Let’s live and breathe AAC

ByLondon Speech and Feeding
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We all have the right and want to express thoughts, feelings, and needs. For non-speaking or minimally speaking children, finding an avenue to communicate effectively can be a challenging journey. Parents are often at a loss as to where to start. Sometimes a little bit of Makaton signing has been used here and there but we mostly find that gradually signing fades as parents feel that it just doesn’t seem to get copied and used by the children.

They live and breathe their system

This is where we need to pick up the pieces and start again: because all successful families where children start using their boards or their electronic AAC (Augmentative and Alternative Communication) systems do this one thing: THEY LIVE AND BREATHE THEIR SYSTEM.

  • They have boards in every single room of the house;
  • They have a board in the car, attached to the side of car door so their child can point to it as they need to;
  • They have a smaller board in their handbag/rucksack when out and about;
  • They have a board for shopping and attach it to the shopping trolley;
  • They are never ever without their board.

Because they realise that a child should never be without their mouths to speak, should never be without a means to speak. They use their own board to model and the child has always access to their board to model back or to just look.

This is where success begins

Success begins at consistent and joyful use of the board/AAC system throughout the entire day. If we think about it, doesn’t it make sense? Of course, it does! We talk to our child for the first two years of their life continuously wherever we are and our child is continuously encouraged to use their mouths for talking in all situations.

Same goes for Signing: Makaton or any other sign system is a very powerful means to aid communication and I certainly advocate and use it in practice. Though much like words, signs are very elusive and temporary—as soon as the sign has been made it is gone and no longer present. Same with words of course. This can be difficult for people who need longer to process information.

The beauty of symbols or photographs is that they are permanent: they don’t vanish, they stay and with the core board they stay in the same place! This is very reassuring. We can learn where a symbol is and we can be assured that it will still be there the next time we look at the board.

AAC core board

Here is a picture of a core board:

AAC board

You can download this and other boards for free on the Saltillo Word Power website.

It has 48 cells and we can see the most frequently used core words on here, words that we use 80% of the day when talking with our non-speaking/minimally speaking children, younger children and children with cognitive delay. We keep our sentences short and we say phrases pertaining to their daily lives;

  • Let’s GET your toy
  • PUT it here, PUT it away, PUT it IN
  • Let’s READ a book
  • UP you get
  • WANT some MORE?
  • That’s GOOD isn’t it?
  • Let’s OPEN the box and LOOK

And so on… All these phrases can be aided with the above board. Your child will learn OVER TIME and OVER CONTINUOUS USE where GET/PUT/MORE/WANT/IN—where these symbols are. For children who are slow to process this is so helpful, to have a visual representation of what has just been said. It aids understanding in the first place. Gradually as a child starts to copy they will point to powerful symbols themselves and if they want to speak they can also speak of course:

A child might point to WANT + MORE and then say with their mouths: BANANA!

Board examples

Here are some other boards I have made specifically for daily situations and preferences of some of my students. Here is one for toileting:

AAC toileting board

And another one:

These boards incorporate high-frequency and versatile words, enabling us to make little sentences.

Building Language and Literacy Skills

AAC Core Boards are not just tools for immediate communication. They also play a pivotal role in language and literacy development. By using these boards, non-speaking children engage with words and symbols, reinforcing their understanding of language structure and grammar.

Over time they naturally absorb language patterns, laying the foundation for improved literacy skills.

Customisation for Individual Needs

Every non-speaking child is unique, and their communication needs can vary significantly. AAC Core Boards are designed with this diversity in mind. The boards can be adapted to include specific vocabulary relevant to the child’s daily life, interests, and activities. This personalisation ensures that the AAC Core Board is a true reflection of the child’s personality and needs, making communication more engaging and effective.

Collaboration between AAC Core Boards and Speech Therapy

While AAC Core Boards are an incredible tool, they are only used effectively by the non-speaking child when the board is used BY ALL COMMUNICATION PARTNERS around the child.

Again, I know I am being repetitive here, but the board needs to be used and modelled by the adults constantly in the first place and for a period of time before we can expect our children to take an interest and use the boards themselves. Think how long it typically takes for a child to learn their first word: around a year! During that time the adults talk constantly to their child without hesitation or expectation! The same goes for introducing this new way of communicating.

Collaborating with your child’s speech-language therapist (SLT) ensures that your child receives the right guidance in using the AAC system. SLTs can assess your child’s communication abilities, recommend appropriate boards and provide guidance on how to best implement them.

Conclusion

For non-speaking children, AAC Core Boards are bridges to their world.

These boards foster language development, social interaction, and personal expression. AAC Core Boards offer a beacon of hope, helping non-speaking children break through communication barriers and thrive in a world that is waiting to hear their voices. Boards are simple for anyone to use and understand. Have a go! You will be surprised how lovely it is to use a board with ease and once your child sees you do this, you have a chance for your child to start copying you…and express something! HOW ABOUT THAT! I look forward to hearing your stories!

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Speech sounds: Expectations vs reality
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Speech sounds: Expectations vs reality

ByLondon Speech and Feeding

Sometimes our kids find it hard to listen to sounds in words and hearing the difference between sounds. This is an important skill which we call “sound awareness”. A lack of it can really impact on clear speech sounds production.

Your child might be confusing similar sounding words. Or they might not notice that a TAT is not a CAT for a DOD is not a DOG. Often children with speech sound disorders or difficulties don’t tune into individual sounds or even syllables. Grow your knowledge to support your child.

Read our latest blog on hearing the difference between sounds to develop speech sound production.

Practice makes perfect

There is a lot more to speech sound production than first meets the eye. Did you know that producing the correct speech sound at sentence level is the last piece to the communication puzzle? There’s a lot of practice before your child develops this last stage of speaking clearly. Your Speech and Language Therapist will start by determining if your child can hear the difference between the sound they are producing and the correct sound. So if your child says LIT instead of LICK we might contrast those two words by perhaps using a candle and a lollypop. Each time he/she says LICK they get to have a lick (or 3) on the lolly. But if they say LIT then we light up and blow out a candle. This way your child can see that there is a difference between those words and that the sounds we make actually matter. Fancy that!!

We call this auditory awareness, which is essentially hearing the sounds in words. Don’t be surprised if you hear your child’s therapist model the sound a lot. This is to develop their awareness. The more your child hears a sound, the easier they will find production. Furthermore, your Speech and Language Therapist will work on phonemic awareness (sound structures) such as the difference between a sound (e.g. sh, is one sound) vs a syllable (e.g., shell has one syllable) vs total number of sounds in a word (shell has three sounds sh-e-ll ), like you can see in my little video clip.

Once a child is able to produce a sound on its own and they can hear and identify how a short word is said correctly we can go and repeat lots of similar words with the sound at the beginning or end until it becomes automatic and new neuro pathways are laid in the child’s brain. From there we branch out into short phrases and then eventually sentences.

Six tips to practise auditory discrimination for speech sound production

  1. Sit opposite your child so they can see your mouth or or sit next to the child and place a mirror in front of you so they can see and hear your production.
  2. Make it fun! Once they’ve identified the sounds in the word, play part of a game (e.g., pop up pirate, Jenga, something which allows plenty of turns).
  3. Use car journeys or walking to school to practise (e.g., oh I see a sheep, sh-ee-p, sh-ee-p has three sounds. Can you spot something beginning with /sh/?)
  4. Remember that spellings can differ (e.g., ‘chef’ and ‘shed’ both have the same initial sound).
  5. Talk about what you’re doing with your mouth (e.g., my lips are rounded for /sh/). Your Speech and Language Therapist will be able to support you with this.
  6. Make silly sentences using your child’s special sound (e.g., Sheep show shepherds shearing).

At this stage you are not expecting your child to produce the sound. This is why it’s important that they continually hear an excellent model. If your child attempts speech sound production at any stage, this is to be encouraged as it’s a great opportunity to model the correct version.

Contact me to develop your child’s speech sounds.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Speech Sound Disorders

Speech Sound Disorders

ByLondon Speech and Feeding
Kids Speech Therapist London
Speech Sound Disorders

Treatment Approaches – A Typical Session

There are various great ways to treat speech sound disorders and I use all the approaches available selectively; I decide what works with each individual child and I also vary the approach depending on the child’s frame of mind at any given time during my session.

Some of the approaches are more “drill-based” and require a child to be able to pay attention and really participate actively in the therapy, and this is what I am showing you today with this video clip.

My little student here has been working with me for some time and from only saying a handful of words which were not very easy to understand he has come a long way. He does have some features of Verbal Dyspraxia which I shall briefly outline here:

  • Making sounds in general is a struggle, especially when asked to copy certain sounds, example: ‘can you say: a ee ou oo?”
  • Repeating sound sequences or words sequences is hard, for example: “say p-t-k in sequence” or “say fish chips fish chips fish chips
  • When saying the same word again and again, different mistakes can be heard
  • Intonation difficulties: speech sounds monotonous
  • Vocabulary is very limited

Some therapy approaches are more play based, for example the Core Word method: here we pick a few words at a time which are very significant to the child and therefore highly motivating to try and say. These could be characters of Pokemon or Minecraft for example, or simple words like “GO!”

When you watch the video you will see that I use a lot of visual prompting, such as showing him where the tongue is moving to or from. I do this with my index finger and this approach is called Tactile Cueing or “Cued Articulation”. Part of the approach is to give a visual prompt and then reduce the prompt as the learner is more able to produce the correct sounds. Once he can produce the sound on its own, we quickly move to the sound within a word.

I do mix and match my approaches and in fact here I am drilling but I also use the Core Word which for him (YELLOW) — it’s his favourite colour and I happen to have quite a few good games where a YELLOW something or other can be asked for….. WHO KNEW!? 🙂

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

A Day In The Life Of An Independent Speech And Language Therapist

A Day In The Life Of An Independent Speech And Language Therapist

ByLondon Speech and Feeding
A Day In The Life Of An Independent Speech And Language Therapist

A Day In The Life Of An Independent Speech And Language Therapist

I often get asked how many clients/children I see per working day or what my working day/life looks like. I always reply that every day is different, which is true, but there is a sort of average working day which looks a bit like this:

I usually start preparing for my first client of the day at around 9.30 am: I clean the room, wipe down all the toys and materials (that’s if they are coming to my clinic room) and then it takes me about 30 minutes to select and sometimes make suitable materials, games and activities for the child’s therapy programme. Client arrives at 10.30 am and the fun begins. They leave around 11.30am, and the cleaning and wiping down starts again – yes it’s the pandemic but to be fair I would do this anyway. I quickly write up my notes and send home work to the client via email. Now it’s 12 noon and I start preparing for the next client at 12.30 pm. This might be online parent-child interaction coaching and so I need different materials and activities that are suitable for teletherapy. We finish around 1.30 pm and I will write up my notes before having some lunch.

Lunch tends to not be around 30 minutes. Around 2.00 pm I start prepping again for the next client: selecting activities, going over their last session, making sure I have everything I need to start at 2.45pm – we finish at 3.45pm, I write up my notes and then have a cuppa. The next client might be more on-line coaching or a child coming to see me: room cleaned and tidy, materials and activities prepared: client arrives at 4.30 pm and we finish at 5.30 pm. I clean the toys again, write up my notes and it is 6.00 pm ready for dinner. So that was four clients between 9 am and 6pm allowing for preparation, aftercare, cleaning and coffee and lunch.

Other days I might see three clients and do more admin like ordering toys or books or teletherapy activities, or making materials (we therapist make tons of materials, we’d put Blue Peter to shame!) Sometimes I do two home visits, one in the morning and one in the afternoon – the travelling/parking in London is so time consuming that it really reduces the number of clients I can see which is why I don’t do many of those.

I hand pick my clients to make sure that we are a good fit, and my service is bespoke: no one client gets the same treatment as another; each client is unique, usually very well-known and always highly valued. That takes time and means that in reality each client gets about 2 hours of my time, that is the actual session plus all the preparation and aftercare.

I love this way of working and would not ever want to return to seeing tons of clients each day, not knowing any of them really well, due to high caseload numbers, staff shortages and an overload of administration.

My way of working affords all my lovely clients the help they need to be able to feel empowered and to then support their children to make progress; when working with children they make the best progress they can make, fulfilling their potential. My lovely reviews and testimonials tell me that my clients appreciate the extra attention.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

Connecting with children in Speech and Language Therapy

Connecting with children in Speech and Language Therapy

ByLondon Speech and Feeding

A deep and meaningful relationship

In the realm of Speech and Language Therapy, connecting with a child goes far beyond the mechanics of language and articulation. It’s about fostering a deep, meaningful relationship that nurtures growth, builds confidence, and unlocks the potential for effective communication.

As Speech and Language Therapists we embrace this art and invest in building authentic connections. We want to pave the way for children to embark on a path of communication success that will resonate throughout their lives.

Establishing rapport and trust is the foundation upon which effective communication and progress are built. In this blog, we explore the significance of making a connection with a child as an integral part of Speech and Language Therapy. We look at strategies, benefits, and the transformative impact it can have on a child’s journey to communication success.

The importance of connection

Every child is a unique individual with their own personality, experiences, and challenges. Recognising and respecting these individual differences lay the groundwork for forming a connection that goes beyond the clinical setting. A strong therapeutic alliance encourages a child to open up, engage actively in sessions, and make greater strides in their speech, language and communication development.

Strategies I use for establishing connection

Face to Face:

I always aim to get down and dirty: I sit on the floor with a child or at a low level so that it is easy for a child to look at me, even for a brief moment, here and there. When sitting at a table I position the child so that they can make eye contact with me should they be so inclined. Important: not every child wants to make eye contact! We must not be too focused on a child looking at our face or into our eyes. Sometimes some individuals find this disconcerting and off putting. They would rather look at what they are doing, and that does not mean that they are not aware of you or not listening!

Active listening:

I devote my full attention to the child. This demonstrates that they are important and that I am genuinely interested in their world. This is not always possible for longer periods of time, but I aim for 3-10 minutes of top-quality time before I might have a little break. I would encourage all parents and caregivers to try this out for 1 , then 2, then 3 minutes: turn off your phone and be 100% with your child no matter what. You will see your child really appreciates your undivided attention.

Shared interests:

I try to discover and engage in activities, topics, or hobbies that resonate with the child.

Play-based learning:

Play is a big part of all Speech and Language Therapy sessions. This is because it is a child’s natural mode of communication and all learning comes through play and fun.

Respect for autonomy:

Encouraging a child’s autonomy is important. Where possible, I involve children in decision-making about session goals, activities, and approaches. This also makes sessions more motivating for the child.

As the connection strengthens, communication barriers begin to dissolve. Children are more inclined to take risks (challenges that are within their reach), try new sounds or words, and explore new ways of doing things.

Long-term progress:

A solid connection sets the stage for ongoing progress. The child is more likely to continue practicing and engaging in speech, language and communication exercises outside of therapy, leading to sustained improvements.

The transformation that can occur through a strong therapeutic connection is nothing short of remarkable. A child who once hesitated to communicate might now eagerly share their thoughts and ideas. Those struggling with speech sounds before might gain the confidence to practise them frequently and thus master them. The bond forged between the child and the Speech and Language Therapist becomes a source of motivation, encouragement, and resilience.

Please get in touch!

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?

What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?

ByLondon Speech and Feeding
Kids Speech Therapist London
What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?

Speech and language therapists provide treatment, support and care for children and adults who have difficulties with communication, eating, drinking and swallowing. We help children and adults who have problems speaking and communicating.

How to find the perfect therapist for my child/client:

There are a huge number of speech and language difficulties, or feeding and swallowing problems that we can help with and the first thing to think about is what age group the person is you are seeking help for. Most SLT’s specialise in a range of disorders and treatments and they often treat specific age ranges. This could be, for instance, very young children up to 3 years, or school aged children, adolescents or just adults. Once you have narrowed it down to age and general area of difficulty you can then go and seek your perfect SLT match.

Generally it is my view that SLT’s with a narrow area of specialist interest are most likely to help you better if the problem you or your child/adult is having is significant and/or profound. For example, if your child has a very severe stutter/stammer but is otherwise developing fine and has good skills all round, then I would recommend to look for an SLT who only specialises in stammering/stuttering, or has only a small range of other specialist areas related to stammering , such as speech and language delay.

The reason is that it is a tall order for any professional to stay up to date with latest research, latest clinical developments and training for more than, say, five distinct areas of interest.

However, a more generalist Speech therapist who has lots of experience in many different areas could be a very good option for your child or adult who has more general speech and language delay in a number of areas, perhaps a global delay or a syndrome which means that their learning is delayed in general. It also means that your child might benefit from a Generalist SLT because they have many more tools in their SLT bag and your child might need a variety of approaches for several areas.

A good place to start is www.asltip.com which is the Association for Independent Speech and Language Therapists in the UK. Any SLT registered with ASLTIP will also be registered with the HCPC (Health Care Professionals Council), as well as RCSLT (Royal College of Speech and Language Therapists). These two important UK professional regulatory bodies ensure all its members are fully qualified, and are fully up to date with latest developments within their areas of work.

Here you can enter your post code and look for a therapist near you and you can look for specific problems such as stammering for example and narrow down your search. Most therapists have a website which you can then access too. I would recommend you speak to a few therapists on your list and then go with the person you had the best rapport with. You and the therapist will be spending a lot of time together and you will need to feel that you trust them and that you can relax into the process.

How I can help you:

I have 3 main areas of specialism:

Parent Child Interaction Coaching

Parent Child Interaction Coaching

This is an amazing way to help children with the following difficulties:

  • Social Communication Difficulties, Autistic Spectrum Disorders and
  • Speech and Language Delay – for children under the age of 4 years old, this is my preferred way of working because it is so very effective and proven to work. If your child is not developing words or not interacting, has reduced attention and listening and you feel is not progressing or, in fact even regressing, then this way of working is the best. For anyone wanting to read a bit more about the efficacy of this method, below are some research articles. You may also like to check out www.hanen.org which is the mainstay of my work and method when it comes to Parent-Interaction Coaching. You can also look at my latest blog, entitled: Tele-therapy, does it work?

In brief, what’s so great about Parent Coaching is that it empowers you the parent to help your child in daily life! This is where speech, language and social communication develop typically, in a naturalistic way and environment. Simple steps and strategies are discussed and demonstrated every week and you are encouraged to use these strategies with your child in daily routines: getting dressed, having breakfast, on the school run, whilst out in the park or shopping or simply playing at home or having dinner or bath time. Whatever your family routine happens to be, every strategy I teach you will help create a responsive communication environment; generally, if your child is able to develop speech then they will do so in direct response to your changed interaction style.

Speech Sound Disorders, Verbal Dyspraxia, Phonology and Articulation

Speech Sound Disorders, Verbal Dyspraxia, Phonology and Articulation

I love working with children of all ages on developing their speech sounds. Whether your child has a lisp, or a couple of tricky sounds they simply cannot produce quite right, or perhaps your child is really unintelligible because he/she is having lots of different sound errors, making it really hard to understand them. I typically work on getting “most bang for your buck” , meaning I address the sounds that cause the most problems and, therefore, when they are fixed your child/person’s speech becomes that much clearer fairly quickly.

Feeding and Swallowing Difficulties

Feeding and Swallowing Difficulties

Having worked for over 20 years in NHS Child Development Clinics and Special Needs Schools I trained and worked with feeding and swallowing difficulties early on in my SLT career. I later trained as a Lactation Consultant and so I am well placed helping and support all types of Infant feeding, both breast or bottle, as well as toddler weaning. I aim to ensure that your little one swallows the right kind of foods and drinks for their abilities. I am experienced in managing and supporting children with physical needs and mobility problems, Cerebral Palsy, Down Syndrome or any other type of syndrome or presentation.

What does a speech therapy session look like?

All sessions differ slightly depending on the age of the child and the nature of the difficulties.

However, mostly our sessions look like FUN! After arrival and washing hands we tend to start off with the tricky work straight away whilst our child still has energy and the will to engage. So, for speech work we will focus on the target sounds first: this could be sitting at a table doing work sheets together, playing games using the target sound and really any type of activity that gives us around 70-100 repeats of the target pattern. For example, a child who is working towards saying a ‘K’ at the end of the word I will try and get around 100 productions of words like: pack/sack/lick/ pick/bike/lake and so on.

Then we often play a fun game where I might try for a ‘rhyming’ activity or other sound awareness type activities, for perhaps 10 minutes and within that time I aim to trial the next sound pattern we need to improve on; I will test which sound your child can do with help from me. During he last 10 minutes we might look at a book, again listening to and producing whatever sound we are working on. If I did not get 100 sounds earlier on in the session I will try and practice them now as part of the story. In total I aim to have about 40-45 minutes of activities, all aimed at the target sound we are working on.

What does a Coaching session look like?

During a Parent Coaching Session we meet online for about an hour and we discuss how the week has been for you trying out the strategies. Typically parents start off recalling what went well, what progress was made and what had been more tricky. We work through it all, and then follow on to the next strategies: I will show you examples and demonstrations of each strategy and I will get you to think about how you can use this with your child and in what situation you might use it. I will explain what we are doing and what the purpose is. You might want to write down what you are going to work on for the week. Over the course of about sessions we can cover all the major strategies that are proven to help kickstart spoken language and/or help your child to connect more with you. Through that connection spoken words most often develop.

Research Papers on the Efficacy of Parent Child Interaction Coaching

Research Papers on the Efficacy of Parent Child Interaction Coaching

  • The It Takes Two to Talk Program has been shown to be effective in changing how parents interact with their children, and that children’s communication and language skills improve as a result.
  • Baumwell, L.B., Tamis-LeMonda, C.S. & Bornstein, M.H. (1997). Maternal verbal sensitivity and child language comprehension. Infant Behavior and Development, 20(2), 247-258.
  • Beckwith, L. & Cohen, S.E. (1989). Maternal responsiveness with preterm infants and later competency. In M.H. Bornstein (Ed.). Maternal responsiveness: Characteristics and consequences: New directions for child development (pp. 75-87). San Francisco: Jossey Bass.
  • Bronfenbrenner, U. (1974). Is early intervention effective? (Publication No. (CDH) 74-25). Washington, DC: Department of Health, Education, and Welfare, Office of Child Development.
  • Girolametto, L. (1988). Improving the social-conversational skills of developmentally delayed children: An intervention study. Journal of Speech and Hearing Disorders, 53, 156-167.

Sonja has been a real help for my 5 year old daughter. Due to her support, my daughter is now able to clearly and correctly enunciate ‘th’ ‘f’ and ’s’. She was also helpful in making positional changes to her seating to help her concentrate better and kept her engaged throughout all the lessons which is a feat in itself on zoom!

Helen, Mother of Catherine Age 5.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

Unveiling the hidden spectrum: Why girls and autism often go unseen
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Unveiling the hidden spectrum: Why girls and autism often go unseen

ByLondon Speech and Feeding
Unveiling the hidden spectrum: Why girls and autism often go unseen
Image by Freepik

Autism is a complex neurodevelopmental condition characterised by social-communication challenges, restricted and repetitive behaviours, and sensory processing difficulties. While the prevalence of autism is estimated at 1 in 54 children, research suggests a significant disparity in diagnoses between genders. Boys are diagnosed with autism roughly four times more often than girls, leading us to question: Why are girls so much harder to diagnose with autism?

The answer lies in a complex interplay of factors, including:

1. Different presentations of autistic traits:

  • Socialisation: The stereotypical image of autism often portrays boys with aloofness and a lack of interest in social interaction. However, autistic girls may exhibit more subtle social difficulties. They may appear interested in socialising but struggle with understanding social cues, maintaining eye contact, or navigating complex social dynamics. This ability to ‘camouflage’ their challenges can lead to misinterpretations of their intentions and abilities.
  • Restricted interests: While autistic boys may have intense interests in stereotypically ‘masculine’ topics like dinosaurs or trains, girls might gravitate towards interests traditionally associated with girls, like specific characters or activities. These interests, often deemed ‘typical’ might be overlooked as potential indicators of autism.
  • Repetitive behaviours: Repetitive behaviours are another core diagnostic feature of autism. However, autistic girls may exhibit these behaviours in more subtle ways, such as intense focus on specific routines, scripting conversations, or engaging in repetitive social interactions. These subtle expressions can easily go unnoticed.

2. The ‘camouflage’ effect:

Autistic girls, particularly those with higher cognitive abilities, may develop coping mechanisms to mask their challenges in social situations. This ‘camouflaging’ can involve mimicking social behaviours they observe in others, leading to significant internal distress and exhaustion. This effort to appear ‘normal/typical’ can further hinder accurate diagnosis.

3. Societal biases and diagnostic tools:

  • Gender bias: The current diagnostic criteria for autism were largely developed based on studies of boys, leading to a potential bias towards male presentations of the condition. This can result in girls who don’t exhibit the ‘typical’ symptoms being missed altogether.
  • Lack of awareness: Healthcare professionals and educators may have limited awareness of how autism manifests differently in girls. This lack of understanding can lead to misinterpretations of their behaviours and missed opportunities for diagnosis and support. I must say that this is really common in my working day. I see a child—girls or boys in this case to be fair, but mainly girls—where parents tell me: the doctor/health visitor/paediatrician has said it was ‘just a little delay’ and I am thinking ‘Really!??? What did they look at? How did they not see X Y Z’… It really is still very common.

4. Co-occurring conditions:

Autistic girls are more likely to experience co-occurring conditions like anxiety and depression, which can overshadow the core features of autism. This makes it even more challenging to identify the underlying autism diagnosis.

The consequences of missed diagnoses and this goes of course for both, autistic girls AND boys!:

The consequences of undiagnosed autism can be significant. Children may experience:

  • Lack of access to appropriate support: Without a diagnosis, children may miss out on crucial interventions and therapies that can help them manage their challenges and thrive.
  • Increased vulnerability to mental health issues: The stress of masking and navigating social complexities can lead to anxiety, depression, and other mental health challenges.
  • Difficulty forming meaningful relationships: Social difficulties and communication challenges can hinder their ability to build and maintain healthy relationships.

Moving forward: Towards a more inclusive diagnosis:

To ensure all individuals on the spectrum receive the support they need, it’s crucial to:

  • Increase awareness and education: Healthcare professionals, educators, and the general public need to be educated about the diverse presentations of autism in girls and of course also in boys. Let’s not forget that we are still seeing older autistic boys with diagnoses given aged 12 years and older who have slipped through the net.
  • Develop gender-neutral diagnostic tools: Diagnostic criteria and assessments should be revised to encompass the broader spectrum of autistic traits, regardless of gender.
  • Encourage open communication: Parents, caregivers, and individuals themselves should be encouraged to voice their concerns and seek evaluations, even if their experiences don’t perfectly align with stereotypical presentations of autism.

By acknowledging the complexities of diagnosing autism, particularly in girls, and working towards a more inclusive approach, we can pave the way for earlier diagnoses, appropriate support, and a brighter future for all individuals on the autism spectrum.

Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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