By Nicola Heady
What ‘camouflaging’ means for the high functioning autistic girl and her mental health
So, firstly what is mental health? For most of us, it’s about having a good emotional, psychological, and social well-being which influences how we feel, think and act. The World Health Organization further defines it as having the ability to think, learn, and understand one’s emotions and the reactions of others. It is well documented in research that autism causes significant impairments and challenges in ALL of these core abilities. So, from the very outset, we can safely conclude that the majority of children with autism are already placed in a disadvantageous position and more susceptible to experiencing poor mental health.
Autism & Mental Health
So, what is out there in terms of research into autism and mental health? Well not a lot unfortunately. Research on how autism impacts on mental health is still in its’ infancy and still very limited. However, if we explore the realms of autistic girls and mental health, it is virtually non-existent. And for that very reason; this blog will focus on what we do know about the autistic girl, ‘camouflaging’ and how it impacts on mental health.
‘She doesn’t look autistic?’ is a phrase that many of us have heard within a professional, personal or societal context. What the parent or carer witnesses within the safety of the home setting does not always reflect what the front-line professional witnesses in their social, educational or clinical setting. And rightly so!
We know that many girls with autism, particularly those who have less severe visible impairments and ‘perceived’ to be high functioning are still being missed or misdiagnosed or do not receive a timely diagnosis. Although, there are a myriad of multi-factorial reasons for this, one significant area that has recently grabbed the attention of researchers is the notion of ‘camouflaging’; which is suggested to be a significant factor in prohibiting or hindering early identification and intervention.
So why do girls camouflage? We know that many autistic girls have an irrational fear of peer and societal rejection. And unfortunately, due to limited awareness and understanding of autism in girls, this fear frequently becomes a reality. Their heightened self-awareness creates a feeling of difference when they compare themselves to their peers and this ignites an obsessional perseverance to appear what they perceive as ‘normal’ in the social setting, sometimes to the detriment of their overall wellbeing. So, like a chameleon, the autistic girl uses this camouflaging technique to protect herself, enabling her to blend into a societal setting, hiding her true and unique identity. The high functioning autistic girl is also a master at mimicry and has an astute ability to be able to act in conformity with any social setting. Utilising these unique aptitudes, they adopt and mimic their peers’ behaviours, belief systems and values to fit into a social world that they do not understand and often fear. These unique aptitudes however come at a high emotional cost to their mental health in the form of debilitating anxiety, depression and other co-morbid conditions which further adds more complexity for the professional who has to detect and diagnose the child.
So, when is the autistic girl detected? It is well established in research that diagnosis can take many years for the high functioning autistic girl to attain. However, the adolescent era seems to be a period where the autistic girl frequently exposes her true self. This era is a critical period for any girl where physical changes occur and emotional wellbeing becomes an area of possible conflict and confusion. However, for the autistic girl, this is a tumultuous and transitional period of life where many go into a mental health CRISIS. Their camouflage dissipates very quickly and frequently results in a cascade of INTENSE behaviours that are not typically or usually associated with the child. Extreme demand avoidance, school refusal, severe anxiety, sleeping problems, eating disorders, social withdrawal, paranoia and frequent oscillating emotional and physical outbursts occur for no rational reason.
So why this era? It’s simple really if we think about it. Not only do they have to deal with unfamiliar physical and emotional changes; many girls with autism struggle to cope with the transition to secondary school and the dramatic changes associated with the educational and social setting. They lose control of their safe and familiar surroundings and their whole environment and social relationships unravel before their eyes, as they are introduced to a new, foreign social world that they approach with trepidation for fear of the unknown. The challenges in emotional and sensory regulation, delayed processing and the impaired interpretation of social and body cues place them in vulnerable situations. These girls are often bullied, lose long lasting friendships, become school phobic and develop co-morbid conditions as a result of the overwhelming social anxiety, impaired social interaction and inability to communicate their feelings of confusion, anxiety and fears.
Repercussions on Mental Health
So, what happens to them? Well, research suggests that many autistic girls; providing they meet the threshold criteria, enter ‘Mental Health Services’ in CRISIS. A service which is renowned for safeguarding our most vulnerable children in society but a service that is also not yet equipped with the specialist knowledge and training that is required to meet the mental health needs of an autistic girl. For the autistic girl who is so overwhelmed by anxiety by this point; engaging in therapy is virtually impossible and unattainable. Many refuse to engage and many cannot even leave their house to attend the appointment.
And understandably so! Our normal expectations for clients accessing these services are for them to attend a designated building, socially interact with a clinician and engage in a talking therapy. However, for the autistic girl, these simple expectations are immense barriers to personally overcome. The new physical and social environment, the act of social interaction and communicating their feelings and emotions to a stranger is virtually an impossible feat for these girls. And the only action they can take is to yet again protect themselves; ‘camouflage’ again, hide their true emotions and feelings and conform to what they think the clinician expects of them. Services discharges them and the mental health cycle continues.
So, what now? Well, more often than not, they and their family are left to navigate an educational, health and social system that is not yet geared to meet their unique needs. Mental health becomes the primary focus as it engulfs and overwhelms their quality of life. Many autistic girls become school phobic or are forced into the home- schooling route in an attempt to protect their escalating mental health problems. Excluding them from education and further socially isolating them from society with additional co-morbid conditions that reman for life, if unsupported. Many will eventually overcome their mental health problems through creating their own coping strategies however, for many the damage is done.
And finally! So what can be done? Early identification and intervention is the key for these girls but we are still a long way away from attaining that 3:1 that is suggested to be the current ratio for boys diagnosed to girls. So meanwhile, a proactive response is urgently needed to create a specialist mental health service not just for autistic girls but boys too. We must remember that these conditions do not just affect the brain but the nervous system also. Mental health services cannot be solely held responsible to meet the mental health needs of these children. A multi-disciplinary way of thinking and approach is necessary, just like the diagnostic assessment process. Interventions are needed that will support, but more importantly protect, these vulnerable children; who through no fault of their own are already more susceptible to experiencing poor mental health.
Hi! I’m Nicola Heady, a very proud mother of two beautiful autistic daughters. However, it took a long, exhausting seven years to get my first daughter assessed for Autism. Eventually she was diagnosed at the age of 13 but by that time; she had developed debilitating anxiety and other co-existing conditions that resulted in her becoming school phobic. So, I did my MSc in Autism & Related Conditions, specialising in autism and girls, to help support her and understand ‘why it had taken so long for professionals to see’ what I could clearly see as a parent. I am now in my last year of PhD but I still love to share my knowledge and support families who are still struggling out there like I was, all those years ago.