Women and Girls on the Autism Spectrum

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“In recent years, questions have been raised about the ratio of males to females diagnosed as having an autism spectrum disorder (ASD). Overall the most recent studies suggest that the prevalence of autism spectrum disorder is about one in 100, but what of the male/female ratio?

There is no hard evidence of numbers. Various studies, together with anecdotal evidence, have come up with male/female ratios ranging from 2:1 to 16:1.

Whatever the true ratio, clinical referrals to a specialist diagnostic centre such as The National Autistic Society’s Lorna Wing Centre have seen a steady increase in the number of girls and women referred.

Because of the male gender bias, girls are less likely to be identified with ASD, even when their symptoms are equally severe.

Many girls are never referred for diagnosis and are missed from the statistics. At The Lorna Wing Centre, emphasis is placed on the different manifestations of behaviour in autism spectrum conditions as seen in girls and women compared with boys and men.

In our paper (2011) we have identified the different way in which girls and women present under the following headings; social understanding, social communication, social imagination which is highly associated with routines, rituals and special interests. Some examples cited in the paper are:

• Girls are more able to follow social actions by delayed imitation because they observe other children and copy them, perhaps masking the symptoms of Asperger syndrome (Attwood, 2007).

• Girls are often more aware of and feel a need to interact socially. They are involved in social play, but are often led by their peers rather than initiating social contact. Girls are more socially inclined and many have one special friend.

• In our society, girls are expected to be social in their communication. Girls on the spectrum do not ‘do social chit chat’ or make ‘meaningless’ comments in order to facilitate social communication. The idea of a social hierarchy and how one communicates with people of different status can be problematic and get girls into trouble with teachers.

• Evidence suggests that girls have better imagination and more pretend play (Knickmeyer et al, 2008). Many have a very rich and elaborate fantasy world with imaginary friends. Girls escape into fiction, and some live in another world with, for example, fairies and witches.

• The interests of girls in the spectrum are very often similar to those of other girls – animals, horses, classical literature – and therefore are not seen as unusual. It is not the special interests that differentiate them from their peers but it is the quality and intensity of these interests. Many obsessively watch soap operas and have an intense interest in celebrities.

The presence of repetitive behaviour and special interests is part of the diagnostic criteria for an autism spectrum disorder. This is a crucial area in which the male stereotype of autism has clouded the issue in diagnosing girls and women.

As highlighted above, the current international diagnostic criteria do not give examples of the types of difficulties experienced by girls and women. In order to recognise the different behavioural manifestations, it is important to take a much wider perspective regarding the social, communication and imagination dimensions in addition to the special interests and rigidity of behaviour.

The girls and women learn to act in social settings. Unenlightened diagnosticians perceive someone who appears able and who has reciprocal conversation and who uses appropriate affect and gestures as not fulfilling the criteria set out in the international classification systems.

Therefore a diagnosis is missed.

It is only by asking the right questions, taking a developmental history, and observing the person in different settings, that it becomes clear that the individual has adopted a social role which is based on intellect rather than social intuition. To quote:

“The fact that girls with undiagnosed autism are painstakingly copying some behaviour is not picked up and therefore any social and communication problems they may be having are also overlooked. This sort of mimicking and repressing their autistic behaviour is exhausting, perhaps resulting in the high statistics of women with mental health problems.” (Dale Yaull-Smith, 2008).

It is important to prepare girls for a life of quality as adult women.

Schools need better trained staff to recognise and address the needs of students on the autism spectrum and especially the more ‘subtle’ presentation in girls.

Schools need to be more ‘girl-friendly’ with girl orientated personal, social skills classes.

There needs to be a focus on the ‘hidden curriculum’ which directly teaches the skills that typically-developing girls learn indirectly and intuitively, such as the unwritten rules of girls’ social interactions. Girl orientated personal, social and health education should be part of the curriculum.

Schools educating girls on the autism spectrum should focus on teaching independence and strategies to reduce vulnerability.

They also need to address self-image, self-esteem and confidence building. Gender identity is a big issue for girls, as is emotional wellbeing and fostering mental health. Society has expectations of both men and women, but many women on the autism spectrum believe that these expectations are greater for women.

In the book ‘Asperger’s Syndrome for Dummies’ (Gomez de la Cuesta & Mason 2010), the authors touch on this issue and describe different ‘types’ of women on the autism spectrum. At work, women experience ‘a glass ceiling that is double glazed’ according to the authors. Women experience the same difficulties as other women, plus the difficulties experienced by women on the autism spectrum. These women often go into professions that are traditionally male-orientated. Harder (2010) has produced a booklet called ‘Illustrated glimpses of Aspergers for Friends and Colleagues’. This gives a valuable insight into the difficulties women on the autism spectrum experience at work and provides explanations to colleagues of the different ways in which such women perceive the world.

The difficulties in the diagnosis of girls and women arise if clinicians continue to use the narrow definitions set out in the International Classification Systems.

It cannot be stressed enough that diagnosis and full assessment of needs cannot be carried out by following a checklist. Proper assessment takes time and detailed evaluation is necessary to enable a clinician to systematically collect information which not only provides a diagnostic label, but more importantly, a detailed profile of the person.

We wish to draw attention to the fact that many women with an autism spectrum condition are not being diagnosed and are therefore not receiving the help and support needed throughout their lives. Having a diagnosis is the starting point in providing appropriate support for girls and women in the spectrum. A timely diagnosis can avoid many of the difficulties women and girls with an autism spectrum disorder experience throughout their lives.”

Dr Judith Gould and Dr Jacqui Ashton Smith
Good Autism Practice, May 2011
This post originated from http://www.autism.org.uk/about-autism/autism-and-asperger-syndrome-an-introduction/gender-and-autism/women-and-girls-on-the-autism-spectrum.aspx

 

‘Doctors are ‘failing to spot Asperger’s in girls’ – article by Amelia Hill

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It is a condition on the autistic spectrum that has long been known to affect boys, who may have obsessive interests or struggle to make friends. Now an expert says many more girls have it than was thought, and failure to diagnose them can lead to misery and self-harm. Amelia Hill reports

Doctors are failing to diagnose thousands of girls who have Asperger’s syndrome, according to one of the world’s leading experts. Dr Judith Gould has accused the medical world of missing and overlooking girls with the condition, condemning them to lives of such misery that many resort to extreme self-harm and anorexia.

Gould and her colleague, Lorna Wing, carried out ground-breaking research into the link between Asperger’s syndrome, autism and other pervasive developmental disorders in 1979. Exploiting that insight, they pioneered the concept of the autism spectrum. Now Gould, a chartered consultant clinical psychologist with more than 35 years’ experience in autism spectrum disorders, has called on the government for a packet of measures to help girls with Asperger’s.

Gould, who is director of the National Autistic Society’s Lorna Wing centre for autism and co-founder of the Centre for Social and Communication Disorders, said: “We’re failing girls at the moment. We are doing many thousands of them a great disservice. They are either not being picked up in the first place, but if they ask for help they are being turned away. Even if they are referred for diagnosis, they are commonly rejected.”

The government is about to launch a consultation on a new national strategy on autism. Gould and the National Autistic Society want the final strategy – due at the end of the year – explicitly to address the misconceptions about gender that can make accessing help, support and services particularly difficult for girls and women.

“Women tell us that these misconceptions can make their particular battles and struggles even more difficult,” said Jane Asher, the society’s president. “They say that getting a diagnosis in the first place can often feel like an insurmountable hurdle, with many doctors unaware that the condition can affect females.”

More children are being diagnosed with Asperger’s today than ever before. A decade ago one in 1,000 children in the UK was thought to have an autism spectrum disorder (ASD). Five years ago that had increased to one in 500. Today the figure stands at one in 100.

It remains unclear as to whether the increase in diagnoses is caused by a true increase in the disorder, or is the result of increased awareness of autism and its broad characteristics.

Even less well understood, said Gould, is the difference in prevalence rates between boys and girls. The statistic most commonly reported is that ASDs are four times more common in males than in females. Many clinicians, however, believe that the ratio is as high as 16 boys to every girl. But Gould believes that significantly more girls have the condition than is recognised; she estimates the ratio to be 2.5 boys to every girl.

“Girls are not being picked up because there is still a stereotyped view of what Asperger’s is, which is based entirely on how boys present with the condition,” she said. “Professionals are not up to speed in knowing how girls present. We are working with the government to ensure they highlight this concern in their upcoming consultation. We are hoping to convince them to target this much under-investigated but vitally important issue.”

Tony Attwood, founder of the first diagnostic and treatment clinic for children and adults with Asperger’s, and author of The Complete Guide to Asperger’s Syndrome, agreed with Gould’s estimation of a 2.5:1 ratio of boys to girls. “The bottom line is that we understand far too little about girls with ASDs because we diagnose autism based on a male conceptualisation of the condition. We need a complete paradigm shift,” he said.

“We need to draw up a female version of Asperger’s that identifies girls on the basis of the way they present, and we need to do this as a matter of urgency: undiagnosed Asperger’s can create devastatingly low self-esteem in girls. In my experience, up to 20% of female anorexics have undiagnosed Asperger’s.”

Girls slip through the diagnostic net, said Attwood, because they are so good at camouflaging or masking their symptoms. “Boys tend to externalise their problems, while girls learn that, if they’re good, their differences will not be noticed,” he said. “Boys go into attack mode when frustrated, while girls suffer in silence and become passive-aggressive. Girls learn to appease and apologise. They learn to observe people from a distance and imitate them. It is only if you look closely and ask the right questions, you see the terror in their eyes and see that their reactions are a learnt script.”

Girls also escape diagnosis, said Attwood, because they are more social than boys with the condition. Their symptoms can also be missed because it is the intensity of their interests that is unusual, and not the oddity of what they do.

“The impairments to their social life or interests tend not to stand out in the same way as boys’ do,” he said. “They might have one friend, while boys with the condition won’t have any. Also, boys hyperfocus on facts and certain interests, such as trains or weather. Girls escape into fiction. They have imaginary friends, live in another world with fairies and witches, obsessively watch soap operas or become intensely interested in celebrities.”

Professor David Skuse, head of the behavioural and brain sciences unit at the Institute of Child Health, teaches clinicians to diagnose the condition. “Increasingly fewer girls are diagnosed as their IQ reaches 100, the population average,” he said. “Some people maintain this is because girls simply don’t have Asperger’s, but I would argue that brighter girls, especially those who are more verbal, are able to mask and compensate for their condition. I make sure I emphasise the difference in the ways boys and girls present when I train clinicians, because I am certain that girls are being failed by the system, especially those with higher IQs,” he added. “My belief is that, if we can prove the ratio of boys to girls is as high as many of us suspect, it would be as significant a milestone in this field as the discovery that the condition is on a spectrum.”

Original source from the Gaurdian.com  2009

 

 

Tony Attwood – The Pattern of Abilities and Development for Girls with Asperger’s Syndrome

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The overwhelming majority of referrals for a diagnostic assessment for Asperger’s Syndrome are boys. The ratio of males to females is around 10:1, yet the epidemiological research for Autistic Spectrum Disorders suggests that the ratio should be 4:1. Why are girls less likely to be identified as having the characteristics indicative of Asperger’s Syndrome? The following are some tentative suggestions that have yet to be validated by academic research, but they provide some plausible explanations based on preliminary clinical experience.

It appears that many girls with Asperger’s Syndrome have the same profile of abilities as boys but a subtler or less severe expression of the characteristics. Parents may be reluctant to seek a diagnostic assessment if the child appears to be coping reasonably well and clinicians may be hesitant to commit themselves to a diagnosis unless the signs are conspicuously different to the normal range of behaviour and abilities.

We have a stereotype of typical female and male behaviour. Girls are more able to verbalise their emotions and less likely to use physically aggressive acts in response to negative emotions such as confusion, frustration and anger. We do not know whether this is a cultural or constitutional characteristic but we recognise that children who are aggressive are more likely to be referred for a diagnostic assessment to determine whether the behaviour is due to a specific developmental disorder and for advice on behaviour management. Hence boys with Asperger’s Syndrome are more often referred to a psychologists or psychiatrist because their aggression has become a concern for their parents or schoolteacher. A consequence of this referral bias is that not only are more boys referred, clinicians and academics can have a false impression of the incidence of aggression in this population.

One must always consider the personality of the person with Asperger’s Syndrome and how they cope with the difficulties they experience in social reasoning, empathy and cognition. Some individuals are overtly active participants in social situations. Their unusual profile of abilities in social situations is quite obvious. However, some are reluctant to socialize with others and their personality can be described as passive. They can become quite adept at camouflaging their difficulties and clinical experience suggests that the passive personality is more common in girls.

Each person with Asperger’s Syndrome develops their own techniques and strategies to learn how to acquire specific skills and develop coping mechanisms. One technique is to have practical guidance and moral support from one’s peers. We know that children with Asperger’s Syndrome elicit from others, either strong maternal or ‘predatory’ behaviour. If the person’s natural peer group is girls, they are more likely to be supported and included by a greater majority of their peers. Thus girls with Asperger’s Syndrome are often ‘mothered’ by other girls. They may prompt the child when they are unsure what to do or say in social situations and comfort them when they are distressed. In contrast, boys are notorious for their intolerance of children who are different and are more prone to be ‘predatory’. This can have an unfortunate effect on the behaviour of a boy with Asperger’s Syndrome and many complain of being teased, ignored and bullied by other boys. It is interesting to note that some boys with Asperger’s Syndrome actually prefer to play with girls who are often kinder and more tolerant than their male peers.

The author has conducted both individual and group social skills training with boys and girls with Asperger’s Syndrome. Experience has indicated that, in general, the girls are more motivated to learn and quicker to understand key concepts in comparison to boys with Asperger’s Syndrome of equivalent intellectual ability. Thus, they may have a better long-term prognosis in terms of becoming more fluent in their social skills. This may explain why women with Asperger’s Syndrome are often less conspicuous than men with the syndrome and less likely to be referred for a diagnostic assessment. The author has also noted that, in general, mothers with Asperger’s Syndrome appear to have more ‘maternal’ and empathic abilities with their own children than men with Asperger’s Syndrome, who can have great difficulty understanding and relating to their children.

Some individuals with Asperger’s Syndrome can be quite ingenious in using imitation and modelling to camouflage their difficulties in social situations. One strategy that has been used by many girls and some boys is to observe people who are socially skilled and to copy their mannerisms, voice and persona. This is a form of social echolalia or mirroring where the person acquires a superficial social competence by acting the part of another person. This is illustrated in Liane Holliday-Willeys intriguing new autobiography, titled, “Pretending to be Normal’.

“I could take part in the world as an observer. I was an avid observer. I was enthralled with the nuances of people’s actions. In fact, I often found it desirable to become the other person. Not that I consciously set out to do that, rather it came as something I simply did. As if I had no choice in the matter. My mother tells me I was very good at capturing the essence and persona of people. At times I literally copied someone’s looks and their actions. I was uncanny in my ability to copy accents, vocal inflections, facial expressions, hand movements, gaits and tiny gestures. It was as if I became the person I was emulating. (p.22)”

Girls are more likely to be enrolled in speech and drama lessons and this provides an ideal and socially acceptable opportunity for coaching in body language. Many people with Asperger’s Syndrome have a prodigious memory and this can include reciting the dialogue for all characters in a play and memorizing the dialogue or ‘script’ of real life conversations. Knowing the script also means the child does not have to worry about what to say. Acting can subsequently become a successful career option although there can be some confusion when adults with Asperger’s Syndrome act another persona in real life as this can be misconstrued as Multiple Personality Disorder rather than a constructive means of coping with Asperger’s Syndrome.

When a child would like more friends but clearly has little success in this area, one option is to create imaginary friends. This often occurs with young girls who visualise friends in their solitary play or use dolls as a substitute for real people. Girls with Asperger’s Syndrome can create imaginary friends and elaborate doll play which superficially resembles the play of other girls but there can be several qualitative differences. They often lack reciprocity in their natural social play and can be too controlling when playing with their peers. This is illustrated in Liane Holliday-Willey’s autobiography.

“The fun came from setting up and arranging things. Maybe this desire to organise things rather than play with things, is the reason I never had a great interest in my peers. They always wanted to use the things I had so carefully arranged. They would want to rearrange and redo. They did not let me control the environment.”

When involved in solitary play with dolls, the girl with Asperger’s Syndrome has total control and can script and direct the play without interference and having to accept outcomes suggested by others. The script and actions can be an almost perfect reproduction of a real event or scene from a book or film. While the special interest in collecting and playing with dolls can be assumed to be an age appropriate activity and not indicative of psychopathology, the dominance and intensity of the interest is unusual. Playing with and talking to imaginary friends and dolls can also continue into the teenage years when the person would have been expected to mature beyond such play. This quality can be misinterpreted as evidence of hallucinations and delusions and a diagnostic assessment for schizophrenia rather than Asperger’s Syndrome.

The most popular special interests of boys with Asperger’s Syndrome are types of transport, specialist areas of science and electronics, particularly computers. It has now become a more common reaction of clinicians to consider whether a boy with an encyclopaedic knowledge in these areas has Asperger’s Syndrome. Girls with Asperger’s Syndrome can be interested in the same topics but clinical experience suggests their special interest can be animals and classic literature. These interests are not typically associated with boys with Asperger’s Syndrome. The interest in animals can be focussed on horses or native animals and this characteristic dismissed as simply typical of young girls. However, the intensity and qualitative aspects of the interest are unusual. Teenage girls with Asperger’s Syndrome can also develop a fascination with classic literature such as the plays of Shakespeare and poetry. Both have an intrinsic rhythm that they find entrancing and some develop their writing skills and fascination with words to become a successful author, poet or academic in English literature. Some adults with Asperger’s Syndrome are now examining the works of famous authors for indications of the unusual perception and reasoning associated with Asperger’s Syndrome. One example is the short story, “Cold” in ‘Elementals: Stories of Fire and Ice’ by A.S. Byatt.

Finally, the author has noted that some ladies with Asperger’s Syndrome can be unusual in their tone of voice. Their tone resembles a much younger person, having an almost child like quality. Many are concerned about the physiological changes during puberty and prefer to maintain the characteristics of childhood. As with boys with Asperger’s Syndrome, they may see no value in being fashionable, preferring practical clothing and not using cosmetics or deodorants. This latter characteristic can be quite conspicuous.

These tentative explanations for the apparent under representation of girls with Asperger’s Syndrome have yet to be examined by objective research studies. It is clear that we need more epidemiological studies to establish the true incidence in girls and for research on the clinical signs, cognitive abilities and adaptive behaviour to include an examination of any quantitative and qualitative differences between male and female subjects. In the meantime, girls with Asperger’s Syndrome are likely to continue to be overlooked and not to receive the degree of understanding and resources they need.

Originally sourced from cloudnine.wordpress.com

Reference:
Holliday-Willey, L. (1999) Pretending to be Normal: Living with Asperger’s Syndrome. London. Jessica Kingsley Publications.

 

Structural Violence and how it impacts on those with disabilities.

Vintage Violence

Structural violence refers to the systematic ways in which social structures harm or otherwise disadvantage individuals

Structural violence is subtle and often seemingly invisible.

There is usually no one specific person or organization who can (or will) be held responsible for this form of violence as it can be insidious and all-encompassing within any given society.

 

 “Structural violence is one way of describing social arrangements that put individuals and populations in harm’s way… The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people … neither culture nor pure individual will is at fault; rather, historically given (and often economically driven) processes and forces
conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific, economic and social progress (Farmer).”

Jo Lindsay and Deborah Dempsey’s (2009:2) investigated the constraints of societal institutions upon those with disabilities within Australia. 

They found that institutions, such as the State/government and its political systems, policies and laws  shape and influence the ways in which ideologies surrounding the rights of disabled children and adults are being constructed and enacted through the constraints of social policy (Lindsay & Dempsey, 2009:2). 

In the case of any person with a disability, it is ultimately the State that has the power to identify and define their
condition as either disabled or non-disabled as a matter of policy.  In order to qualify for financial support a
physical or neurological condition experienced by a person must first be accepted and acknowledged by the State as being a “disabling condition”.

The State therefore has the power to determine both which societal resources a disabled person will be able to
access and the manner in which those resources will be delivered to (Llewellyn et al,
1996: 166).

 


By holding the power to define what will and will not be considered a disability, the State also holds the power to determine who will and will be able to access funding  and disability services
(Llewellyn al, 1996: 166; Habibis &
Walter, 2009).

For this reason theorists Nadia Heredia (2007:129) argues that the act of positioning the State and its social
structures as the arbiters and enforcers of such definitions, places  persons with disabilities at the mercy of a system which applies only external definitions and validations to personal experiences of disability.


In so doing, this enacts  a form of structural violence in which a disabled persons rights are replaced by the State’s rights to define that person’s ability to access services based on their level of disability (Heredia, 2007:129).

Thus creating the structural barriers that enable structural inequalities to occur.

 If a citizen cannot receive government services because he/she does not have a disability that is recognized by the State, or experiences a level of disability that is not considered severe enough to impair permanent function, then they will not be considered eligible to receive either financial assistance nor access to therapies.

As such, these constraints maybe considered structural and therefore the barriers they create may be considered  structural barriers.

These structural barriers can in turn be seen to create those structural inequalities which in many instances go on to become social inequalities.

From this it can be seen that structural inequalities can and do lead to social and personal harm. 

Although the level of  harm created is often only portrayed through individuals stories, such as the suffering caused by the limiting of funding and access to services for children with Autism, never the less, the ultimate cause of that harm is structural.

Equally the term “structural violence”  can be seen to act as an umbrella term that encapsulates the
various forms of social and institutional failings, which have real, if not always immediately appreciable consequences in peoples’ lives. 

Parody – The Problem With Fitting In For Women With Aspergers Syndrome

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“I’m an effigy,
A parody,
Of who I appear to be
Put your flaming torches under me “

Effigy by Natalie Merchant.

Like a lot of women with Asperger’s Syndrome, I struggle with the reality of having to present myself in ways that are acceptable, preferable or pleasing to others.

I understand that there is a need for me to look a certain way when I leave the house and that appearances are very important in this day and age to most people.

The thing is though, to me, appearances are just not that important.

I’m much more at ease with my inner being than the outer persona I’m forced to create, every day, just to blend in.

In all honesty, I like to wear clothes that make me feel comfortable, safe and secure.

Heck I’d be happy to wear PJ’s everywhere and I probably would if it weren’t for the fact that people would stop and stare at me  and never be able to take anything I’d have to say seriously ever again.

Yet even though I understand the social requirement of having to look “nice and normal” to others in order to be treated well, I still have problems understanding how it is that I’m supposed to conform to and create this so-called “nice/normal” look.

Oh sure, when I was younger I could plaster my face with makeup and style my hair with the best of them and somehow pull off the whole passing as ‘normal’ thing.

Mind you, I was a bit of an Emo/Punk back in those days so basically I could have worn nappy pins in my ears and no one would have dared look twice at me.

Apparently dressing differently is considered ‘normal’ when you’re younger but dressing differently when you’re older is just considered sad and a sign of maladaptive-ness.

So I find it somewhat ironic that these days, even though I’m trying so hard to fit in and look “normal’, that I still always seem to get it, if not entirely wrong, then at least wrong enough to make people , shall we say, just a tad bit wary.

Well, that’s how it feels anyway.

For example, if I have a meeting to go to or some other important occasion to attend I find that I can spend hours agonizing over the right choice of top to wear with the right trousers, only to discover once I’m out and about that most people would never deliberately put together the unique combination of colors or styles of clothing that I’ve so carefully chosen.

In short, I just never seem to get it right.

And because I know how much effort I go to just to try and fit in, when really I’d much rather be wearing my PJ’s and being accepted for who I am on the inside instead of having my worth rated by my outer appearance , I often feel like I’m being  forced to betray who I really am by giving in to this societal need for constructing an artificial outer shell, in order to get by.

So no matter how carefully I draw on my outer shell, the effigy that I present so ineptly to the outside world, the inner me still wishes to reside in a world in which the comfort of acceptance provides all the safety and security required for a human being to thrive.

“I’m an effigy,
A parody,
Of who I appear to be

Put your flaming torches under me”
Effigy by Natalie Merchant.

https://seventhvoice.wordpress.com/2013/03/06/high-functioning-autism-in-females-addressing-the-level-of-misdiagnosis-reported-by-parents-of-daughters-with-aspergers-syndrome-high-functioning-autism/

https://seventhvoice.wordpress.com/2013/04/27/can-you-tell-just-by-looking/

https://seventhvoice.wordpress.com/2013/08/18/beautiful-not-broken/

https://seventhvoice.wordpress.com/2013/05/03/differences-between-aspergers-and-autism-fruit-salads/

https://seventhvoice.wordpress.com/2013/05/02/love-isnt-in-your-eyes-baby-girl-its-in-your-heart/

https://seventhvoice.wordpress.com/2013/05/01/inertia-and-autism-why-people-with-autism-often-feel-stalled-in-their-tracks-the-difficulty-in-connecting-intention-with-action/