Editor's note: This text-based course is a transcript of the webinar, Understanding Girls And Women With Autism In A World Where They Are Often Overlooked And Misdiagnosed, presented by Christina Marsack-Topolewski, PhD, MSW, LMSW.
*Please also use the handout with this text course to supplement the material.
Learning Outcomes
- After this course, participants will be able to explain the difference between social isolation and loneliness.
- After this course, participants will be able to identify populations that are at risk for social isolation, exclusion, and loneliness.
- After this course, participants will be able to identify signs of loneliness, and strategies to combat it.
Introduction
One of the key reasons I began researching and working in this area was the growing number of adolescent girls and young adult women seeking a diagnosis or coming to us for various forms of support. Often, these individuals or their families would describe their challenges in terms of anxiety and depression.
However, as we dug deeper into their cases, we noticed that many of these individuals were not receiving an accurate diagnosis, leading us to explore other potential co-occurring conditions. Today, we’ll discuss the reasons behind the misdiagnosis and underdiagnosis of autism in females. Finally, we’ll differentiate the common co-occurring conditions that females with autism often experience.
Today's Focus
Autism is an incredibly broad category, and many of you are likely familiar with the re-categorization of autism spectrum disorders in the Diagnostic and Statistical Manual. While we won’t be able to cover everything today, I want to acknowledge the broad continuum of autism and focus on what is most commonly observed.
To give you a bit of background about myself, I’ve been working in public schools with populations with disabilities for about 20 years. I’ve also practiced privately in a clinical setting and am a tenured associate professor of social work at Eastern Michigan University, within the College of Health and Human Services. We’re located just outside Ann Arbor, a place that sports enthusiasts, especially those into Big Ten sports, might recognize. My work has predominantly focused on populations with intellectual and developmental disabilities and juvenile-onset conditions, and much of my research centers on autism across the lifespan and its impact on family caregivers.
I’m thrilled to see such a large audience here today—welcome, and thank you for joining us.
Building on our learning objectives, one key area of focus today is understanding how autism manifests differently in females. These differences in exhibited characteristics can lead to late diagnoses or, in some cases, misdiagnoses. This issue is a significant driver behind my research, as many females with autism are overlooked altogether. Clinically, we’ve seen individuals in their forties, fifties, or even older seeking support and receiving an autism diagnosis for the first time. The more we can learn to identify these differences, the better we can support this population in our work.
Today, we’ll explore what these differences look like, how we can help females with autism navigate a world that often revolves around social interactions, and what relevant services are available. We’ll also discuss how autism manifests in females and what clinical considerations we should keep in mind. I recognize that many of you work in diverse settings, and that’s perfectly okay. I hope we’ll cover a broad range of options that you can consider in your practice.
To set the stage for our discussion, I’d like to invite you to share your thoughts. Since we’re in a virtual setting, please take a moment to think about what comes to mind when you think of girls with autism. The chat should be open, and I’ll pause for about 60 seconds for anyone who would like to share.
Thank you for your input—words like "sweet," "isolated," "social challenges," "loneliness," and "social interactions" are coming up. These reflections resonate with many of the themes we’ll be discussing today. Thanks again for sharing your thoughts.
Common Differences
Let's begin by discussing the common differences in the characteristics and manifestations of autism in females and males. To get us oriented, I’ll start by referring to the DSM, or the Diagnostic and Statistical Manual of Mental Disorders, which serves as our primary guide for understanding and diagnosing autism.
By grounding our discussion in the DSM, we can better appreciate how these differences play out in clinical practice and what they mean for our understanding of autism in females compared to males.
Autism Spectrum Disorder Characteristics
As I mentioned earlier, the way we understand and categorize autism changed significantly when the DSM was revised. Today, autism is characterized primarily as a social communication and social interaction disorder. This means individuals with autism will often face challenges in these two critical areas, which is why collaboration with various providers is so important. A team approach involving speech therapy, social work, occupational therapy, physical therapy, and other disciplines can be highly effective in supporting our clients, patients, or students.
The second key characteristic of autism is the presence of restricted, repetitive behaviors, interests, or activities. Many of us might be familiar with specific examples, like an intense fascination with trains, typewriters, or Civil War reenactments. These restricted, repetitive interests are very common among individuals with autism. For instance, anime is another area where some individuals may develop a deep and focused interest.
One of the interesting aspects we’ve observed is that females with autism often display different types of repetitive interests compared to males. These differences can sometimes allow them to socially camouflage or blend in more easily within their environment, whether it’s in a classroom, a social setting, or elsewhere.
Another important point to note is that, according to the DSM, symptoms of autism must be present during the early developmental period, although this doesn’t necessarily mean that a diagnosis is made at that time. In fact, many individuals are not diagnosed until much later in life—sometimes in their twenties, thirties, forties, or even beyond. Retrospectively, we can often see that these characteristics were present in early childhood, even if they weren’t recognized as such at the time.
Finally, it’s crucial to be aware that these impairments can significantly impact a person’s life across various domains—social, occupational, and other areas of functioning. In different settings, whether in a classroom, at home, or in a clinical environment, we can employ strategies like role-playing and other interventions to help individuals manage these challenges. Ideally, these approaches will prove effective in supporting their development and improving their quality of life.
Points of Consideration
Understanding the generalization of autism characteristics across different settings can be challenging, but it’s essential to recognize that individuals with autism are affected in various ways depending on the context. With that in mind, I’d like to briefly touch on prevalence, comorbid presentations, and the relationship between communication and behavior, as these are critical areas in understanding autism.
First, let's discuss prevalence. I’ve been researching autism for over a decade now, focusing on it from both a research perspective and through direct work with individuals, mainly adolescents, in school-based settings. During this time, I’ve observed significant changes in the prevalence numbers reported by the CDC. Currently, the rate of autism diagnosis stands at about one in 36 children. However, this figure doesn’t necessarily mean we’re diagnosing every case accurately or promptly—there are still instances of misdiagnosis, underdiagnosis, or late diagnosis.
Several factors contribute to these shifting numbers. One major reason is the broadening criteria for diagnosis. The changes in the DSM expanded the scope of who might be classified under the autism spectrum disorder umbrella. Additionally, societal awareness has grown significantly. There’s more information available, from billboards to commercials, fundraisers, and dedicated organizations, all of which have helped reduce stigma and encouraged families to seek screenings. We also have more practitioners trained in recognizing autism, which has led to greater identification and, consequently, a rise in reported cases.
To give you a clearer picture, recent studies indicate a male-to-female ratio of about 3:1 in autism diagnoses—meaning 75% of those diagnosed are male and 25% are female. This ratio may reflect the populations you serve in your respective professional capacities. Some studies suggest an even wider gap, with a 4:1 ratio, or 80% male and 20% female, which is increasingly supported by the literature.
One particular study I want to highlight offers a comprehensive analysis by examining many different studies, and it reaffirms this 3:1 ratio. However, when we consider females, especially those who are considered high-functioning—a term that, while not perfect, is commonly used and understood—we see a much more significant discrepancy. There is an estimated 1:10 ratio for high-functioning females, meaning they are often not identified. This is especially evident when working with individuals who might have both autism and intellectual deficits; these comorbidities often signal a need for additional services and support. But for high-functioning females, it’s easy for them to go unnoticed, slipping under the radar, which can lead to a lack of necessary support and accommodations.
This discrepancy underscores the importance of being vigilant and aware of the subtle ways autism can manifest in females, particularly those who might not fit the more recognized or stereotypical presentations of autism. As we move forward, we need to continue refining our diagnostic approaches to better identify and support all individuals on the autism spectrum, regardless of gender or level of functioning.
Reasons for Misdiagnosis
The signs of autism in girls and women often differ from those in males, frequently manifesting in more subtle ways. There’s a growing body of research surrounding the concept of "social camouflaging," where individuals with autism learn to mask their symptoms to blend in with societal expectations. This ability to socially camouflage is thought to be more prevalent in females, making their autism traits less obvious and sometimes harder to detect. This subtlety can pose significant challenges in terms of evaluation and diagnosis across the lifespan, particularly for those who present fewer overt difficulties.
In many cases, those with more pronounced challenges—whether behavioral, social, or academic—are more likely to be identified. For example, in school settings, I’ve been part of referral teams where children were brought to our attention due to noticeable difficulties in the classroom. These could range from behavioral issues to social challenges or academic struggles. These overt signs often draw the attention of teachers and staff, leading to further investigation and, eventually, a diagnosis. However, for those who are more "high functioning," particularly females, their challenges may be less visible, leading to underdiagnosis or even complete oversight.
Let me share a story that illustrates this point. I once worked as a consultant in a school, mainly with students in special education, though we also supported those with 504 plans. We received several referrals for a girl who had previously done well academically but was suddenly struggling in school. Despite having no history of academic difficulties, teachers noticed she was asking unusual questions and seemed to be having a hard time in the classroom. Her family mentioned she was being treated for anxiety and depression by an outside clinical social worker, and she started receiving accommodations through a 504 plan.
One day, while I was in the school’s academic support center during lunchtime, this student asked if she could close the door. This was unusual, but I agreed, sensing she needed privacy. To my surprise, she hid behind a faux tree in the room—a behavior that seemed out of place. This incident led us to dig deeper into her case, and we eventually realized that, in addition to anxiety and depression, she had high-functioning autism. This revelation highlighted how easily some individuals, especially females, can go unnoticed for years, blending in through social camouflaging until something triggers a closer look.
This pattern of late diagnosis or misdiagnosis continues into adulthood, where I’ve seen females with autism struggle in areas like maintaining employment or forming relationships, often feeling misunderstood by those around them. For instance, I’ve worked with adults who excelled at social camouflaging but found it exhausting, requiring significant recovery time after social interactions. This need to recharge is often misunderstood by family and peers, further complicating their social and emotional lives.
The COVID-19 pandemic has also added complexity, particularly for students returning to school after extended periods at home. Even those who previously managed well in school settings may find it challenging to readjust, and for those with autism, this transition can be especially difficult. This brings us to the broader issue of why females with autism are frequently misdiagnosed or underdiagnosed.
Several factors contribute to this. Social camouflaging is more common in females, leading to their autism traits being overlooked. Diagnostic tools have historically been based on male presentations of autism, making them less sensitive to picking up these traits in females. Additionally, societal norms often accept shyness and introversion in girls, further masking potential signs of autism. Research, such as the systematic review by Dr. Lockwood and colleagues in 2021, highlights gendered symptoms, clinician bias, and a lack of resources as barriers to accurate diagnosis in females.
Moreover, females with autism are underrepresented in research, making it harder to understand their experiences and needs fully. For instance, national studies I’ve conducted typically show an 80% male and 20% female split among participants, reflecting the gender disparity in diagnoses. Despite this, there has been significant progress in recent years, particularly in the UK, where much of the groundbreaking research on girls and women with autism is being conducted. Hopefully, we can apply some of these insights and improvements to our practices in the U.S.
When it comes to how autism manifests in females, their interests and behaviors often differ from those of their peers. While these differences might not be as pronounced as, say, an adult male’s intense interest in trains, they are still significant. Females with autism might have a deep fascination with animals or a preference for solitude and fewer friendships. They often invest a lot of effort into social camouflaging, which can be exhausting and may lead to them displaying different personality traits in different settings.
Comorbid conditions are also common among females with autism. Anxiety, depression, and eating disorders are frequently seen, and recent literature has highlighted the prevalence of conditions like Avoidant/Restrictive Food Intake Disorder (ARFID) in this population. This newer eating disorder, characterized by a highly selective diet and a lack of interest in eating, can lead to severe nutritional deficiencies and other health issues.
To summarize, autism in females is often more subtle and complex, making it harder to diagnose and understand. Social camouflaging, gendered symptoms, and comorbid conditions all play a role in this. As professionals, it’s crucial that we stay vigilant, continue learning, and refine our diagnostic and therapeutic approaches to better support females with autism across the lifespan.
Comorbidities
When considering common reasons for comorbidities in females with autism, social isolation is a significant factor. The literature on social isolation in the United States has been growing, and it’s a topic I’ve spoken on frequently because it aligns closely with my work and the populations we serve. For females with autism, social isolation is often prevalent, and this lack of connection can understandably lead to anxiety and other comorbid conditions. The feeling of being disconnected from others can create a need to control one's environment, which may further exacerbate these challenges.
Craving social inclusion but facing difficulties in achieving it is another common issue. In K-12 settings, we often work with children and adolescents who deeply desire friendships but struggle to navigate the social complexities needed to form and maintain them. Over the years, various programs and supports have been developed to help these individuals, focusing on effective strategies with proven efficacy. This is a crucial area of intervention as it directly impacts the mental health and social well-being of individuals with autism.
Sensory challenges are another contributing factor to comorbidities. These challenges often affect individuals across all settings, not just in isolated environments. For instance, a child with autism might struggle with sensory issues at school, and these difficulties don't simply disappear when they return home. Similarly, an adult with autism might face challenges at work that persist in other environments. The need for consistency and routine is also critical, and any disruption to these can lead to additional stress and anxiety.
Bullying is another serious concern, with research indicating that individuals with disabilities, including those with autism, are at a much higher risk. I recently co-authored an article on this topic, focusing on the specific experiences of populations with disabilities. Safety issues are a related concern, as individuals with disabilities are at a greater risk for abuse. This risk is often tied to their vulnerability, social isolation, and communication difficulties, making it an essential consideration in both clinical and educational settings.
Understanding these factors is crucial for providing effective support and intervention for females with autism, helping to mitigate the risks of comorbidities and improving their overall quality of life.
Clinical Considerations
So, what can we do? This is always the key part of any discussion—what strategies can we employ to support individuals with autism, particularly females, given the unique challenges they face?
Emphasize Team Collaboration
Working as a multidisciplinary team is essential whenever possible. Depending on your setting, this might involve collaborating with psychologists, speech therapists, occupational therapists, and other professionals. Each discipline brings a different perspective and expertise, which can greatly enhance the support provided to individuals with autism. For example, in my experience working in public schools, I’ve seen firsthand how a team approach can make a significant difference in creating effective, holistic plans for students.
Tailor Communication Approaches
Given the social communication challenges often present in individuals with autism, less can sometimes be more. Simplifying communication using clear, concise language and visual supports can reduce stress and confusion. It's also crucial to allow for adequate wait time after asking a question or giving an instruction—what might seem like a long pause to us can be essential processing time for someone with autism.
Proximity and Environment Awareness
Be mindful of proximity and environmental factors affecting the individual’s comfort or behavior. Something as simple as how close they stand, the room's lighting, or background noise can significantly impact their ability to engage and participate.
Use of ABC (Antecedent, Behavior, Consequence) Analysis
Understanding the triggers (antecedents) for certain behaviors and the consequences that follow can help identify patterns and develop strategies to manage or modify behaviors. This requires some detective work but can be incredibly effective in creating supportive environments.
Front-Loading Information
Front-loading, or preparing individuals for upcoming events or tasks by providing information in advance, can be very helpful. However, it's important to ensure that the language used is clear and relatable to the individual. This approach helps reduce anxiety by setting clear expectations and minimizing surprises.
Recognize and Respect Overload Triggers
Individuals with autism can easily become overwhelmed by sensory input, social demands, or cognitive tasks. Recognizing the signs of overload and knowing when to step back or modify the environment can prevent escalation and help the individual maintain control.
Assistive Technology
Utilizing assistive technology can support communication, organization, and learning. Tools such as visual schedules, communication devices, or apps designed to support executive functioning can be particularly beneficial. Each individual may require different tools, so it is important to explore and find what works best for them.
Avoid Making Assumptions
Especially with high-functioning individuals, it’s important not to make assumptions about their abilities based on outward appearances or specific skills. They may excel in certain areas but struggle significantly in others, which can be masked by their ability to socially camouflage. Always assess each situation carefully and be ready to provide support where needed.
Focus on Life Skills and Practical Application
Teaching life skills such as money management, social skills, and activities of daily living is crucial. These skills should be taught intentionally, practically, and tailored to the individual's specific needs. The goal is to equip them with the tools to navigate various life aspects independently or with minimal support.
Consider Brain Development and Executive Functioning
Executive functions, which include problem-solving, reasoning, and organization, are often underdeveloped in individuals with autism, particularly those with juvenile-onset conditions. Understanding this can help create strategies that support these areas in school, work, or daily life.
Address Comorbid Conditions
Comorbid conditions such as anxiety, depression, and ADHD are common in individuals with autism. Recognizing and addressing these conditions alongside autism is essential for providing comprehensive care. This might involve therapy, medication, or interventions to manage these co-occurring issues.
Learning from Adults with Autism and Their Families
Finally, continually learning from the experiences of adults with autism and their families can provide valuable insights. By understanding the challenges they face across the lifespan, we can better prepare younger individuals with autism for the future, ensuring that our interventions are effective in the short term and pave the way for long-term success and well-being.
DSM Vs. School-Based Eligibility
When working in a school-based setting, I frequently emphasize to colleagues and families the critical distinction between DSM criteria and school-based eligibility for special education services. The Diagnostic and Statistical Manual (DSM) provides medical diagnoses like autism or ADHD, but in the school setting, these diagnoses don't automatically translate to eligibility for services under the Individuals with Disabilities Education Act (IDEA).
I've seen firsthand how this can cause confusion, especially when a child has an outside medical diagnosis but doesn't qualify for special education under the same label in the school system. For instance, a child with a diagnosis of autism might not be eligible under the category of Autism Spectrum Disorder in the school but could instead qualify under a different category, like Other Health Impairment (OHI), which is often used for conditions like ADHD.
It's important to communicate to families that the school focuses on how a condition impacts the child’s ability to learn and participate in school, not just the presence of a diagnosis. This means that a child with a significant medical condition might receive services through an IEP, while another might only need accommodations under a Section 504 plan—or might not need any services if they’re performing well academically.
I always strive to ensure that our support is appropriate—neither too much nor too little. It's a bit like the story of Goldilocks and the three bears; we want to find the "just right" level of support. This approach ensures that each child has the opportunity to succeed in the least restrictive environment possible.
In my conversations with families, I make it a priority to explain these distinctions clearly. I want them to understand the rationale behind eligibility decisions so that they feel informed and empowered to advocate for their child’s needs effectively. By helping them navigate these complexities, we can work together to ensure that every student gets the support they need to thrive in school.
IDEA Law
I have provided a comparison here in case kind of the differentiation between 504 and IDEA is helpful.
Section 504 | IDEA |
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Accommodations vs. Modifications
When discussing accommodations and modifications in the context of education, it’s important to understand the distinct roles each plays in supporting students with diverse needs.
Accommodations
Accommodations are adjustments made to help a student access the general curriculum without changing the expectations or standards of the educational content. Essentially, these are supports that allow students to engage with the same material as their peers but in a way that accounts for their individual needs. The goal is to provide access, ensuring that the student can participate fully in the learning process.
Some common examples of accommodations include:
- Extended time on tests or assignments, allowing students who need more time to process information or complete tasks.
- Preferential seating to minimize distractions or to allow for better engagement with the material.
- Use of a calculator for students who struggle with math, enabling them to focus on higher-level problem-solving rather than basic calculations.
- Reading a test problem aloud can help students with reading difficulties better understand the questions.
Accommodations can also involve adjustments in:
- Amount: Reducing the number of tasks or problems to focus on quality over quantity.
- Time: Providing additional time or breaking tasks into shorter segments.
- Level of support: Offering additional help, such as an aide or peer support.
- Output: Allowing students to demonstrate their knowledge in different formats (e.g., oral presentations instead of written reports).
- Difficulty: Adjusting the complexity of the tasks while maintaining the same learning objectives.
- Participation: Encouraging or supporting the student’s active participation in classroom activities.
Modifications
Modifications, on the other hand, involve changes to the curriculum itself. These adjustments are typically more significant because they alter what the student is expected to learn or how they demonstrate their learning. Modifications are often necessary when a student’s abilities are such that the standard curriculum needs to be adapted to be achievable.
Examples of modifications include:
- Modified workload: Reducing the amount of work required, such as fewer homework problems or shorter reading assignments.
- Modified length of assignments: Shortening tasks to make them more manageable.
- Adjustment in the grading system: Changing the criteria for grading based on the student’s abilities, such as focusing more on effort or improvement rather than meeting standard benchmarks.
- Alternate projects or activities: Providing assignments that align better with the student’s skill level.
- Word bank of choices for answers: Offering pre-selected answers to help guide the student during tests or quizzes.
Modifications are often challenging to design because there is no standard list of options; they must be tailored to the individual student’s needs and capabilities. The focus is on providing an alternative learning path that still supports the student’s educational growth, even if it’s at a different level or pace than their peers.
Both accommodations and modifications are crucial tools in personalized education plans. They ensure that all students have the opportunity to succeed in their learning environment, regardless of their individual challenges.
Strategies
- Addressing processing speed
- Accommodations (more is less sometimes!!)
- Chunking of assignments
- Reduced workload / shorter repetitive assignments (Key: avoid redundancy; e.g. even #ed problems)
- Written instructions
- Don’t overload with homework
- Work can be graded based on mastery of information rather than work completed
- Provide an outline/notes
- Frontload material (this can be tricky)
- **Encourage/teach students to self-advocate (e.g. email teacher questions)
- Accommodations (more is less sometimes!!)
I wanted to share some valuable strategies that can be applied across various settings—whether you're working in schools, clinical environments, or directly with families—to address challenges like processing speed. These strategies are grounded in both research and practice and can make a meaningful difference in helping individuals thrive. For the sake of time, I won’t go through each one, but these are some of the most effective techniques I've found.
The focus should always be on building on strengths and offering the right supports while also making sure we avoid fostering learned helplessness. One of the best things we can do is to continuously foster independence, ramping up those skills in a way that builds confidence and self-reliance.
A key area we need to reconsider is the environment. We've tried to fit students into existing structures for a long time, but there's growing recognition that we need to rethink this approach. We need to ask ourselves: Where are they going to thrive? How can we adapt the environment so it works for them? It's all about creating spaces and situations where their strengths can shine and they can do their best work. We should also focus on identifying the key skills they need to take away, making sure the learning environment does justice to that process.
For many of the female students with autism that I’ve worked with, being a student is their primary role, and when things aren’t going well in that role, it can deeply impact their self-esteem. It’s especially challenging for girls, as the signs of autism in females often present differently than in males, and they may struggle in ways that aren’t always obvious to others. That’s why it’s so important for both educators and families to reinforce effort rather than focusing solely on outcomes. Schools don’t always create the best environments for every child to shine, and part of our role is to ensure we’re finding ways to help students feel successful in what they can do, even when the traditional academic environment doesn't highlight their strengths.
I’ve also compiled a number of resources that can be helpful in this area. I’ve included materials from the Autistic Girls Network in the UK, which offers some great insights. There are also key books from experts like Tony Attwood and Temple Grandin, who have written extensively on autism, especially in females. These are excellent references for understanding the nuances of how autism presents in girls and how we can best support them.
Ultimately, it’s about shifting our mindset—rethinking how we approach education and environments so that we’re creating spaces that truly allow all students to succeed, especially those who may need a different kind of support.
Summary
Let me summarize our learning outcomes before we move to the final poll to ensure we're all on the same page.
1. We differentiated the common differences in characteristics and the manifestation of autism among females versus males: We explored how autism presents differently in females, often leading to challenges in recognizing the condition due to more subtle signs or camouflaging behaviors.
2. We discussed the reasons for misdiagnosis and underdiagnosis in females: We examined how traditional diagnostic criteria and stereotypes about autism contribute to underdiagnosis or misdiagnosis in females, who may not exhibit the same characteristics typically associated with males on the spectrum.
3. We reviewed the co-occurring conditions that females with autism often experience: This included conditions like anxiety, depression, and eating disorders, which frequently accompany autism in females and further complicate diagnosis and treatment.
Now, let’s move to the poll. There are five questions to gather some final insights, and we’ll wrap up shortly after that. Thanks for your engagement throughout the session!
Exam Poll
1)What is the diagnosis ratio of males to females with an autism diagnosis?
If you answered A, you are absolutely correct. It's roughly three to one as there's a ton of studies on that.
2)What is the reason for misdiagnosis and/or underdiagnosis for females with autism?
All of the above is correct.
3)Which is NOT a common co-morbidity with girls with autism?
If you guessed B, you are correct. We certainly did not talk about vision issues today, but we do know anxiety, depression, and eating disorders can become co-occurring conditions for girls with autism.
4)A possible reason for co-morbidities are:
All of these are possible reasons for co-morbidities so D is the correct answer.
5)Tools or supports that a practitioner can use with this population include ALL EXCEPT:
The correct answer is B. They do not do well with a lot of direction and information.
Thanks for your participation. Let's now move to your questions.
Questions and Answers
What can be done to support students, particularly those with autism spectrum disorder (ASD) characteristics, who don’t qualify for an IEP because their academic performance is too high and they score too well in evaluations?
This is a common challenge in schools, particularly when students exhibit ASD-related traits—like sensory or social difficulties—but don't meet the criteria for an Individualized Education Program (IEP). The first step is to consider how these characteristics impact the student's performance and experience in various school settings, such as the classroom, cafeteria, or extracurricular activities. Even if they perform well academically, they may still struggle socially or spend excessive hours on homework. This can indicate a need for support.
A 504 plan can be a helpful alternative to an IEP. It provides accommodations that help students access the learning environment and meet their needs without requiring a medical diagnosis. Importantly, there's a misconception that students must have a medical diagnosis or be medicated, especially for conditions like ADHD, to qualify for a 504 plan. This is not the case—students can still qualify based on their functional needs in school.
As 504 plans have become more common across schools, it’s essential that they are well-managed and that staff are trained to implement them consistently. Ensuring proper oversight and follow-through with accommodations is critical to the student's success. So, even when students don’t qualify for an IEP, there are still meaningful ways to support them, and the 504 plan often provides the necessary flexibility to address their needs.
What should schools consider when implementing a 504 plan?
Schools need to ensure a system is in place for managing and monitoring the 504 plan. This includes assigning a specific person, such as a case manager, to oversee the implementation of accommodations and ensure that all staff are aware of and adhere to the plan. It's essential that everyone involved understands the accommodations and their purpose so they effectively support the student’s learning and development.
Can a student with ADHD or anxiety qualify for a 504 plan even if they don’t qualify for an IEP?
Students with diagnoses such as ADHD, anxiety, or depression can qualify for a 504 plan if these conditions impact their ability to perform in a school environment. Even if a student’s academic performance doesn’t warrant an IEP, their functional needs—such as challenges with focus, social interaction, or emotional regulation—might still require accommodations through a 504 plan.
What should parents and educators focus on when determining if a student needs a 504 plan?
It’s essential to look beyond academic performance and consider the broader impact of the student’s condition. Factors like social navigation, emotional regulation, and the amount of time and effort the student puts into tasks can indicate underlying challenges that may require accommodations. Educators should collaborate with parents to assess the student’s overall functioning and determine what supports might be necessary, even if the student is performing well in terms of grades.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Beck, J. S., Lundwall, R. A., Gabrielsen, T., Cox, J. C., & South, M. (2020). Looking good but feeling bad: “Camouflaging” behaviors and mental health in women with autistic traits. Autism, 24(4), 809-821. https://doi.org/10.1177/1362361320912147
Brede, J., Babb, C., Jones, C., Elliott, M., Zanker, C., Tchanturia, K., & Mandy, W. (2020). “For me, the anorexia is just a symptom, and the cause is the autism”: Investigating restrictive eating disorders in autistic women. Journal of Autism and Developmental Disorders, 50, 4280-4296. https://doi.org/10.1007/s10803-020-04479-3
D'Mello, A. M., Frosch, I. R., Li, C. E., Cardinaux, A. L., & Gabrieli, J. D. (2022). Exclusion of females in autism research: Empirical evidence for a “leaky” recruitment‐to‐research pipeline. Autism Research, 15(10), 1929-1940. https://doi.org/10.1002/aur.2795
Foggo, R. S. V., & Webster, A. A. (2017). Understanding the social experiences of adolescent females on the autism spectrum. Research in Autism Spectrum Disorders, 35, 74-85. https://doi.org/10.1016/j.rasd.2016.11.006
Hamilton, K., & Kessler, E. (2014). Accommodations and modifications: Wait, they’re not the same? Georgia Department of Education. https://www.gadoe.org
Heath, S., & Shine, B. (2021). Teaching techniques to facilitate time management in remote and online teaching. Journal of Teaching and Learning with Technology, 10, 164-171.
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Citation
Marsack-Topolewski, C. (2024). Understanding girls and women with autism in a world where they are often overlooked and misdiagnosed. OccupationalTherapy.com, Article 5739. Retrieved from https://OccupationalTherapy.com
