Nicola Heady, who focuses her interests on women with autism, wrote two articles for DifferentBrains, which is a site created and organized by a handful of autism advocates who strive to encourage understanding and acceptance of individuals who are nuerodiverse. Heady wrote one article titled, "Autistic Girls and Camouflaging," which focuses on specific behaviors and the overall mental health of young women and girls with autism. She starts her article by discussing mental health and more specifically, mental health in people with autism. The World Health Organization defines mental health as "having the ability to think, learn, and understand one's emotions and the reactions of others." Heady acknowledges that for most of us, mental health is more about having a good emotional, psychological, and social well-being as it influences how we feel, think, and act. We know from research that autism causes significant impairments and challenges in all of these core abilities, thus, it is safe to conclude that the majority of children with autism are already at a disadvantage and a more susceptible to experiencing poor mental health. There is, however, little information available in terms of the connection between autism and mental health, specifically in the exploration of autistic girls and their overall mental health beginning in infancy. Heady also points out that girls with autism, particularly those who have less severe impairments or are "perceived" to be high functioning, are continuously being missed or misdiagnosed or not receiving a timely diagnosis. The notion of camouflaging is suggested to be a significant factor in hindering or prohibiting early identification or intervention. So what is camouflaging? Why do girls with autism do this? It is known that autistic girls have a fear of peer and social rejection and unfortunately, these fears often become reality. Their already heightened self-awareness creates an intense feeling of difference when they are surrounded by their peers and they begin to obsess over the idea of being seen as "normal." So, they enable their skill of "camouflaging" to protect themselves and blend into the social setting. A high functioning autistic girl is also a master of mimicking and has an ability to conform to any social setting. They adopt and copy their peers' behaviors, belief systems, and values to fit into a social world that they do not understand and might even fear. However, this behavior comes with a high emotional cost to their mental health by increasing the risk of anxiety, depression, and co-morbid conditions that adds a complex combination of challenges for the professional who needs to diagnose and serve the child. It can be difficult to diagnose a young girl with autism because of their ability to camouflage and hide their true selves. However, during adolescence, autistic girls have been seen to divulge their true selves and their diverse characteristics as this is the period of considerate physical changes and their emotional wellbeing becomes an area of possible conflict and confusion. This can be a tumultuous period for autistic girls and they can go into a mental health crisis. Their ability to camouflage will likely dissipate very quickly, resulting in intense behaviors that are not typically or usually associated with the child. Behaviors like extreme avoidance, school refusal, severe anxiety, sleeping problems, eating disorders, social withdrawal, paranoia, and emotional and physical outbursts that seem to occur for no reason, may be observed by the child's caregivers, parents, or the professionals that work with them. During adolescence, autistic girls have to deal with unfamiliar emotional and physical changes and struggle to cope with the transition to secondary school and the dramatic changes to their educational and social setting. These girls will face a multitude of challenges in their emotional and sensory regulation, delayed processing and their impaired interpretation of social and body cues, which may place them in some vulnerable situations. These girls may face some bullying and lose long lasting friendships, which may lead to them becoming school phobic or developing 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. So what happens in regard to the repercussions on their mental health? Research suggests that many autistic girls, if they meet the threshold criteria, may enter "Mental Health Services" in what could be considered, crisis. These services are supposed to be there to safeguard some of the most vulnerable children in our society, however, these services have proven that they are not yet equipped with the knowledge and training that is required to meet the mental health needs of young autistic girls. By the time they reach these services, they risk being so overwhelmed by anxiety that they refuse to engage and may not want to leave their house for an appointment. It is expected for these girls to walk into a designated building, socially interact with a clinician and engage in talk therapy, however, these things that may seem so small to everyone else, are actually immense barriers for the autistic girls to overcome. This forces them to feel the need to "camouflage" to hide their true emotions and feelings and conform to what they think the clinicians expect from them; the cycle continues. Because of this, these girls and their families are forced to navigate an educational, health, and social system that is not yet equipped to meet their unique set of needs. Their mental health needs to be the main focus in these situations. So, what can be done to improve the services that they receive? Early identification and intervention is the key to solving the ratio of boys to girls who are diagnosed and treated. A multi-disciplinary approach needs to be implemented to encourage interventions that will provide support and protect these vulnerable children who are already more susceptible to experiencing poor mental health. Not only are practitioners and professionals responsible for having the knowledge and tools to navigate the challenges that these girls face daily, but their parents and caregivers should be keen on the behavior of "camouflaging" as it is a key indicator of what might be going on in these girls' lives and the diagnosis and services they may be needing.
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