and State University in Blacksburg, USA. nine0003

She and other experts say one way to improve the support system is to listen to autistic people talk about the harm society has done to them. "We need to do the hard work and figure out what's going on in the systems that allow this to happen," says Katherine Corr, professor of special education at the University of Illinois, USA. “And I believe that the information from the people themselves who have experienced such experiences is the key to understanding how existing systems fail them.” nine0003

Shocking numbers

Child abuse is a broad concept that includes neglect, emotional, physical and sexual abuse. Children with disabilities are particularly vulnerable to abuse, as evidenced by numerous studies over the past decades. There are far fewer studies that address only autistic children. In 2014, McDonnell was writing her thesis on child abuse, and she was able to show that developmental disabilities, including autism, were much more common in children who were investigated for abuse. However, this picture was not consistent with the scientific literature: studies of traumatic stress resulting from child abuse did not include children who were diagnosed with autism. And autism researchers almost never considered the possibility of abuse in their research participants. nine0003

Rare studies in this area have shown conflicting results. Some results suggested that children with autism were more likely to be abused and more likely to be involved in investigations involving child protection services. Other studies have not shown an association between autism and an increased risk of violence, although these studies have been severely limited by small sample sizes and often use outdated definitions of autism.

McDonnell and her colleagues set out to investigate this connection by analyzing data on autism cases and records from the South Carolina Department of Human Services. They compared data on abuse and neglect for nearly 5,000 children with and without autism who were born since 1992 to 1998. They found that nearly 1 in 5 autistic children, and 1 in 3 children with autism and intellectual disabilities, suffered abuse that was brought to the attention of social services. Even after controlling for factors such as low family income and low parental education, children with autism were three times more likely to experience abuse than their neurotypical peers, a research team reported in 2018. “We were blown away by these numbers and how huge they turned out to be,” McDonnell says. nine0003

Lack of necessary care is especially common among children with autism, as well as among children with intellectual disabilities. However, neglect is generally the most commonly recorded by social services, says Kristen Seay, professor of social work at the University of South Carolina, USA. The higher numbers may simply be because children with autism often have special needs and their families may not have the resources to take care of them.

McDonnell's team also found that autistic children are extremely vulnerable to physical abuse. Parents and other family members are the most likely to physically abuse children, but children with autism or intellectual disabilities are far more likely than children without disabilities to be physically abused by other adults—relatives, hired nannies, kindergarten teachers, and so on. nine0003

Similar data were obtained in the US state of Tennessee. The researchers analyzed data from the US Centers for Disease Control and Prevention's autism monitoring website, and they found that having autism almost doubles the chance of a child being referred to child protection services. The study included more than 24,000 children born in 2006 and found that 17% of 387 autistic children were mentioned in calls to the state's child abuse hotline, compared with 7% of other children. Despite high referral rates, only 62% of allegations of abuse of autistic children were investigated by child protection professionals compared to 92% of reports about children with typical development. “We need to raise awareness that this is an extremely vulnerable population,” says study lead author Zachary Warren, a clinical psychologist at Vanderbilt University, USA.

Daily Injury

When P., Nancy Nestor's son, was 3 years old, a year before he was diagnosed with autism, he came home from kindergarten, went to his room and, playing, mumbled under his breath over and over again : "P. fool, P. fool.” (To protect confidentiality, only the initial of his first name is used.) P. did not know what the word "fool" meant, but Nestor's heart bled. She spoke to the teacher, who was shocked. She didn't hear the other kids say the word, but she promised to look into it and put an end to the problem. However, Nestor continued to worry - her son hardly speaks, he will not be able to tell her if he is offended. “No one wants to hear their child called a fool, especially if the child cannot speak,” she says. nine0003

In the following years, P. faced occasional bullying, including a group of high school boys who threw rubbish from lunch at him and demanded that he clean it up. But he also found compassion and support among his classmates, as well as coaches and members of his sports team (he was a runner). Now 22, P. attends a local college and lives at home with his parents. Nestor is still listening to what he says to himself in order to understand what is going on in his life. nine0003

Physical attacks by peers can leave autistic children with facial cuts, dislocated joints, and large scratches all over their bodies, says Daniel Hoover, a child and adolescent psychologist at the Kennedy Krieger Institute in Baltimore, USA. In 2018, Hoover and colleagues reviewed existing research and concluded that children with autism are 3-4 times more likely to be bullied than children without disabilities, including their own siblings. According to various studies, 40-90% of children with autism are bullied compared to 10-40% of neurotypical children.

Sometimes parents notice bullying that their autistic children may not be aware of. When P. was in elementary school, his peers defaulted to making him a prisoner in the game "cops and thieves." The opposite can also happen.
Some research suggests that children with autism may view behavior as bullying, although their parents and other adults do not. Two years ago, Hoover was working with an autistic teenager who was desperate because a boy from his school was making fun of his favorite sports team. To piss off the teenager, it was enough to hint at the accusations against one of the team's players. The boy "can't even function, he couldn't switch from it," says Hoover. To an outside observer, teasing a football team is almost friendly derision, but not bullying. However, the boy was in great pain. nine0003

Some people with autism experience a lot of stress even from normal everyday events because they take the world literally and do not notice the nuances of what others do and say, which makes it difficult for them to trust other people who may say one thing, but do something else. “They may have a kind of chronic trauma from living in the world where they are constantly only 50% aware of what is happening because they miss all these social cues so they constantly feel out of place and experience severe chronic stress,” says Connor Kearns, a psychologist who runs the Anxiety, Stress and Autism Program at the University of British Columbia in Vancouver, Canada. nine0003

Research shows that introverted or anxious children are more likely to experience psychological trauma after being abused than more socially active and outgoing people - lack of social circle can worsen the problem. Autistic children without intellectual disabilities may be especially vulnerable, experts say, because they are more understanding and can be very sensitive to social situations compared to children with intellectual disabilities. nine0003

In addition, many autistic children may be extremely sensitive to mistreatment. “They explode, they run, they get nervous, they scream, they get angry,” Hoover says. “And that can make them targets for new bullying, because it’s easier to get a violent reaction from these kids.”

Abusers choose autistic children for their own reasons. Mainly because often children on the autism spectrum don't have enough communication skills to complain about abuse, or they are not believed even when they complain. Shiei recalls a time when a little girl with a developmental disability told her family about sexual abuse at school. The girl's parents turned to the school administration, but both sides doubted her words until her neurotypical sister spoke about the same abuse. A physical examination confirmed her words. “Those who abuse children know that it is better to choose a child who will not tell anything, who will be difficult to tell, or who will be easier to say that he is lying,” Seay explains. An additional problem is the fact that autistic children are more likely to come into contact with a wide variety of adults in care systems, and this makes them more likely to encounter an abusive adult. nine0003

Abuse of autistic children may continue because educators are not trained to recognize the signs of abuse in children with developmental disabilities, or because educators are afraid that their intervention will make things worse for the child, Corr says. “Very often they are afraid to report abuse to the child protection system if the child has a disability,” she says. “And social workers may not have been trained to work with children with disabilities, what happens to a child if he gets into the system?” nine0003

Recognizing a pattern

One of Asasumasu's earliest and most painful memories is that she is 3 years old, a teacher is sitting in front of her, a baby chair is sandwiched between her legs so that the girl cannot go anywhere. The teacher gives instructions: “Sit down. Get up. Look at me". If Asasumasu does not follow the instructions, the teacher pulls her in the right direction and opens her eyes with his hands.

Many autistic adults have spoken of their traumatic memories when they were subjected to similar "therapy" as children. Critics of such approaches compare such experiences to relationship abuse, because children are taught not to complain about discomfort. “My earliest memories are of adults unclenching my eyelids with their hands and forcing me to look at them,” says Asasumasu. Until today, when someone says "look at me", it's like "I'll never look at you again." nine0003

Abuse can lead to chronic problems, including severe stress, depression, anxiety disorders, and post-traumatic stress disorder (PTSD). Most studies have not shown an increased risk of PTSD among autistic people. But it's possible that the reason for this is that the criteria for PTSD don't fit people with autism, or because psychological trauma in this group is more likely to lead to anxiety, depression and other mental health problems than to PTSD, Kearns said. Moreover, there are no reliable tools to screen autistic children for symptoms of trauma, which is defined as an event or events that negatively affected the individual, and sometimes continue to affect the individual to this day. nine0003

Meanwhile, researchers are developing therapies. Hoover, for example, is adapting a technique for autistic children called trauma-focused cognitive behavioral therapy. This 12-week program aims to encourage children to talk about what happened to them and teach them how to deal with their fears associated with the experience. Because many children with autism have trouble understanding verbal instructions or remembering what they need to do outside of psychotherapy sessions, Hoover developed visual reminder schedules at home and also enlisted the help of parents. This modified program also includes children's special interests, such as Spiderman or Harry Potter, to help them tell their stories. nine0003

This modified method seems to work, at least according to preliminary observations, says Hoover. Parents report positive results, and autistic children who receive this therapy show improvements on the UCLA Child/Adolescent Response Index for PTSD. This is a PTSD screening questionnaire for children and adolescents. Hoover is currently writing a manual for this method, and he says he receives many requests every day from all over the world from professionals who want to be trained in this method. Now he and his colleagues are collecting therapy data from several dozen children over the past year, after which they plan to conduct controlled clinical trials. nine0003

McDonnell, meanwhile, is preparing an assessment of the potential benefits of standard trauma treatment for children with autism. Her team is trying out programs from community organizations that focus on education about violence, sexuality and how to stay safe.

Many autistic people come up with their own strategies. Adrienne Lawrence, a 36-year-old lawyer from Los Angeles, USA, learned that she had autism a year ago. But she has always realized that she relies on logic rather than nuance to understand the world around her. For example, if a man tells her on introduction that his mother is dead, she assumes that it just means that his mother is dead, she doesn't think he's trying to put pressure on pity to sleep with her. If he apologizes and says he won't lie anymore, then she assumes he will. This is one of the reasons why autistic people experience violence so often. Lawrence says that many non-autistic people lie, but autistic people don't even think about the fact that others might be lying. nine0003

Lawrence has always come up with rules to help her make sense of the world around her, and after her diagnosis, she began to follow many of the new rules. For example, she has her own guide on how to avoid sexual harassment she faces at work, including a list of inappropriate behaviors for different situations. “I used to rely on 10 years of forensic science and do statistical and logical analysis in my head about whether it’s safe to come home to a man, given the various factors in the situation.

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