 While we're doing this, Soph, is that I think I'm just trying to admit people while you were talking there, and it seems to be hitting the 300, even though we've bought that additional add-on. So you might just want to double check that because there might be people who are getting bounced out and can't join. So can you just double check that that large meeting add-on worked for today's meeting, is on the right account and stuff? Thank you. Hello everyone. So it wouldn't be a true Zoom meeting if we didn't have at least some technical joy. Other bits of Zoom bingo that I'm fulfilling right now. There is a cat in the room who will join the session periodically and I'm in my slippers. I hope you are too. And thank you ever so much for all coming along today. We've had a really brilliant response to, oh, you can't hear me. Can anyone else not hear me? Is it just Carol Locke? Sophie, can you hear me? Yeah, I can hear you. OK, so in which case you might want to touch in with Carol, right? I'm going to put the chat to one side and Sophie will tell me if there's anything I need to see. Otherwise, it will distract me. So, yes, thank you ever so much for joining us. We've had a really, really good response on this. So we're thinking about autism in girls, why we don't always pick it up, how we might go about picking it up and how we can best support. And this is a topic that we've done a little bit of work on. Some of you might have done our on demand training on autistic masking, which Jody Smith and put together for us, which is we'll link through to all this in the notes, which Sophie will send through to you afterwards. And that's had a really good response. But we've had lots and lots of interest around autism generally, but autism in girls and this kind of increased understanding that there might be girls that we're missing and we want to make sure we're not missing them and help them as best we can. I have a vested interest in this because I am an autistic girl or woman who was missed, only diagnosed in my 30s. And it would have made a big difference to me and my life if I had been recognised sooner and now that I'm aware of my autism, I'm much better able to manage. But just in terms of kind of reassurance and kindness to self, I think a helpful touch point here is that I didn't recognise that I was autistic and it was not suggested to me or recognised in me by others in my life, despite the fact that I had worked in an autistic unit and done a lot of work in autism and with autistic people across quite a lot of my career. It's been an area of interest and yet it never occurred to me that this might have been a challenge that I had because it presents so differently. And yes, pretty much whenever I'm researching autism in girls and women, I tick all those boxes of how brilliantly we tend to hide it and the other things that can be challenging for us. So a reassurance that there's quite a lot that we'll cover in this session, but I have written notes and also made some suggestions of further reading and resources that you might refer to afterwards. And as Safi said, the session is recorded should you wish to watch it back. And I will also take the key elements of this and turn it into an on-demand session on our website as well. So the first thing I wanted to think about was just why autism in girls in particular can be so difficult to spot. So we know that or increasingly we understand that autism in girls is picked up on average several months or a year later than in boys statistically. But actually we know kind of anecdotally that it can be years and years and years later and certainly my story of discovering I'm autistic in my 30s is very, very far from rare. What happens with girls is that when they're younger, the way that their autism kind of presents and displays tends to mean that they manage quite well and we'll look at that in a bit more depth. But they manage quite well and it's only really as they get a bit older that it becomes more difficult for them to manage that perhaps the way in which they do manage it becomes less sort of a thing that their peers are responsive to and life can become more challenging for them. But crucially, it just looks different than what we're expecting to see. So in girls, often we pick up first on signs like anxiety or we might see some sort of obsessive or perfectionist type behaviours and we will often diagnose with other things or we'll go down other routes. Anxiety and autism are kind of very best friends for many, many people with autism. Anxiety is something that they live with and manage every day. And in our girls in particular, we find that this is often the big thing that we see presented and that that can often mean that we're not picking up on other issues because we think this is this is just anxiety and we're looking at what kind of anxiety and how do we help with that? And we don't necessarily realise that the cause of the anxiety or the thing that sits alongside it might be autism. So we often get this misdiagnosis or a first and primary diagnosis that means we don't see the autism. The next thing about girls is that they are brilliant imitators. So girls are really, really good at copying what they see around them and also they will often look to things like books or YouTube these days or films or TV shows or things like that that they might really like and really get very, very lost in many autistic girls will be very avid readers and get lost in these worlds. And they learn a lot from that and by watching the people around them about how to be and they copy that because they get a good response when they behave in the way that other people do. And the thing you have to remember is that we only know how the world feels to ourselves. We never have the chance to stand in someone else's shoes. So as a young autistic girl, when you are watching everyone else and you realise that, well, OK, this is quite hard work, but I'm going to learn the rules and I'm going to copy them and mimic them and imitate them and then the world kind of works for you, even though that's quite tiring. You don't realise that everyone else isn't having to do it that way, that these things feel more natural to other people. Girls won't necessarily know that they're doing this. They won't be aware that they're kind of imitating and mimicking and copying. And sometimes later on and with understanding of self and as we begin to pick this apart, they can see this in themselves, but often it's quite a natural thing that will happen in those earlier days. So we see, you know, they're very good imitators. So we may well not pick up on the issues because they're not we're not presenting. They're mimicking their friends. They they look normal and they look neurotypical. The other thing that we see in girls is that they mask really well and masking is about presenting neurotypically. It's about hiding what's going on for us. It's about feeling that anxiety, feeling fear and just getting on and doing things anyway. And this can mean that we're able to manage in all sorts of different situations, but it does come at great cost. And this is one of the things that Jodie looks at in her course is why autistic masking, you know, can be an issue for girls and how it can really result in burnout. And this is one of the things when we're thinking about how we support autistic girls to manage is actually understanding, you know, actually sometimes masking is a really helpful skill. And it's something that many of us learn to do. But actually sometimes we need to be given permission to actually take off that mask and to kind of be ourselves. But so that masking again, along with the mimicking and the imitating, these are things that mean that we don't see that there's an issue because what we're seeing is a child who is essentially presenting as neurotypical. Does that make sense so far? Yeah, so they're copying really well. They're masking the issues as they're arising. They're doing what we do on a really tough day. Yeah, when you've had really bad night's sleep, you've got loads of stuff going on at home, but maybe you've got a class to teach children to support. You put on your game face and you get on with it. For some autistic girls, this is there every day. But it means that to us, they look neurotypical. Other things that mean we don't pick up on issues with our girls early is that some of the things that we expect to see in autism look different in girls. So something that we're really familiar with with autism is that many autistic children will have special interests. And with our boys, we will often see that that's Lego or trains. There are certain things that they go to and we begin to think that for the boy who has those interests, we begin to wonder and we become curious about maybe autism is a possibility here. For our girls, those special interests often take a much more socially acceptable kind of form. And it means again that they might be able to interact with other girls in a way that for us seems neurotypical. So these special interests might be around animals. That's quite typical in our girls. It might be things like ballet, pop stars, these kinds of things that we just expect to see. And our girls kind of talking about. And just as a kind of little caveat here, I'm talking about the presentation of boys and girls here because we're thinking about autistic girls. There are men and boys who present in a more female way as well as well. And this kind of division is perhaps not quite as clear cut as it might seem. But we're thinking specifically about why we miss girls and it's this more typically female presentation that we're kind of missing out on. And the final point I wanted to make here about why we so often miss autism and girls is that another thing that we think we know about autism is that this kind of lack of empathy and lack of emotion that we have been taught to expect to see. And that's kind of a real kind of misconception about autism generally. And actually our boys and men with autism also will often feel things very deeply, will often have great empathy. They might not express it in the same way and it might be more difficult for them to interpret the feelings of others. However, they are thinking, feeling salient beings who think and feel things. In girls though, often we will see that they're what we would call hyper-emotional. So rather than kind of seeming devoid and removed from emotion, actually we'll often find that they're more emotional than their peers. And this just doesn't kind of sit with what we think of as a typical autistic presentation. So if you've got a girl who you've got to mind who is someone who gets the extremes of emotion, then it's possible that autism is a possibility there. Whereas traditionally we might automatically assume that a child who feels things really deeply in that way couldn't possibly be autistic. So these are kind of key reasons why we might miss it. And I think that the question to kind of go away and sort of think about here would be, does it matter if we don't always pick our girls up very promptly? And maybe if you've got thoughts on that, just type them in the chat box. We won't go to breakout rooms yet because there's so many of us and it takes a couple of minutes to go in and out. But just thinking does it matter. And I think that one thing here that I would ask of you and yourselves really is that if there are things that you learn today or that you've learned because you've created, you've become interested in autism in girls, that means that you think that you've missed this in the past or perhaps as a child that will come to mind today as you're learning with us that you think, oh, I've perhaps let them down. We haven't pursued this avenue before to be kind and forgiving to yourself. We can't change what has happened, but we can change what we do moving forward. So even if you think that you're picking someone up really late, actually you can make a change as of tomorrow and begin to do things a little bit differently. But does it matter that we don't always pick it up promptly and how forgiving should we be of ourselves for that and how early should we be beginning to start looking? There are some great resources out there that can help us to start looking for these signs really, really early. And I've worked with early years practitioners who with children, very, very young children, coming in at nursery age, are able to begin to pick up on these signs, but it does really take a lot of skill and training to begin to recognise that and to have a bit of confidence to pursue when you've got a bit of a niggle that things might not feel quite right here. So Cathy here is saying, yes, it does matter, as girls can be considered subjectively without diagnosis. Yes, and that's something that we'll come onto a little bit later, actually, Cathy and others as well. So one of the things here, when we're thinking about the signs that we look out for and how can we recognise that a girl might be autistic, it's really important just to note at this point that the process for getting an autism diagnosis is really, really long and slow. And so actually, if you think that you're seeing these signs in a girl that you're working with or otherwise caring for, then it's worth thinking about how you can support and how you would support her if she were autistic because those things will never do harm. You could universally apply these approaches and they would do good rather than harm and you can treat as if in the meantime. Some people never actually pursue a formal diagnosis with autism. You know, we almost think a bit like you would with dyslexia these days, where we say, whether or not we get that diagnosis, the things that we would put in place will help. They certainly won't hinder. So perhaps in the meantime, we treat as if. So Louisa, and yes, it matters hugely because when it does become more apparent, their mental health deteriorates quickly. Yeah, and I think again, for girls, for anyone with autism, if it's not picked up and we don't support appropriately and we don't help them to learn how to understand themselves and to gain a bit of an understanding about who they are and why things feel the way that they do and teaching them strategies for managing day to day as well, crucially giving themselves enough downtime and enough time to reset in between times, we do find it really can impact on their mental health. It's really, really difficult trying to live in a neurotypical world when you're neurodivergent, if you haven't been taught the strategies and if you don't give yourself or aren't given respite from it sometimes too. The other thing I think that's helpful here and people mentioning in the comments is that when we recognise that a girl is autistic, actually that gives us a kind of tribe with which they can identify and it gives us a set of tools that we can lean into and sometimes a helpful label that we can use with other adults who are involved in their care, whether that's at school or home or elsewhere. How easy is it, Jenny, says to go down a formal assessment route when a girl is young and very good at masking, imitating and probably won't recognise it in themselves. It can be quite challenging and I think this is something really worth recognising and you'd really want to look at this as a team around the child working with the family in the school together, understanding what you think you're recognising and also just stopping and asking the question what do we think we'll get out of a formal diagnosis, will it actually move things forwards or should we recognise that this might be an issue and we'll start to support as if and see if that has a positive impact and perhaps pursue this later if we need to. In terms of the signs that we can be looking out for whilst recognising that there are severe limitations to potentially getting an actual diagnosis but assuming you might look for these signs and treat as if in the meantime some key things to look for in terms of recognising autism in girls because it's hard to spot, they're masking, they're imitating, they might just come across as fairly neurotypical. So firstly anxiety, girls who seem highly anxious should be, we would be looking to support them in any case but many girls who are autistic will struggle with anxiety and we will often find that as they go through primary school, particularly as they're getting up towards the upper end of primary school that that anxiety will worsen. We will find them perhaps going to extreme lengths to avoid things, places, people, situations that provoke anxiety and actually that can often present as school avoidance as well. So we see a lot of overlap between autistic girls and school-based anxiety and avoidance because schools are a really hard place if you're autistic, particularly if it's not been recognised. So anxiety, that can also come across as a girl being very, very shy or quiet. And again, if you put yourself in the shoes of a girl who is autistic who doesn't really quite understand the world, it happens in quite a strange way. It's like being transplanted into a totally different culture overnight. You wake up tomorrow in a culture that you've never been in before and you just don't know how to be here. That's how it feels every day for an autistic girl and so that does provoke anxiety because you're having to just double and triple and quadruple think every single interaction that you have and you feel things in this hyper-emotional way. So if you get things wrong, if you say the wrong thing, you make a bit of a fool of yourself or you do something in class that's not quite appropriate, actually you feel that in a really big way. You can't just brush it off and move on like your peers might be able to. You feel it really deeply. So again, that really adds this feeling of anxiety and what can that can mean is that these girls will withdraw and become very quiet and shy because they fear doing and saying the wrong thing and so perhaps they do and say very little as well. Also, it can be difficult for them to form and keep friendships particularly as they get older and again, that can mean they seem quite withdrawn and quiet. With younger children, younger autistic girls, they can come across like they're getting on quite well with their friends and you might see them being quite imaginative or you think they're being quite imaginative in their play and their conversation might be quite good. But when we look a little bit closer, what we'll often find is that these girls have created kind of whole worlds and they're directing play. So rather than going into kind of really imaginative role play, it's like this constructed world like if you created a world in Minecraft, so it's a bit like this for them and they've got this very clear idea often of this world they've imagined and they will prescribe what the characters say and do so. You might find that these girls kind of really dominate play and that they're kind of scripting it for other children and they can get frustrated when other children don't want to play in that way, that's something we will often see in our autistic girls and that's often fine when the children are younger. As they get a bit older and the other kids don't want to be bossed around and told how to play by this child, that can be when friendship issues begin to arise and these girls begin not to kind of thrive in the school environment and you get these sort of friendship issues and perhaps some bullying and social difficulties there as well. And the other thing with the language is often you'll find that when you stop and you listen into their language whilst they might seem very fluent and as if the conversations happen quite naturally and those interactions are good and positive, often again this is quite scripted, quite learned, they might have learned it from books or from watching other people and you might find they don't deviate too far from what's familiar to them and when put in new situations that you'll find that they begin to struggle. One thing we see as well, whole other aside, is that sometimes that we'll see kind of selective mutism or tendencies that way in girls who are autistic or otherwise highly anxious so mutism has been rediagnosed recategorised as anxious disorder and anxiety disorder and so again when very anxious or in situations which provoke huge anxiety you might find that girls just completely stop talking so that might be something that you notice. I'm just checking in any questions anyone who's not. Okay yeah so yeah keep up there's really interesting things coming up Sophie rather will tell me if there's anything I specifically need to answer as we go but are there warning signs that you might see so we kind of talked about anxiety in all its many forms you might find that she goes very shy or quiet that she contends to kind of direct and dominate play. Another really key indicator is if you've got a girl who seems to have a dual personality in particular that you've got a girl perhaps who you know perhaps you work at school and she seems absolutely fine and then she goes home and it's really challenging for the family or vice versa but it's usually that school is okay and the home is really challenging and this is quite typical because this might be a girl who is imitating, masking, trying to do all the things that get all the good praise and positive responses when at school and then they go home and they're exhausted and the mask comes off and we get the kind of melts down or shuts down so they might either get kind of very very kind of angry or big and loud and melts down in quite a loud way or they go into complete shutdown and go very very quiet and kind of completely shut off from the wild and both those things are fairly typical this is really important to note because a it's a key indicator that autism may be a potential diagnosis here but also that this is something that for parents and there will be parents and carers on the webinar here I'm sure often we as parents and carers feel we're doing something horribly wrong because here's our daughter who we're hearing from school is a perfect child works really really hard often very academically able gets on okay with peers it seems and then they come home and we can't interact at all it's awful everything's terrible the whole time and how can it you know this jackal and hide be and that must mean that as a parent or carer I'm doing something horribly wrong and what is it not the case actually very very often when we see this this is that the girl feels comfortable at home they are in their safe place and actually finally they can let go and it kind of often comes out and it's quite challenging ways and so that's sometimes what's happening there so if you're seeing this dual personality really really crucial and really important to work with the family and help them understand this is not a failing on their part but yes we do all need to work together to think about how to make those transitions work and how to support a child so they're not getting to that point where their day has become so overwhelming that by the time they go home they're no longer able to cope and manage sorry Pukie here's a really good question about do these behaviours typically get worse with age? Good question um I think I don't know that I have a really good answer to that but what I would say is if we don't recognise that there's a problem and we don't support then often we will find in particular that mental health will suffer so we will often find that anxiety will worsen we do find that girls with autism are more prone to things like self harm and eating disorders I'm involved in a fascinating research project about the co-morbidity of anorexia and autism and there's a very high prevalence when we stop and we start assessing women with anorexia about a quarter we think but it's quite early on about a quarter are autistic and so if we don't recognise and we don't support then the you know there can be quite negative outcomes and it can make life very very difficult because it's hard it's really really hard to live with autism without the right support and understanding of self and the world whether it specifically worsens with age I think that the tricky thing for girls in particular is just that their friends are less open to them acting in the way that comes more naturally to them as they get older so we often find that in primary school by about year five is when things begin to get really really challenging for those girls where yeah they are it's no longer really okay with their friends for them to dominate play and tell them what to do and where actually the limits of what we can do purely by mimicking and copying kind of reaches you know it's its end point and it becomes more apparent that yeah when we're not quite like our friends and friends become less tolerant and so on and so forth and it's really important here that we think about how do we help girls to understand themselves and help peers to understand each other that's um yeah that's really really really crucial I hope that answers the question sorry I sometimes just don't know the answer are the other kind of signs that we would be sort of that might sort of suggest there's an issue here so I've mentioned before about girls potentially being avid readers and that's something that we often will see in our autistic girls not always and all these signs you know when you've met one autistic person you've met one autistic person so you won't see all of these signs and you know you'll see different things as well but being an avid reader really getting very lost in kind of other worlds that kind of makes sense and have clear rules and we know who the people are and we can read about it and learn from it crucially how to manage in the world we will often see that's being really yeah really avid readers or getting lost in other worlds it might be computer games for some it'll be kind of youtube channels bit hard to differentiate that from their neurotypical peers of course but it's the the level of that obsession really and seeing them really mimicking what they're learning there finding that they're beginning to struggle with their friendships from about age nine or ten so that's about year five here in England and then also that you will as things begin to worsen or if things begin to worsen for them you will sometimes find that these girls do become overwhelmed and either that they will melt down and that's our kind of big response to not managing anymore where we become very anxious in a big way or very angry or that they shut down and this is you know where they become quite incommunicative so where we're thinking about our fight flight freeze sort of melt down is your fight and your flight response and shut down is your your freeze response essentially both just as a point of reference both are a child who is extremely distressed who is no longer coping who really needs your help so the child who is in shutdown if you are a teacher an educator the girl who is in shutdown might not be causing problems in your classroom and you might not respond to them in the same way as the girl or the boy who's throwing things around and biting and kicking and screaming but they're distressed their inability to cope right now is every bit as deserving of our attention and does need our response and support to help them to regulate the kind of final final point I wanted to make in terms of signs to look out for before I give you a moment to just reflect on what you've heard so far and think of any questions in your breakout rooms is that you will often find with the girls they are really academically able they get on quite well in school they are quite good at doing what's needed to get a positive response from the adults around them but they tend to be pretty inflexible and quite perfectionist in their approach so if you're seeing this kind of perfectionist tendencies and they're very able but they need to always sit in the same place or do things in a certain way or they need things to be quite consistent and predictable all kids need and want that to a certain extent but our autistic girls in particular thrive on that and can become quite challenging if that isn't stuck to and adhered to quite unable to manage change okay I'm going to chuck you into your breakout rooms for five minutes to give you a moment to reflect on what you've heard and I want you to have a think in your breakout rooms if there are any of those signs that surprise you and if a particular child has come to mind but also take the discussion wherever you want I'm going to give you five or six minutes there do speak do use that opportunity talk to each other and then come back with any thoughts, reflections or questions and pop them in the chat and we will address those at the end if not now so Sophie if you can chuck everyone into their rooms if you don't have a camera or you don't have audio you can chat in your room on the box we've avoided that moment for everybody yeah so we shall continue so okay so anything in the chat that we want to address before we move on so have you been having a look at that are you too busy trying to make breakout rooms work I have been looking at that there have been a few questions what would cause a girl to mask at home and release at school rather than the other way round okay so that does happen sometimes more typically it happens the other way round but sometimes you know as we know for some children school is their safe place and if school is your safe place that is the place where perhaps you will be kind of more yourself and allow your master drop perhaps you've built a particularly good relationship with a trusted adult at school or maybe you formed a really strong friendship autistic girls do form really good close bonds if they find the right person often they will form individual friendships rather than friendship groups we find but you know if you find a place where you feel really safe to be yourself then you may find that the mask is dropped there and if you know things are challenging at home or they've been perhaps punished reprimanded had a negative response to the kind of autistic behaviours then we might find that those behaviours are masked and you know we see this in it's not just an autism thing you know children respond based on the feedback that they're given and how safe they feel in a given environment a child who feels safe will be more themselves and a child who feels less safe or is getting negative feedback for what they're doing will generally modify their behaviour and a thing there just to understand just in terms of behaviour is that a bit like I said before we need to help parents and carers understand that if a child is seeming not to manage at home and they're coping really well at school and so we think that we're doing something wrong just more generally as an adult if you build a really good trusting relationship with a child then you may find that their behaviour begins to deteriorate because actually it may be that they begin to feel more comfortable with you and that they don't work so hard to mask how they're feeling and so we sometimes have this kind of slightly painful bit where they've not yet begun to learn strategies to manage and regulate because you're perhaps still working on that with them but they feel able to be themselves so that should be seen actually as a positive sign although it might not feel like it at the time just worth noting any other ones you want me to respond to you right now? If you're looking to refer a teenager for diagnosis where would be your first port of call? Good question so pathways are different in different areas so generally speaking it might be a Senco who asked the question if so do you say but normally I would go and I would speak to my Senco I would speak to my Senco network find out what happens locally a GP is often a really good port of call if in doubt go to the National Autistic Society they've got really good information on their website and can often help to direct and they have got they respond to queries as well so they're a really good place to go but yeah just it really varies in different places but every local area should have a recognised pathway it's just about understanding what that is in your area but yeah I would talk to my Senco if I'm not the Senco I would talk to my Senco network if I am a Senco and get advice from other Sencos and I would consider talking to the GP and the National Autistic Society Any more? There's loads of questions that they keep on piling up Are there differences in how girls are affected by sensory difficulties? Good question so yes and no so autistic girls like autistic boys often really struggle with being a sensory overload some have the opposite and don't really feel things but often we'll find that yeah sensory they get overstimulated basically by noise sound the feel of things and the main difference in terms of their response to it is more about what we see rather than what they're feeling so we generally find that girls are better at kind of just pretending to be fine about it whereas we don't so much see that with our boys although again some of them will mask that so but no the kind of overstimulation that issues around sensory issues is similar for girls and boys we believe and that's something that when we're thinking and I'll move on now to about our practical strategies for supporting one of the kind of key things that we always think about when trying to support autistic children is actually trying to create an environment or a safe space they can go to which is really calm and quiet so in particular those of us who are working in early years or primary settings we have traditionally had these really busy bright wonderful classrooms and they're so fun and so wonderful to look at and there's always so many different things to see but if you're a child who is like overwhelmed by the world generally being in a really really busy bright classroom and there might be quite a lot of different noises and smells and stuff going on as well that can be quite overwhelming and having even just a little corner I've seen it done in classrooms where it just you know there's a desk with a pillow and a safe space under there where they can just go and be quiet where it's kind of a bit cooler, calmer, darker bit more neutral can be super super helpful and increasingly schools, many schools I work with are moving towards having a more kind of calmer more neutral environment generally because we know that what helps our autistic children tends to help everyone to regulate and there'll be many kids on the spectrum who haven't been diagnosed who benefit from this but as a minimum thinking about where would be a calm safe neutral space that this child could retreat to if needed ideally within the classroom or within the home that they can go to as and when and proactively as well as reactively so reactively being I'm feeling overwhelmed I need to go to my safe space but proactively being I know that if I go to this safe space regularly for just a minute or two perhaps you know break times then I'm able to kind of emotionally regulate and then continue with my day better so I think when we're thinking about autism and our ability to manage and emotionally regulate for me the most helpful analogy is to think of myself as like a computer character so you know like when you're a computer character you have the energy bar yeah and if you're playing like sort of street fighter or something like that you need a certain amount of energy or you die and you will break it down in street fighter by being hit or blown or headlocked or whatever but in an autistic person's life that is through social interaction or a really busy environment or really strange sounds or things being out of routine there'll be all sorts of different things that will knock that energy bar down and it's about understanding what will help to build that energy bar back up and actually just having a little bit of time in a safe space perhaps with some kind of fidget toys or using practicing kind of breathing calming relaxing strategies will help to build that energy bar back up I mean I have to wait till the point at which we die until we begin to do that much more effective if we kind of you know every now and then as that energy is dipping that we build it back up another analogy you can look up and can be a really helpful starting point for conversation particularly with older autistic girls is spoon theory there's a lovely TED talk where I can't remember the name of the woman now but she talks about spoons it's about chronic illness and how when you're chronically ill everything takes a certain number of spoons so you start the day with 20 spoons and throughout the day you're using these spoons to interact to get up to work to whatever it might be and then you need to do things to bring more spoons back every now and then so you don't run out of spoons so people refer to themselves as spoonies it's a spoon theory so that's a nice analogy that girls might understand and I have occasionally done it with kids where we've done it as a physical thing like we've sat there with spoons and we've talked about a typical day and we've thought about well how many spoons do you think that activity would cost and actually kind of put them down and then go oh well if you know break time and being out and about in the playground and all that noise and you know the all the different discussions that you're having with other children means that you've that's cost you five spoons what could we do just after break to try and get back a couple of those spoons oh okay maybe you know five minutes of mindfulness or an opportunity to sit in the reading corner for a few minutes with a buddy or going and talking to the school dog or whatever it might be and and you can kind of work through the day like that and try and think about what are the what are the costs of the different things that they're doing and how can we build that energy or the spoons back up communication and the key thing here is just keep on talking to her keep on trying to understand more about her help her understand more about herself and be curious and think about what's working and what's not Other things in terms of our practical strategies for supporting remembering that it can take a long time to get a diagnosis so if you suspect then treat as if we'll do no harm work with the family so we'll have all sorts here on the webinar you will some of you will be here because you are family some of you will be here because you're educators I know we've also got school nurses and social workers we have all kinds of people and this works best when the child is at the centre of what we're doing and we're all working as a team around the child we must as educators in particular work with families if a family are telling you I suspect my daughter might be autistic please listen it's so common that we find out that girls get really late diagnosis but mum dad carer have been saying for years that they think that something's wrong something's not quite right here and they're not sure what it is and sometimes they suspect autism or that you like suspect other things when you hear those suspicions listen to the families they won't always be right but they will often and when we come together and we provide an environment where we can hear each other and we can explore curiously together with the child's best interest right at the heart of it often we will come to ways of working and supporting much more quickly than we do when we're more dismissive of those concerns which can sometimes happen I'm sure this wouldn't have you wouldn't be here if you weren't someone who listened but try to encourage colleagues to do the same and make sure that you know if families have concerns about their child that there's a really clear pathway that they know where to go with those concerns who to talk to are the things that we can do in terms of supporting and remember you will get notes on all this I'm referring to my crib sheet so you'll get my crib sheet are the things that can help is emotional literacy and skills around emotional regulation and we have got I was going to say we have a fantastic course I wrote it so that's really I'll be more modest we have a course that I think is okay around emotional regulation in autistic children on the website which we'll send you a link to afterwards and this is about how we as adults can teach our children to better emotionally regulate to manage the feelings of distress and overwhelm that we might feel in any given day we also need to help them to recognise those feelings what it actually feels like what's going on here and to work through those things and also learn to let us know when there are issues too but essentially just really learning together about how a child is feeling and what they can do to change how they feel when we teach children or adults if they've never learnt and you will work with families where the adults have never learnt when we teach people the skills around emotional regulation about changing how we feel taking a feeling of overwhelm and managing to calm it down and get back to a point where we're able to think we're able to prop themselves we're able to access all those higher level cognitive skills that's like a superpower so if you can teach a child that you can teach them simple breathing techniques relaxation techniques grounding techniques no there's no end of them and I will link again through to a few of my YouTube videos that share some of those simple strategies but when you teach these strategies to kids it's like a superpower when we realise that when I feel like this there's something I can do I am in control of that it's amazing so I will often teach kids things like the five finger breathing techniques so it's where we take one hand and put it out in front of us and we take the other hand and we breathe in as we draw up a thumb and then we hold we breathe out and we hold we breathe in and we hold we go around the whole hand and this is really effective because we take our hands everywhere so we've always got them with us it's really tactile it's easy to remember it's a good and simple script and it helps us take control of our breathing and that helps us to feel fundamentally a little bit different and so yeah it's like a superpower to teaching children to understand what they're feeling to name it to share it with other people as appropriate and to take steps to change how they feel when they don't like how they're feeling can be super helpful we talked already about the safe space to retreat to and thinking about using that proactively as well as reactively and the kind of the proactive bit there I always term as mini resets so I would think with any child who is prone to overwhelm for whatever reason I would think about what points in the day would it be helpful for them to have a mini reset and what that mini reset looks like will depend on the child it's whatever for them works in terms of you know building that energy bar back up replacing those spoons and for our autistic children often it is a calm, quiet environment where they're not overstimulated so I will often say in jest that after something like this I go and lie in a darkened room it's kind of said half in jest that's basically what I do and if we did this face to face like tomorrow I'm teaching a conference all day if we actually did that in like in the old days when that used to happen with people all in the room together I would literally the day after that really barely speak to anyone and just stay in a very very calm and quiet kind of place and so we need to think for for the child what works for them for other kids who become overwhelmed for other reasons for some of them they will need to kind of have the opportunity to to kind of get it out they might have different things on their mind they need to write them down or draw them or play them or whatever but those many resets will look different for different kids but we want to build them in at various points throughout the day in order to enable them to continue to cope think particularly here about transitions and think particularly about if there are certain things that a child finds especially challenging whether we can help them to find that place of coping and calm before they enter that situation so if for example they hate lunchtime they find it really hard that it's too noisy they don't know how they're meant to be then if we help them to kind of find a place where they're relatively coping and calm before they enter lunchtime they're more likely to be able to to manage it other things we can do with our autistic girls teach them about friendships actually help them understand how friendship works what it means to be a good friend how we do that what's expected of us how we can interact in a way and what friends expect of us and what we can expect of them we often assume that these often very articulate very academic girls that they've got it sorted that they understand all these things but often they don't really understand exactly about how they feel and they don't really understand about friendships and how they work so we need to teach them and explore it with them and be curious about it with them and finally helping them to find and make friends in particular if they can make at least one really good solid friendship that's really helpful and their kind of special interest the thing that they really like can often be a really good way into that so if they particularly like a certain hobby for example finding another child who shares that hobby with them can mean that they get on very well and the other thing here is that we will often find that autistic children will get on well with other autistic children not always and as I've said already a couple of times when you've met one autistic person you've met one autistic person just because two children are autistic doesn't mean they'll automatically get on but it might and it's worth considering okay any any kind of quick questions there who have gone to the last last bit there's been loads of things put into the chat I'm just trying to think of there's a really good one that I think is ideal for you to answer is it beneficial for adult females to realise they are autistic yeah okay yes yes definitely I can tell you from my point of view and from other adult females that I've spoken to about it on a more personal rather than professional level I guess for me it was a hugely important realisation but quite a challenging one so some of you will know the story so apologies for repeating but the reason that I came to be diagnosed was because I was in hospital with anorexia and I was very very sick and I wasn't getting better in fact I was actively getting worse and the more that the hospital tried to treat the anorexia the worse it was getting and so I was not only unresponsive to treatment but it was actively sort of harmful and I was yeah very very high risk of death and at that point it was suggested my care team kind of came together trying to understand really what on earth was going on and this was before the pathway for autism and anorexia existed and it's why I'm on the team they're working on it but it was suggested that perhaps I was autistic and perhaps they should start to treat as if and overnight things began to completely change and that was partly because we all had a better understanding of the things that would help me and how to stop me feeling so overwhelmed all the time I was no longer forced to do loads of group therapy for example in which I became completely mute as a point of interest and the other thing was that it meant that my treatment team were more flexible around lots of parts of my treatment and the things that they were trying to force because they thought what they were seeing was anorexia when actually what they were seeing was autism and that by trying to force things like trying to make me try different flavours of things for example just wasn't a helpful approach and so they radically changed their approach and changed their focus however so it was helpful from that point of view and longer term so that was about three years ago now four years ago maybe it helped me to manage so I had gone through periods my whole life has been a period of basically managing really well really thriving being hugely productive and very very successful and then completely crashing and burning and everything going horribly wrong and that's basically been a cycle forever and now I hope touchwood I'm kind of out of that cycle because I'm able to take steps to manage every day so those were all really positive things but the negative thing was that when I got a label of autism I suddenly realised this was something I had to live with forever so anorexia is something that you work to overcome and wouldn't be a significant part of your life you hope every day by at some point autism doesn't go away and realising that some of the aspirations that I had for my future were never going to be realised because actually I was basing my interpretation of my future reality on an impossible you know I was never going to be in particular I think I remember being very very ill and thinking one day when I'm better I will host big dinner parties and for some reason this was something I had latched on to as an idea and I don't am now at peace with the idea that I don't want to do that I wouldn't want to do that it wouldn't be helpful to me I wouldn't enjoy it but at the time letting go of that kind of yeah future was a bit challenging so yeah it was difficult from that point of view but the a really great thing about getting a diagnosis later is a we often find that autism is quite heritable and so often autistic parents have autistic children and many autistic adults learn they're autistic when going through the diagnosis process with their child and when we begin to understand more about ourselves we can really support our child well so that's really positive but also it means suddenly we know who we are and we can identify with other people like us and we can ask people to help us so we can ask people to make what's the word reasonable adjustments to help us all the time so yeah basically I would say yeah it's a good thing it's a good thing okay final point and I will happily stay on for questions after five as many as we have but I'm aware some of you will need to log off so final thing I want to just talk about is about the importance of taking a strengths-based approach when we're working with our girls with autism and actually I mean this is a point I come back to all the time no matter what's title this session had what kind of additional or special need we were talking about a strengths-based approach is always the right approach in my opinion we need to sometimes just forget about momentarily the challenges that might come with a label and there are challenges and actually look into what makes this child unique and in particular with autism what are the good things that it brings so actually there are brilliant positives that come alongside autism some of those traits once we learn to understand ourselves and to manage day to day some of the autistic traits can make for the most brilliant people we will often find that our autistic girls and boys are very good at being really hyper focused and really interested and engaged with specific areas of interest and sometimes children are encouraged to think more broadly and move away from the special interest because this is something that's to do with your diagnosis and therefore bad but actually you know other people have hobbies and interests and passions and that's okay and autistic people have special interests and that's bad no just forget that if a child has a special interest use it lean into it have a think you know this girl loves animals is obsessed with animals reads everything watches everything about animals great maybe she'll be a vet one day actually lean into that special interest encourage it obviously we need to make sure that she's able to talk to and engage about other things as well but lean into those special interests she really cares about them use them to your advantage there are other traits here so often again we'll find our autistic girls are really brilliant friends when they make a friendship they might not make many but they'll often make really good deep friendships and they're often really really loyal you have to protect them because if this friendship goes wrong it will be devastating for them and they can often be very vulnerable to being taken advantage of and you know so we need to really help them to learn and understand around things like consent and looking for signs that things aren't going okay and who we should talk to but they can make brilliant brilliant partners and friends really really loyal yeah good good good people and if you're an educator you'll often find that they are very eager to please in the classroom very able often able to to learn new things very well it might take them a little bit longer and you might need to simplify your instruction sometimes and repeat a little bit more often at the beginning but often you will find that they are very very capable we have to try to encourage them to be bold and brave in their learning and not too perfectionist or obsessive but yes they can be absolutely asset in your classroom the other thing I'd say here around this kind of strength based approach is to look for role models for your autistic girls so it's there are more and more people out there who you can look to as role models I would particularly recommend Sienna Castellian no Castellian so this is her book which again I'll put in the list of this is the other book I'm just going to say like whilst I'm saying what you should read if you read two things read these I'll put links to them in the notes but so Sienna was 17 when she wrote this book she's autistic she's awesome and she would be a really good role model this is also really good book to read and share with an autistic girl about it's just about life the universe and everything if you're an autistic girl the other really good role models to look to I don't have the book to hand because I'm a fool and I've left it in the other house but the other really really good role models are the children at Lymphsfield Grange so they wrote two books it's a school for autistic girls and it's an amazing place so Lymphsfield Grange Girls wrote with support M is for autism and M in the middle and M is for autism is helping you learn to manage in younger when you're younger and M in the middle is kind of moving into sort of middle and secondary school and then the other book is what's it called it's gone completely from my head Libby Dylan I can see you can you see me I'll look it up and I'll put it on the list but again another child who wrote with support a really brilliant book and it includes specifically ways in which you know that people can help her and things that help her as as it goes through so you look for role models look for autistic role models the other thing is if you ask around if you're in a school ask around within your staff staff you will have autistic autistic women if there are women on your staff who identify as autistic they might be very willing to talk to your autistic girls and share their experiences and it can be really reassuring I get parents all the time saying you know oh it's helpful for my daughter to know that you're an adult autistic woman and you're managing that's inspiring and it's you know it's helpful for girls to know that it can be okay very very final final point on this one around strengths and taking that strengths based approach is just work with her work with the girl that you have in mind today to define her strengths and her quirks and return to them really often and remind her that these are her awesome this is what makes her who she is and try as hard as you can not to allow life the universe and everything in the system to hammer these quirks out of her because she's brilliant just as she is and if we support her and we help her to manage and cope and thrive and try and help the world to adapt a little bit to her as well as her always adapting to the world and that we'll find that she can be herself and that's a really good thing okay I'm aware some of you need to go because it's five but I'm happy to stay on and I will continue to answer any questions that you have do not feel obliged to say at this point if you have a question do feel free to or a comment or any other feedback or a resource you want to share either press and hold the spacebar or pop it into the chat thank you so much for your attention and sorry we couldn't make the breakout rooms work so Sophie I'm leaning on you here I was actually going to say there's a really good question which has intrigued me are there any famous role models that some of my students can look at how they've achieved and not feel like failures of female autistic women female women I need to go and have think about that I'm sure there are loads I'll do you know I will ask my twitter followers to make some suggestions and I will share a link to the tweet and then you can all have a look at that I'll make myself a note to do that note to yourself and I believe the book title was called can you see me that's it yes I can picture it it's blue with a yellow and there's going to be a follow-off as well I'm very excited about this it's a really brilliant book thank you wow people are already putting in autistic women in the chat that they're so quick that's really brilliant and I have to whilst many of you are still here as well I will continue answering questions in a minute just my husband will completely destroy me if I don't do my like hi creative education we're amazing things so many of you already know about creative education so we are a training company used to provide face-to-face training for school staff and then the pandemic hit and it got interesting so it all went online so we now have hundreds no not hundreds yet over a hundred courses that you can access on demands online either through a personal subscription or through an organisational or team membership all of which are really reasonably priced but all of which you can also do as a free trial so if you would like to find out more about that Sophie you'll send everyone an email anyway won't you about it in particular if you've got a team that would like to have a free trial set up Sophie's sister sorts that all out we love families here so me and my husband run the business with my mother-in-law and the cat obviously and then Sophie and her sister take care of much of the rest of it whilst her dad does our premises work so yes Sophie's sister would help you get set up with the trial if you wanted to have your whole team able to access our courses and they cover all sorts of stuff loads of them and stuff I've done around kind of emotional well-being and mental health and SEND but there's a whole range of other stuff on there as well so if that's of interest we can set you up with a full week free trial so Sophie will send you the details of how to sort that out and maybe put Eliza's email just in the chat in case if no one wants to email her directly safe yeah no problem there's a really good question about a child who wears an elastic band to stop themselves from self-harming the child shows that they've snapped it so hard that it's left to mark yeah okay it's like they really want it to snap good is there any advice for that yes don't use an elastic band as an alternative to self-harm this was a very widely advocated technique for many years it's in loads and loads and loads of recommendations of alternatives to self-harm including things I've written in the past it's no longer a strategy that we recommend there is new evidence that it does harm rather than good and just ends up as a kind of alternative an alternative means of harm so whilst it was very very widely advocated for a long time we no longer do advocate it and we look to other alternatives instead we've got a course on self-harm on the site and actually I'm thinking about doing a longer more in depth course around self-harm for anyone who's interested but the one on the site at the moment is around breaking that cycle of self-harm and so for the person who asks that might be a helpful course to go and have a look at and maybe include it in the if you might say if you're adding it to the notes that I sent through the self-harm course and maybe the eating disorders one as well because we really often see both those issues in our autistic girls yep no problem and just to say there there will be loads of you listening who have recommended the elastic band thing and maybe still are and are now thinking oh gosh I've done harm we can only do the best that we can with the information, knowledge understanding and skills that we have at the time forgive yourself but please as of tomorrow don't advocate that anymore and look for some different strategies with that particular child so in terms of like you know so don't do the elastic band thing first point second is when we're trying to work out good strategies good alternatives to self-harm for an individual child the most helpful question that we can ask ourselves or them is what is their unmet need basically what do they get out of self-harming and to begin to understand this we're going to have to have some really good conversations with the child whether that's verbally or through play or writing or journaling there's all different ways that we can do this we want to try and understand basically what's in it for them habits do not form without some form of positive reinforcement and if we can understand what's the good thing that happens when they self-harm maybe they feel a bit calm maybe it makes them think about other things for a moment rather than all the horrible voices going around in their head maybe it gets them some much needed attention or support or listening from a trusted adult there's all sorts of different reasons why a child might self-harm when we understand what the unmet need is what the positive is in it for them then we can think how else might that need be met and then we can begin to think what are different strategies that we might turn to could be brilliant I'm just scrolling through so many lovely comments about how it's really great you being open with your own journey it's been a really informative session would your course on self-harm apply to ASD girls yes yes it would so um yes the the the one thing I would say about self-harm and autism so we get a really high prevalence of self-harm in autism and often that is because sort of alongside our autism goes kind of mental health issues and challenges with managing because it's really overwhelming being autistic the world is not designed for us and it's hard and if that's the case if this is essentially related to kind of low mood anxiety then the regular kind of self-harm training will help however for some children who are autistic and self-harming actually they're self-harming for a very different reason and this is a form of stimming up for them so stimming refers to essentially seeking ways of getting sensory input to help us to regulate and calm so in our autistic boys in particular will often kind of flapping or spinning I tend to rock I find this when I watch myself back on on on video if ever I'm standing that I just rock but yeah we'll do different things but for some kids some form of self-harm or kind of picking, biting those sort of harmful behaviours can be because they're seeking that ability to regulate and calm themselves and so that might be the unmet need essentially and the course that I've done wouldn't necessarily specifically look at that but if there's enough interest I would really happily put together a course specifically around self-harm and autism though I think there's not there's not loads of really great stuff out there but I'd be happy to do some research and you know add to the can and if there's a need so if that's of interest to you, then drop an email to us afterwards and let us know the questions that you're facing what you've tried what would be helpful for you if I were to put together a course on that Is sleeping a problem generally? For autistic can be yeah so yeah that's an interesting question so again what we will often find is that autistic girls it's quite messy like there's often a whole range of different issues that we're seeing but yeah sleeping and eating we can see disturbances in both of those sleeping is often an issue for anyone who struggles with anxiety it can become an issue because we've got lots of different thoughts racing around in our head so it can be linked to that and sometimes as well we will find that our autistic girls are just really tired because they're managing they're working so hard you won't believe how hard an autistic child person anyone works all day every day just to do normal things it's really really tiring so we might find that they're very very tired and can seem kind of quite lethargic at times so we can get that kind of yeah both ends of the spectrum really kind of seemingly oversleeping needing more sleep than we might expect for their age and stage and then sometimes really struggling to sleep as well and sometimes both which is really difficult and can really get them a really low ed everything's harder when we haven't had enough sleep and just as a general rule I would say any child that we're worried about or any person that we're worried about who's struggling everything will feel better if we can get their sleep on track if they can get a little bit more a little bit better sleep than things will feel better universally applicable advice that yourself if you find you're struggling you're at a low ed actually what can you de-prioritise in order to prioritise sleep everything's more manageable then again we have on the website Tom will be proud of me I've mentioned several courses on the website we have a really good website on the a really good course on the website about sleep and supporting healthy sleep habits which is put together by Annie O'Neil who is likely on the course somewhere but there's so many people here Annie is a school nurse and runs a consultancy and provides really good practical strategies for supporting children in all sorts of different ways with that amazing school nurse hat on we love school nurses and so that would be a really good course to look at as well for parents or educators or anyone else This next question I feel like is a point that we might have to take away and reflect on and maybe make a greater course but do you have any information about autistic girls in gender dysphoria? Okay so yeah that's for another day but what I can tell you is that the incidence of gender dysphoria in autistic girls is remarkably high and again that's another reason why you know what I said before so we're talking about autism in girls and autism in boys but sometimes you know you see autistic girls who present like males and vice versa and actually there's this really messy bit in the middle because the incidence of gender dysphoria in the autistic population is is high I read a statistic yesterday when I was preparing for this course that suggested one in four autistic girls experienced gender dysphoria but I don't know how like I don't know if that's true that feels far too high surely but it's high we know it's high yeah there's a really high instance and there are you know lots of questions around sort of gender sexuality those sorts of issues we would I think that's that's a big big topic to start going into but I think it's important just the one thing I would say on this is that for girls in particular questions around gender and also puberty is really hard like puberty hitting puberty for girls managing periods actually again that's another thing which is dealt with really really well in this book is how to do puberty as an autistic girl it can be a really challenging time and yeah those things are hard and what we the key thing we need to do is that adults in an autistic girl's life really is to help her begin to be curious about herself to begin to feel comfortable in who she he they are and to try and create that safe environment where they can begin to explore this in whatever way feels comfortable for them and just to yeah just to be be curious and be interested in them and to try and allow them to kind of find their feet find themselves in this very interesting world we find ourselves in so there's a question that's been requested by other people to be read out you said your treatment for anorexia change once they treated you as autistic in what way did it change we seem to be seeing an increase in eating disorders yeah so so how did it change well if you're interested again if you can make a note of this Sophie and add it to the notes if you're interested in the the pathway so we're developing this clinical pathway for treating co-morbid anorexia and autism and there's some really good practice already that's come out of this work which I've been working on with the Maudsley I say that like I I have a very small part in this I just sit on the on the expert reference group and occasionally do training with them but but it's amazing work they're all doing they've published quite a lot they've changed quite a lot of practice already so following them and it's the peace pathway and it's it's King's College and the Maudsley that you'd be looking up Kate Chanchuria which is not about how you expect it's TCHAN at the beginning so look that up I also have a YouTube video which is I spoke at an international conference on this topic recently and I gave sort of five things to understand about the interplay between autism and anorexia but just going to that very specific question around what helped me in that moment so firstly understanding what was autism and what was anorexia so the the kind of the crux point for me was that like many autistic people I find lots of different flavours and textures of food really overwhelming and the assumption was that when I was cutting out food groups or finding them too difficult to manage that this was anorexia talking and that I was trying to avoid calories and so on and so forth and actually it was that I just found these things completely overwhelming but in an autistic way rather than an anorexic way and the tipping point came when I had like many people who suffer any kind of anxiety made my world smaller and smaller and smaller the number of foods I could eat had gone down to one and it was a liquid food supplement and I could only eat it in one flavour or only consume it in one flavour and on this day the unit I was on did not have the right flavour and this was you know they couldn't see why this was an issue and for me it was completely not possible to have the wrong flavour I couldn't manage it and it ended in well I wasn't proud of my behaviour it's not a nice day to look back to and it ended up being force fed and it is horror it's I mean yeah it's not nice but at this point you know began to wonder what's actually going on here when we look back on that incident with the view the lens of autism then we understood and my caregivers were able to be a lot more compassionate but questioning always questioning is this autism or is it anorexia I recently lost my sense of taste and smell and found that I was oversensitive to textures that had previously been palatable to me because I didn't have the taste to kind of cover up the textures I think and again I then found myself going to my psychiatrists and saying how much leeway do I give myself because I fall very rapidly into a downward cycle if I begin to restrict my foods and I you know how much leeway do I give myself because I'm a bit worried about cutting out food groups how much of this is actually anorexia pretending to be autism because anorexia is very crafty and how much of it is autism and we really explored that so I'm picking what is anorexia and what is autism remembering that anorexia is the bully that sits on your shoulder and tries to manipulate and convince everyone including you that you shouldn't be eating shouldn't be consuming that you know this is bad next thing is that a starved brain acts quite like an autistic brain so a starved autistic brain means like autism on steroids so I was like became very autistic in terms of normally now if I don't disclose my autism then generally people wouldn't make that assumption about me and I can pass as normal if you like but there's no way that would have happened when I was severely anorexic my brain was very starved my thinking became entirely black and white I was so rigid I was completely inflexible to any kind of change in deviation all the things you would expect to see in a small autistic boy was how I was behaving so very very autistic presentation and then the final thing in terms of how they change it so I said before about group therapy I no longer had to do that and the final thing was that they were more thoughtful about sensory epistimulation so in particular once I moved from group therapy to individualised therapy then I had that individualised therapy in a very calm beige room and the unit was generally quite busy and loud in terms of noise but also it was beautiful they made it all pretty and lovely which was overwhelming but this room was just plain just magnolia and that was easier but it had a clock in it and I found the clock to be really overwhelming and all I could focus on was the clock and so they removed the clock completely and then I was able to focus in on the therapy and little things like that little things make a huge difference if you are overstimulated and noises that might not bother other people but it's all you can hear for me that clock was like the equivalent of your school's fire alarm just going off and going off and going off and going off and trying to dig deep into kind of trauma therapy with that in the background impossible so making adaptations and helping me to find those kind of places of calm the other thing was just about just generally I did a lot of learning around my own emotional regulation actually taking my own advice and giving myself space in between but yeah it would I'd you know I'd love to say it was easy and once we had the diagnosis it was all plain sailing it was quite hard work and it's still hard work every day but you know it's that's life isn't it okay any more for any more I was going to say should we do one last question and then bring it to a close how would you support an autistic girl with hygiene issues she doesn't like to wash on any showers once a week ooh um yeah that's something that we do get asked um I'm trying now to think what was the name of oh it's gone completely when I tweeted this question out a couple of months ago there was somebody who came back to me who was like a cosmetic scientist like he was literally like he had a phd in kind of yeah he was a chemist but he had developed a range of skincare products for no they weren't for autistic people but he found that they were being used a lot by autistic people because they were really neutral the thing I would be asking basically so this is a fairly common issues where I'm going with this the thing I'd be wondering is what about the kind of self-care and washing and things is it that difficult because often it's something really simple that's the problem it might be that shampoos or shower gels are really heavily scented or that the feel of the shower is overwhelming and so we sometimes just need to find like really explore it and be curious and instead of going down the route we normally do of well you need to wash come on let's just get on with it actually just providing a safe space for the child to talk about it and explore what about it is it that they're finding difficult and then be curious about different ways forward and you know begin to experiment things that we might try that might be okay and being accepting that they might also not can be helpful but often it will be moving to unsented product thinking really carefully about what we're actually you know if we're using a poof or a flannel whatever looking for something that's really sort of soft and acceptable to the child for doing that thinking about you know a shower might feel harsh and overwhelming perhaps they would rather have a bath or a kind of standing wash with a flannel the old fashioned way just just being a little bit yeah being curious about it and the other thing is about having some discussions about why do we need to wash and helping them to understand in a stage and age appropriate way the importance of hygiene and exploring together about how we might be able to kind of meet those needs if not in the way that that's currently happening yeah so as we come back to all the time be curious explore it together and be prepared to get it wrong at first and keep experimenting brilliant well thank you poofy for all that information information overload I'd just like to say that there's been so many people leaving such wonderful comments saying how grateful they are for you shedding light on this topic and you know talking about it in a different way so thank you we'll leave the questions for now and I can see that lots of people are thanking you even more now that I've just highlighted it and yeah so I'll be sending the recording and the notes with bits and pieces afterwards so if anyone else you know if you signed up you will get a copy of the recording it just might take a couple of days to hit your inbox yeah because safety has got a life as well haven't you