Wednesday, 30 November 2016

It's not only girls who can mask

Following on from the previous article regarding masking in children on the Autistic spectrum, this article is going to look at boys who mask.  These boys seem to fall into two distinct categories. The first group is those who understand the rules at school and appear to manage the structure of school very well, but who are often struggling socially and academically, and who keep ‘below the radar’ whilst at school.  

When teachers and other staff at school report that they are doing well socially and have lots of friends, sometimes they will need to look more closely at the quality of these friendships – is the young person on the periphery of the social group in the playground, looking for an opportunity to join in?  Do they go on 'play-dates' and more importantly, are they invited back for a second or third visit?  This can cause stress and anxiety because he will have no idea why this happens or what to do to fix it.

These young people also often have what psychologists refer to as a ‘spiky profile’ in terms of their IQ.  They may be exceptionally good verbally but have much poorer non-verbal skills. This may lead to them being poor at mathematics and/or poor at organising themselves. They may also have difficulties with auditory memory.  Basically, information goes in one ear and out the other without being fully processed, so the young person will not be able to follow an instruction given verbally.  This will more than likely mean that homework instructions will be forgotten.  If you then combine that with poor processing speed (another very common problem for young people with Autism) and the poor child will not even be able to copy information off the board or complete work in time.  It is hardly surprising that this apparently well behaved child becomes angry and stressed in the safety of his own home.  It is important that teaching staff (and parents) recognise that for some children on the spectrum it is not a case of ‘won’t do’ but ‘can’t do’.

The second group of boys who tend to mask their difficulties are those higher functioning boys who appear superficially sociable, but who often end up becoming the class clown or mixing with the wrong type of peers in order to fit in.  Going back a number of years now a well-known Psychiatrist, Digby Tantam, in his book Autism Spectrum Disorders through the lifespan, talked about an ‘Atypical Asperger’s’ profile.  These were young people, usually boys, where the key impairment is in the area of non-verbal interpretation. This leads to a lack of ability to empathise with the perspective of another person, and an inability to see the potential consequences and impact upon others of certain actions.  This can lead to social and behavioural difficulties and social vulnerability.  Atypical Asperger’s syndrome (as described by Digby Tantam) often co-exists with attention deficit hyperactivity disorder (ADHD), or attention deficit disorder (ADD). These boys will often fail at school, with many being excluded or becoming effectively marginalised from the education system by the age of fourteen.

Although they often manage to form a number of superficial friendships, they will struggle to maintain these, and often suffer from low self-esteem and poor identity.  This tends to encourage them to either become the class joker (in an attempt to ‘fit in’), or behave in an increasingly outrageous or anti-social manner.  At this point, they often become more aggressive - towards people and objects - and frequently they refuse to obey rules of any kind. This can lead to them mixing with other ‘troublemakers’. However, there continues to be a naivety about this group with them frequently getting caught or scapegoated.  

Quite often, when the police or other authority figures are called, these boys are the ones left standing there, looking around when all the others have run off.  They will often mimic the other boys (in terms of clothes, accent or expressions that appear to be ‘cool’). However, they very often get this wrong and, to their peers, they can appear odd or an easy target.

The overriding feature of these boys is likely to be, once again, anxiety.  Although obsessive special interests tend to be less common in this sub-group (often due to co-morbid ADHD), cognitive rigidity is still present and can manifest itself in the inability to see anyone else’s point of view or admit that they may be wrong.  In addition, very literal thinking, and a lack of ability to understand and process ambiguous language and metaphors, leads to frequent misunderstanding and this is often coupled with an inability to ‘move on’ from what they see as ‘injustice’.


I hope this week’s blog has shown that it is not just girls who mask and sometimes Autism in boys can be just as difficult to spot.

NEXT TIME - In the next article I will be discussing the strategies that schools can use to help manage and support the child with PDA in the school environment.

5 comments:

  1. I can relate to a lot of this with my 11 year son. He's diagnosed with HFA and ADHD. He also has severe dyslexia, very impaired working memory & executive function combined with very high IQ (in the 99th % ile). He has significant sensory issues also. He is very eloquent and hides his issues well. He wants to socialise but struggles to maintain friendships.
    He is in a supportive ASC resource in a large mainstream secondary school. His teachers there tell me he fits a PDA profile very closely as the strategies for PDA work much better than traditional ASC approaches. Generally once he's at school though he is very compliant and engaged. Home life is very different. Most mundane requests are met with extreme resistance / point blank refusal. Getting ready for school, washing, coming to meals and we can forget leaving the house at weekends. Unfortunately he is increasingly refusing school. School say there are no specific problems as school as he is happy when he's there and believe he's simply trying to claw back his personal time (he views school as a "waste of his life") . They have suggested we follow an approach which he is punished for lateness by losing increasing amounts of screen time (this is precious to him and his special interests revolve around this and he uses it to relax ). So far it's making things worse as he's getting more stressed and that's causing more avoidance. I am going along with it as I don't want school thinking I'm not trying but such reward/punishment approaches have not worked in the past. Do you have any advice on the best way forward as I feel this is step backwards and is damaging me already fraught relationship with my son? Any advice greatly appreciated.

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    1. Thank you for your comment. If you can email us at office@help4psychology.co.uk we can then provide you a free screening for PDA.

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  2. thank you for sharing this . my son being looked at for asd spd but I really think he has pda . he always has to be in control if not it causes meltdowns . i will look into this further as at school not a peep when I pick him up he's kicking off before I've got out the school gate . xx

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  3. Thank you so much for these articles. It is so refreshing to find something, after years of puzzling, that describes my 8.5-year-old son and our experiences so well. He has been diagnosed and had occupational therapy for SPD, but her still has always seemed to have more that we need to understand. I know nothing will fit completely, but for the first time as I am reading about PDA I feel like I am reading something written about my son specifically. He falls into your first group description so completely, it's remarkable. We live in the USA, so I know our resources are different, even down to accepted diagnoses. But this gives me so much help and information to hopefully show and start somewhere. We have been puzzling for years, and actually already self-implementing may strategies described for PDA without even knowing this was a "thing". Thank you for the helpful blog!

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  4. Wow that is my son he was diagnosed with global developmental delayment he, s now 12 and he is the joke of his class , and we have been fighting for help , he has tics , he doesn't process things very well , everyone who spends time with him see and worry about him apart from the school , I contacted your clinic as I really need my son assessed so he can get the help he needs, I can't find the screening section so I can go forward , we can't see our son suffer any more , thanks

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