Autism and Camouflage - how girls with ASD can keep it hidden from sight

This week I have been learning about the concept of 'camouflaging' as a technique used by autistic people to get by in the world of neurotypicals.  It has been a real eye-opener, not least because it's blatantly obvious that this is the very method I have used to get through my life to date.

Also known as 'compensation', camouflaging is the term for how autistic individuals manage to hide or disguise their autistic traits, allowing them to come across to the casual acquantaince as entirely neurotypical, often to the point that no-one would ever suspect that the individual is on the spectrum.  It is a real hot topic currently, and it seems that long-overdue research is finally being undertaken into its mechanics and its effect on autistic people who employ it.  At its most basic, camouflaging appears to rely on intense effort and stress on the part of the individual as they utilise their excellent memory of social cues to 'artificially' fit into social conversation and situations - essentially making their social life an endless act in order to prevent showing behaviours that they would be embarrassed or even ashamed of.  The range of skills involved is pretty daunting - the individual will have learned in minute detail how to react appropriately to the actions, speech and expressions of others, often using memorised details from their own life and even the media (films, TV shows) to help them 'say and do the right thing.'  As Meng-Chuan Lai notes in the introduction to the article 'Quantifying and exploring camouflaging in men and women with autism':

"One such coping strategy is that they may ‘camouflage’ difficulties during social situations by either hiding behaviour that might be viewed as socially unacceptable or artificially ‘performing’ social behaviour deemed to be more neurotypical – they Pretend to be Normal".

Forced eye contact, moderation of voice volume, even jokes and types of laughter can be examples of this camouflaging, all of which can usually serve to allow the autistic individual to 'fly under the radar', as Lai puts it, never getting diagnosed as there is never any concern from their teachers, parents or doctors.  The turmoil is all on the inside and is invisible to others.

Several clear patterns are beginning to emerge from the studies that continue to be published.  Firstly, successful camoflaging seems to be more prevalent in female autistic people for reasons that are still unclear; the ability to hide one's autistic traits (especially social ones) seems to be more readily within the purview of females, and female children in particular seem to have far more success in establishing friendships, for example (though maintaining them is often far less successful).  It appears that girls are more adroit at performing the expected social cues, and presumably more able to identify them in the first place.  Boys, in contrast, are far less capable of this, meaning that their autistic traits and behaviour may be more visible and obvious.

This, I think, has significant ramifications in the school environment.  The overwhelming 'maleness' of autism and aspergers in schools is well noted, and I think SEN departments, teachers and other stakeholders would benefit from being aware of the fact that female students who are on the spectrum are very good at hiding the fact, and therefore more care and time should be taken when trying to identify a students extra needs.  From my reading, I would suggest that the following considerations be taken when working with female students who may be on the spectrum:

1. Do not dismiss the possibility of ASD if they seem to have a social life - closer examination may be needed to establish the nature of the social interaction and whether friendships are maintained or falling out is commonplace.

2. Do not dismiss the possibility of ASD if eye contact is maintained, conversation with known adults is easy and a sense of humour is apparent!  Firstly, a sense of humour is often finely developed in people with autism (I, for example, am hilarious); secondly, it tends to be that conversation and interaction with other children and adults known to the student will be fine, flowing naturally - the student knows the rules and cues for those people.  They will, however, struggle with strangers for whom they have no record or knowledge.

3. Consider the other traits of ASD more carefully.  Obsessive behaviours, limited and intense interests, dislike of physical contact are all quite noticeable if you know what to look for.

It goes without saying that male children can be adept at camouflaging their symptoms, right up to adulthood.  I was only diagnosed at 34 because I had felt for years something wasn't quite right; at school it was never even considered as far as I am aware.  With male camouflaging, autistic traits can be hidden by a desire to not appear unusual, to avoid bullying, or just to avoid stressful situations getting worse.  This compensation is draining - it seems that males with autism that has been well-hidden are far more likely to suffer with anxiety and depression, mostly (it seems) due to sheer constant effort such camouflaging requires.

Finally, this phenomenon seems to be one of the reasons for some autistic children showing less severe traits as they grow older - they simply learn to cover them up.  All of this brings us to the rather uncomfortable conclusion that people with autism, girls and boys, have to expend considerable energy and mental strength to appear normal, for fear of being bullied, ostracized or treated unfairly.  This leaves them drained, depressed and even at times suicidal.  Surely this is no way for society to handle such a potentially talented and bright segment of the population?

Teaching students with ASD - some practical tips that might help. Part One

I am coming at this purely from an angle of experience - please bear that in mind.  However, I have always had considerable success in helping students with ASD make the most of their time in school, and now I find myself on the Spectrum I am more able to identify why this may be the case.  What follows are possible methods that have the potential to help.  Of course, every child (and adult) with ASD is quite different, so there will be a requirement for lashings of professional judgement too!

1. Empathy for the student

This is probably pretty much a given, but I feel all neuro-typical teachers could gain some insight into the mind-processes of those with ASD if they knew a little more about how it affects everyday interaction with the world.  The thing to bear in mind for all ASD students is that they are doing pretty well just by being in school.  I don't mean they should be congratulated for this - that would be patronising and wouldn't help the general attitude towards ASD one bit.  Rather that this should be taken into consideration when dealing with them.  Students with ASD are so much closer to breaking point that most other students; they are one or two straws closer to having their metaphorical back broken.  Everything that school comprises of (with the possible exception of the safe, repetitive routine) can be anathema to any student on the spectrum, from the shouting children, lack of safe, quiet spaces, loud and sudden bells to the hard-to-read teachers and hidden, unknown expectations of them.  As such, it is worth pausing to remember this.  Imagine taking in nearly every single sight, sound, smell, taste, touch around you, unable to block it out, all layering over one another over and over again creating a white noise that you can only escape from if allowed to do one of your coping strategies, which are probably not entirely suited to the classroom environment.  This video, from the National Autistic's Society, does a pretty good job of simulating this - can you blame the child for getting upset at the end? 

The child that you are trying to get the best out of is dealing with this all the time, and the younger they are, the less expert they will be at handling it.  Take a moment.  If the student is struggling to get started on a piece of work, or is extremely distracted, then it is possible they are close to melt-down or over-stimulation.  Give them a break, allow them to take a brief time out or indulge in some doodling or reading for a moment to ground them.  See if your SENCO knows what the student's strategies to calm themselves are and make sure you allow the student to utilise them.

2. Keep the environment routine and calm at all times.

A calm environment (that crazy red sun from a month or so back)

There is a benefit to this generally, let's face it.  Having strong routines and a calm but friendly and safe atmosphere in the classroom is a real boon for behaviour management with all students, but it will transform your room from a mad carnival/zoo arena into a pleasant place to be for a child on the spectrum.  Make sure lessons begin and end in the same way every day if you have an ASD student in the group.  Ideally let them know what they will be doing at the start of the lesson, if you have a good relationship with them.  Minimise surprises, especially surprise tests (are they ever a good idea for anyone??) and make sure that if a routine will change (a school trip, say), that the child is spoken to and made to feel aware AND considered by the teachers and other staff - often I feel just the fact that time has been taken to remember that a student may have difficulties is enough to help them through, as they feel more secure (I know I do).  I have found that even a quiet glance and a reassuring nod of the head can help a student cope with whatever new challenge is approaching - it shows them that you understand, and with ASD it helps so, so much if other people understand.  See my blog post here for some insight into the stresses that environment and people can bring.

3. Be clear in your instruction.

Make nothing ambiguous when setting work.  Again, all students will tend to benefit from this, but I cannot state enough how vital it is that a student with ASD knows what you expect of them.  Modelling is a great tool here, of course - showing the students work that is successful will work wonders with many students on the spectrum, and especially those with Asperger's, as it will remove a major source of debilitating procrastination - the fear of not doing the job correctly.

Even clarifying exactly how much should be written (an admittedly annoying task at times, but I ALWAYS let a student with ASD know what is needed) can boost the effort and motivation in class, as can any other clear expectation ("complete all four questions before you move on to the next task in 5 minutes", for example).  I think this is one of the greatest kindnesses you can show to a student on the spectrum, as it will make the task clearer and crystalised, a possible end goal rather than a vague and misty 'something'.  For English teachers, Slow Writing (thanks to David Didau) can be an excellent technique to employ, for the same reasons - it allows students to explore their creativity (and they may be startlingly creative) within safe and clear boundaries.

Behaviour Management will be the focus of the next post - this is a tricky one!

I hope this helps both teachers and students and please let me know if you think I've made an error - as I said, this is mostly from personal, long experience.

Three Scenes from an Awkward Mind

I know that face: that face means upset.  It's the angle of the head and the amount the eyes are closed, seen it many times before.  And usually it means upset with me because when she's upset with something else then the angle of the head is different and she doesn't do that thing with her mouth.  So I must have done something wrong, but I don't know what.  I went to get a mars bar after work - does she know about that somehow?  I should offer to get her something to see how she reacts, that'll tell me what I need to know.

Oh, didn't work.  She doesn't seem to want anything but wasn't snappy, but wasn't cheerful either.  Could she be upset with something that's happened that I don't know about?  But then why wouldn't she tell me?  I can't work it out and I don't think she'll tell the truth if I ask, as people don't do that especially when they're upset.  Her tone of voice I recognise though, so I'm pretty sure I've annoyed her in some way, but I still don't know why.

***

Don't say anything.  Please don't say anything.  I just want to get my drink and then go and sit down quietly.  Don't make eye contact, that will make him start talking, just keep looking at your phone and try to calm down, you're only getting a coffee from a new barista you've not met before.  Oh god, he's talking about the holidays, am I going anywhere nice?  Stock phrase - no, not this summer, you - and wait for the reply that I don't care about at all.  Why would I care about where this stranger is going on holiday?  Do that quick laugh of blended appreciation and understanding, always works.  Still don't look in the eyes.

***

An empty pair of seats.  Thank God. Train's a bit too busy, don't like the noise or the heat.  I'll sit by the window, put my bag next to me.  Please don't anyone sit down here.  Still people coming down aisle from both directions.  Are there any other empty seats?  Can see a few down there, one or two there unless they have short people in that I can't see.  Is putting my bag there rude?  Don't want to seem rude but don't want to have to sit next to someone all the way to Leicester.  Three people coming.  What chances do I have that I'll be left alone?  20%, maybe 30%? Maybe they'll be too awkward to ask to move the bag.  They've sat down elsewhere!  Rejoice! Relax!

...

What about when we get to Bedford?  Loads will get on there.  Shit, where will they all sit?  Wait for the platform....

...

Platform's bloody crowded.  Typical.  Bloody hell.  Here they all come.  That guys looking at the seat.  Oh god, he's going to sit down.  Scoot over as close to the window as I can, bag on knee, too awkward now to stand up and stow it overhead, so doomed to discomfort.  Got to keep legs away from his; can't let them touch, even a little.  Hope I don't come across as weird.

Teaching with Asperger's - a paradox to ponder (Part One)

Asperger's syndrome, being on the autistic spectrum, is a combination of three key areas of daily difficulty: social interaction, social communication and social imagination

See this handy diagram for how they operate and interact:

As you can see, there are whole worlds of problems here, all of which are concerned with dealing with other human beings.  Some are quite extreme, such as "inappropriate touching of other people", whereas most are fairly straightforward.  None of them, I think, would be associated with quality teaching.

The fact I am a relatively successful teacher who has managed to rise to middle management and still get good results was always in the way of me thinking I really had some kind of autistic condition.  No matter how miserable I was, trying to operate like everyone else, my successful career always stood out as a veto to the concept of my being ASD.  How could I teach the way I do with autism?  How would that even work?  It is something that I have given a lot of thought to, and I believe I now have some understanding of how it works.

As I have noted before in this blog, I have managed to develop, over the years, lots and lots of coping mechanisms and little tricks to help keep all of this at bay and hopefully invisible to the naked eye.  I believe this started very young, to the point where there was never any concern for my psychological well being as a child.  I was thought shy, a little awkward and something of a loner, but little more than that.  I had picked up at an early age how to avoid stressing myself out and how to act with people so they were comfortable and happy, and this skill got more sharply honed as I grew up.  As such my repetitive movements that help keep me relaxed (stims, as they are known in the Aspie community) are very subtle (clenching and unclenching toes, rubbing feet together, basically stuff you can do without anyone noticing) as I hated the thought of standing out or appearing to be 'weird' in any way.

Masks. From Skyrim, obviously.

By the time I was doing my PGCE and was in schools teaching for the first time, I had been managing my symptoms for nearly 20 years and as such was pretty good at it.  I was also very confident as I had been successful at university and was hugely buoyed by how natural teaching felt for me.  I think everyone who teaches can agree that there is an element of acting involved - whether this is a means of holding the class's interest or to hide true feelings (or hangovers), and this is exactly how it felt for me.  Teaching a class was going on stage.  Now bear with me - I'm not suggesting that I set out to be some kind of comedian-teacher (imagine how that would go down on Twitter!) - more that I found wearing a 'teacher mask' and being something of an exaggerated persona made teaching not only possible for me, but even successful.  Students tended to be happy with my passion for the subject and my slightly intense humour making imaginative links between topics and ideas.  I could teach precisely because I wasn't myself in the classroom, and all my discomforts and issues with social interaction were hidden behind my mask.  This works because teaching isn't a normal social interaction, just as being on stage isn't either.  The power balance and attention is not equal or eithin the usual bounds of social interactions.  As a teacher, you are telling a narrative, explaining a concept, talking at the world even (at times) - you are not engaging in small talk and reading facial expressions carefully, worrying about whether the other person likes you or thinks you're weird.  In short, teaching doesn't fire off the usual Asperger's traits that make social interaction so difficult

But it still takes its toll.  I still feel deeply anxious before and after every lesson I teach, and each lesson exhausts me, drains me of energy.  You can't wear a mask all the time, and every minute with it on requires still more minutes with it off, preferably alone, recharging. But I can do it, and that keeps me coming back for more.

Next time I'll consider how Asperger's actually helps with reading a classroom.

A diagnosis of Asperger's. Part Six

On Wednesday morning I went to Devizes for my third and final assessment appointment, four weeks after I had started.  These assessment sessions were about two hours long each, with the psychiatrist working her way through an enormous questionnaire that seemed determined to access every last neuron of my memory and experience, split into several clear sections.  In the first appointment we had covered social communication; in the second, social imagination, friendships and work; in this one we had something of a light relief period, as it focused on things such a motor capabilities and sensory quirks.  Needless to say, these appointments left me feeling extremely drained and worse, in Devizes.

By the end of the session, after I had discussed how I can't help but read and decode every single car numberplate I see (it's true, and pointless, and tiring), and how I am hugely over-sensitive to repetitive sounds, the psychiatrist looked at me and informed me that there was little doubt at all that I was on the autistic spectrum, and that specifically I had Asperger's.  I had it in spades, in fact,  The feeling of relief was powerful, as I had invested a lot of time and energy into the process, and had begun the long and arduous task of re-evaluating my life with this potential diagnosis in hand.  Discovering that there was no further doubt, and that I'd be getting my report through the post in a week or so, was hugely comforting and still is, a day and a half later.  We spoke for a while about my most immediate concerns (I made the most of being assessed by an actual psychiatrist - apparently this is quite unusual) and then we parted company.  I have spent the last 36 hours since thinking about what the diagnosis means.

Ultimately it means a lot.  I don't think it will change who I am (though I fear I may 'relax' into it a little), as I have always had Asperger's, so there is no reason for change.  But it will (and to a point already has) change how I view myself and my interactions with the world.  How this pans out will be interesting to see, but I am determined to see things with a new optimism as I realise how far I have come with a brain that is not neuro-typical, and therefore how much further I could go.  I am hopeful that this diagnosis will bring peace of mind and comfort when I'm feeling low, and I am thankful for the opportunities and strengths it has brought me.

Where do I go from here?  That is the question, and I think I will continue to blog, as I'd like to go into more detail about living with Asperger's, in the hope it helps folk like me in future.  I am also going to immerse myself in the Aspie community and see what that brings.