Parents looking for a private autism assessment for a teenage girl should make sure they use a service that is experienced in assessing the female autism presentation. This is because females often mask their autistic differences, and their presentation is much more nuanced and therefore often missed.
We are a specialist autism service that provides private autism assessments accepted by the NHS across the UK.
Our team has significant expertise in the assessment of females with autism; in this article, we outline the signs of autism in teenage girls, what to expect in an autism assessment and the impact a diagnosis can make.
Is it common for autism to be identified in the teenage years?
Our clinical team regularly undertake autism assessments for girls whose difficulties did not become apparent until the teenage years. Girls with autism spectrum disorder begin to mask their differences from a surprisingly early age and often manage primary school without any apparent difficulties. It can come as quite a shock to parents when difficulties emerge in secondary school.
As girls reach adolescence, social expectations become increasingly complex and social relationships become much more challenging to navigate. This, along with the busy, noisy environment of secondary school, can be overwhelming for a teenage girl on the autism spectrum.
The move to secondary school can be challenging for those with autism in many other ways. The daily movement between different classes and teachers can be difficult to manage. Wearing a uniform can be a struggle, as can the various sights, sounds, and smells in different areas of the school.
Often, teenage girls with undiagnosed autism will initially present with anxiety, low mood, school refusal or eating difficulties. Difficulties are often attributed to these conditions, and the underlying cause of them can be missed.
Autism is a lifelong developmental condition, whilst difficulties might have only come to light in the teenage years, differences will have been present since the early years.
What are the signs of autism in teenage girls?
The core differences in autism are the same for everyone, regardless of age or gender. However, how the signs or characteristics present varies between individuals and by age and gender.
The core diagnostic criteria for autism are:
- Deficits in social communication and social interaction
- Restricted, repetitive patterns of behaviour, interests or activities
Let’s consider how these may present in teenage girls:
Deficits in social communication and social interaction
Problems with socio-emotional reciprocity: Finding it difficult to manage the to-and-fro of conversation, being able to chat about specific subjects or topics of interest but struggling with social chit-chat, worrying about (or rehearsing) what to say to others, finding it hard to respond to others when they are hurt, upset or concerned, copying the way others interact
Decreased non-verbal behaviours: Using a reduced amount of hand gestures when interacting, feeling uncomfortable with eye contact, only showing extreme emotions through facial expression, consciously using non-verbal behaviours to ‘fit in’, non-verbal communication appears exaggerated at times due to being copied
Problems with friendships and relationships: Struggling to make and maintain friendships, only able to manage one or two friendships, struggling to understand issues within friendships, taking an unequal role in friendships (being more passive or taking the lead)
Restricted, repetitive patterns of behaviour, interests or activities
Repetitive motor movements: Tapping fingers, picking skin, cracking knuckles or repeated movement of the hands on objects or other parts of the body (for example, twiddling rings on fingers)
Needing sameness and predictability: Dislike of spontaneity or surprises, upset when things do not go to plan, following the same routines, struggling when things change or do not go to plan, needing to know when things are happening in advance
Intense interests or interest in certain aspects of objects: Spending a significant amount of free time engaged in the same hobby, activity or interest, needing to research facts and in-depth information about a subject area, collecting things, watching the same TV programme, needing to place or set-up objects in particular ways
Sensory differences: Avoidant of certain sensory input, such as noise, bright lights or the textures of certain foods. Seeking sensory input, such as chewing pencil tops, stroking blankets or smelling items in shops
Masking and camouflaging in teenage girls with autism
As mentioned earlier, autistic girls can start masking and camouflaging their differences from a very early age.
It is thought that females are more socially driven than males and therefore have more drive to ‘fit in’ socially. This leads to them suppressing autistic behaviours such as finger movements or talking about their niche interests when around others as they do not want to appear different. Autistic females will also watch how others interact, be it in real life or on screen, and copy behaviours and social phrases to compensate for their difficulties in social communication and interaction.
Masking and camouflaging make teenage girls with autism appear as if they are coping better than they really are, and this is the main reason so many autistic girls are missed.
Barriers to assessment
In many areas, access to the local NHS autism assessment pathway is via a child’s school. Many autistic girls are so conscious of fitting in, they follow the rules and are good students, and there are no concerns raised in school.
Unfortunately, many professionals are unfamiliar with the presentation of autism in girls, and if autism is not recognised in the school setting, you may struggle to access an NHS assessment.
NHS autism assessment waiting lists are growing across the UK, and even if a referral is obtained, the wait to be seen is years.
How to access a private autism assessment for a teenage girl
We do not require a professional referral to undertake an autism assessment. We believe that parents know their children best, and therefore, parents can refer their child for an assessment with us at any time.
I am not sure whether my teenage daughter needs an autism assessment
If you are seeing some of the signs of autism but are not sure whether an autism assessment is needed, you can contact us for a free autism screening.
We will ask you to complete some questionnaires for us and then discuss your responses, as well as other concerns you have.
One of our experienced clinicians will advise you as to whether your daughter is showing signs of autism and would benefit from an assessment.
As registered professionals, our clinicians will give you an honest opinion and will not recommend an assessment if it is not warranted.
If my teenage daughter is masking, and school don’t see the signs of autism, how will it be picked up in an assessment?
We are highly experienced in the assessment of autism in teenagers and females who mask. Whilst high-masking females successfully hide their differences from their peers and even teachers, we will be able to see the masking behaviours. When we observe girls as part of an autism assessment, we look for nuanced social behaviours and the way in which all aspects of communication and interaction are integrated. You can read more about how we manage masking and camouflaging in an autism assessment.
When we complete the Autism Diagnostic Interview – revised (ADI-r) with you as parents, we will be able to elicit autism traits. We understand the way in which autism presents in females across the lifespan and will explore the traits with you in detail.
What to expect in an autism assessment
There will be at least three different clinical experts involved in your assessment.
Onboarding: When you decide to go ahead with an assessment with us, you will be allocated one of our friendly clinical assessment coordinators. They will explain what to expect during the process and serve as your point of contact throughout your assessment.
Background information and school information: Your clinical assessment coordinator will send you background information questionnaires, which you can complete at your convenience. They will also ask you to sign a consent form for us to source information from your daughter’s school. When received, they will contact the school to request the information we need.
Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2): We will complete the semi-structured interview and observation with your daughter online or in person, depending on our preference. During the session, we will look at her social communication and interaction behaviours
Autism Diagnostic Interview -Revised (ADI-r): The ADI-r will be completed with you as parent(s) via a video link. In this in-depth session, we will gather information about your daughter’s behaviours both currently and in earlier childhood
Multi-disciplinary review: When we have gathered the extensive information we require, we review as a team and decide whether the clinical evidence suggests that the DSM-5 criteria for diagnosis are met
Robust, professional report: After the assessment is completed, you will be provided with the diagnostic outcome and an extensive report. The report will summarise all information gathered, the reason for the diagnostic decision and provide you with personalised recommendations
Feedback session: You will be offered a post-assessment session with one of the clinicians who formed part of your daughter’s assessment team. You can use the session to discuss the assessment and/or to ask advice
Is it better to have my daughter’s autism assessment in person or online?
There is no clinical benefit in choosing an online or in-person assessment; it is a matter of personal preference. You can find out more about online autism assessment here.
How do I prepare my daughter for an autism assessment?
Your daughter will only need to be present for the semi-structured interview/observation part of the autism assessment.
You can prepare her for the assessment by reassuring her that the session is about us getting to know her and finding out about her strengths and differences. Offer reassurance that it is not a test and that there are no right or wrong answers or responses.
All of our clinicians are experts in the field of autism, but are also friendly, skilled, and experienced at working with people who are neurodivergent. You can assure your child that we will make her feel at ease, and she does not have to complete any part of the session that she is not comfortable with.
Can parents stay for the ADOS-2?
It is better if your daughter can manage the session on her own. Many teenage girls will look to their parents to answer questions for them if they remain in the room, and this makes the observation more difficult.
However, if she is particularly anxious and cannot stay alone, you may stay in the room. We ask that you sit quietly and try not to answer for or correct your daughter’s responses.
What are the benefits of an autism assessment for a teenage girl?
An autism diagnosis is extremely important in terms of self-understanding for teenagers. Many teenage girls will have been masking their difficulties since a young age, and this in itself has a huge impact on self-esteem and self-understanding. A diagnosis is the first step in understanding identity, embracing difference and self-acceptance.
A diagnosis can be helpful in terms of others’ understanding too. It can help you as parents to recognise the reasons for particular struggles or behaviours. Many parents find that their approach to parenting changes after diagnosis.
The diagnosis also helps raise awareness of the needs among school staff. The Equality Act also places a duty on schools to make reasonable adjustments for pupils who are on the autism spectrum.
An autism diagnostic report can provide evidence that supports examination adaptions, and can be useful for the future in terms of accessing support in college, university or the workplace.
Will a private autism assessment be accepted by school and the NHS?
As long as the assessment has been completed in line with the NICE Guidelines, and this is evidenced in a report, the NHS and schools will accept the diagnosis. Public bodies readily accept our assessments and diagnoses.
Further advice
If you would like more information about a private autism assessment for a teenage girl, or would like to arrange an assessment with us, please get in touch. We will be more than happy to support you on your journey.
