Dysgraphia

What Is Dysgraphia?
Dysgraphia is a brain-based learning disability that affects writing. As with all learning disorders, dysgraphia is common among individuals with ADHD.

By Devon FryeVerified

Medically reviewed by ADDitude’s ADHD Medical Review Panel

Updated on March 28, 2022

What is Dysgraphia?
Dysgraphia is a neurological disorder of written expression that impairs writing ability and fine motor skills. It is a learning disability that affects children and adults, and interferes with practically all aspects of the writing process, including spelling, legibility, word spacing and sizing, and expression.

It’s estimated that 5 to 20 percent of all children have some type of writing deficit like dysgraphia.1 Dysgraphia and other learning disorders, like dyslexia and dyscalculia, are common in children with attention deficit hyperactivity disorder (ADHD or ADD); Up to half of children with ADHD in the U.S. have a learning disorder.2 3
Dysgraphia Symptoms

Dysgraphia is typically identified as a child learns to write. However a disorder of written expression may remain unrecognized through the early school years as a child’s writing ability continues to develop; dysgraphia may remain undiagnosed until adulthood.4

According to the National Center for Learning Disabilities (NCLD)5, symptoms of dysgraphia include:

Trouble forming letters shapes
Tight, awkward, or painful grip on a pencil
Difficulty following a line or staying within margins
Trouble with sentence structure or following rules of grammar when writing, but not when speaking
Difficulty organizing or articulating thoughts on paper
Pronounced difference between spoken and written understanding of a topic

Dysgraphia symptoms typically change over time. Children with dysgraphia generally have trouble with the mechanics of writing and exhibit other fine-motor impairments, while dysgraphia in adolescents and adults manifests as difficulties with grammar, syntax, comprehension, and generally putting thoughts on paper.4

Is Dysgraphia a Form of Dyslexia?
Dysgraphia is associated with writing difficulties, whereas dyslexia is associated with reading difficulties. Both learning disorders share some symptoms, like difficulty with spelling, that may complicate a diagnosis. It is possible for an individual to have both dysgraphia and dyslexia6 (see “Dysgraphia Diagnosis” below for more information on learning disorders).
What Causes Dysgraphia?

Dysgraphia is commonly thought of in the following two ways.4

Acquired dysgraphia is associated with brain injury, disease, or degenerative conditions that cause the individual (typically as an adult) to lose previously acquired skills in writing.

Developmental dysgraphia refers to difficulties in acquiring writing skills. This type of dysgraphia is most commonly considered in childhood. The causes for developmental dysgraphia are unknown, but researchers have identified several subtypes4 that correspond to certain neurological mechanisms:Motor dysgraphia: Lack of fine-motor coordination and visual perception have long been tied to dysgraphia and may explain difficulties with producing written text. Individuals with motor dysgraphia typically exhibit illegible and slow handwriting, poor drawing and tracing skills, and slow finger-tapping (a common measure of fine motor skills).

Spatial dysgraphia is likely related to problems of spatial perception, which affects letter spacing and drawing ability. Individuals with spatial dysgraphia struggle with handwriting and drawing, however spelling and finger-tapping speed are typically normal.

Linguistic dysgraphia impacts the language processing skills required in the writing process. It most strongly affects spontaneously written text (which hasn’t been traced or copied), which is often illegible. Drawing, copying, and oral spelling are not affected by linguistic dysgraphia.

Dysgraphia Diagnosis
The term “dysgraphia” is not recognized by the American Psychiatric Association (APA) in its Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5)7. Instead, the DSM-5 lists problems in writing (as well as in reading and math) under the “specific learning disorder” (SLD) diagnosis category. The category also includes the specifier, “SLD with impairment in written expression,” which is most closely aligned with common notions of dysgraphia.

To merit an SLD diagnosis, an individual must meet these four criteria:Exhibit at least one of six outlined symptoms related to difficulties with learning and using academic skills for at least six months. Difficulty with written expression is included in the list.
Exhibit academic skills that are substantially below what is expected for the individual’s age, and cause problems in school, work, or everyday activities.
The difficulties started during school-age, even if problems only become acute in adulthood.
Other conditions and factors are ruled out, including intellectual disability, vision problems, and lack of instruction.

SLD with impairment in written expression is diagnosed when an individual exhibits deficits in subskills that include spelling and grammar accuracy, and clarity or organization of written expression.

Dysgraphia is typically diagnosed by a licensed psychologist who specializes in learning disorders, though it may involve a team of specialists, including occupational therapists, special education teachers, and educational psychologists.4

The team can use a variety of tools to determine a diagnosis, including:School reports
Psychoeducational measures
Review of the individual’s developmental, medical, and familial history
Standardized writing assessments

Tests for dysgraphia typically include a writing component — copying out sentences or answering brief essay questions — as well as a fine-motor component that tests the individual’s reflexes and motor speed. The diagnosing specialist works to get a sense of both the quality of the writing — how well does the patient organize thoughts and convey ideas — and the physical act of writing itself. Does writing hurt? Are letters formed correctly?
Why Is a Dysgraphia Diagnosis Critical?

Even in the digital age, handwriting is an important skill necessary for success in the classroom and beyond. With dysgraphia, the mechanics of writing and other foundational writing skills are difficult, making a student more likely to fall behind peers without the learning disorder. Writing problems are also associated with persistent academic struggles and low self-perception, which can persist to adulthood.4

What’s more, the act of writing often helps the brain remember, organize, and process information. When the physical act of writing is incredibly challenging, a child can’t effectively “show what they knows.” A student with dysgraphia may fail an exam simply because they can’t translate his thoughts and answers to paper.
Dysgraphia Treatment

Dysgraphia and other learning disorders are lifelong conditions that have no cure. Treatment for dysgraphia focuses on interventions, accommodations, and special services to circumvent writing-related tasks and/or improve writing abilities. Given the nature of dysgraphia, attempts at remediation and “more practice” alone are not enough – accommodations and other modifications are necessary to successfully manage the condition.8

Under the Individuals with Disabilities Education Act (IDEA), students with learning disorders like dysgraphia are eligible for special services in the classroom. Adults with dysgraphia can implement several fixes in the workplace on their own, or after communicating with management.

Dysgraphia Accommodations in School and at Work

Utilizing larger pencils with special grips, or other writing instruments
Using paper with raised lines to help with margins
Permitting or asking for extra time on writing-related assignments and tasks
Allowing alternative methods to showcase learning and work, like oral or recorded responses
Using assistive electronic technologies, like voice-to-text programs
Asking for a copy of written materials given in class or the workplace
Opting to type notes during meetings

Other Dysgraphia Interventions

Letter-formation drills
Handwriting-training programs, including: Handwriting Without Tears
Sensible Pencil

Dysgraphia At a Glance
Comorbidity with ADHD · Up to half of children with ADHD in the U.S. have a learning disorder, including dysgraphia.

Suggestive Symptoms · Handwriting is slow and/or illegible
· Inconsistent spacing, or running out of space on the paper; irregularly sized letters
· Speaking the words out loud while writing
· Omitted words in sentences
· Difficulty with grammar and syntax structure
· Avoidance of writing tasks
· Difficulty organizing thoughts when writing them down

Professional to See Evaluation should be conducted by a school psychologist or special education professional. School supports may be provided by special education professionals and/or your child’s classroom teacher.

Treatments & Medications · There is no medication to treat dysgraphia and other learning disabilities
· Your child may qualify for an IEP to receive special-education services

Sources
1 Reynolds, C. (2007). Encyclopedia of special education: A reference for the education of children, adolescents, and adults with disabilities and other exceptional individuals (3rd ed.). New York: John Wiley & Sons.

2 Larson, K., Russ, S. A., Kahn, R. S., & Halfon, N. (2011). Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics, 127(3), 462–470. https://doi.org/10.1542/peds.2010-0165

3 DuPaul, G. J., Gormley, M. J., & Laracy, S. D. (2013). Comorbidity of LD and ADHD: implications of DSM-5 for assessment and treatment. Journal of learning disabilities, 46(1), 43–51. https://doi.org/10.1177/0022219412464351

4 Chung, P. J., Patel, D. R., & Nizami, I. (2020). Disorder of written expression and dysgraphia: definition, diagnosis, and management. Translational pediatrics, 9(Suppl 1), S46–S54. https://doi.org/10.21037/tp.2019.11.01

5 Cortelia, C., Horowitz, S. (2014). The State of Learning Disabilities: Facts, Trends and Emerging Issues. National Center for Learning Disabilities. Retrieved from https://www.ncld.org/wp-content/uploads/2014/11/2014-State-of-LD.pdf

6 Döhla, D., & Heim, S. (2016). Developmental Dyslexia and Dysgraphia: What can We Learn from the One About the Other?. Frontiers in psychology, 6, 2045. https://doi.org/10.3389/fpsyg.2015.02045

7 American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders. DSM-V. Washington, DC: American Psychiatric Publishing

8 Mayes, S. D., Breaux, R. P., Calhoun, S. L., & Frye, S. S. (2019). High Prevalence of Dysgraphia in Elementary Through High School Students With ADHD and Autism. Journal of Attention Disorders, 23(8), 787–796. https://doi.org/10.1177/1087054717720721

ADHD in Girls

 ADHD in Girls: The Symptoms That Are Ignored in Females

Girls with ADHD — especially those with inattentive symptoms — are often drowned out by loud, hyperactive boys who demonstrate the condition’s stereotypical behavior. Learn how to recognize the mistaken, misunderstood symptoms of ADHD or ADD in girls, and turn around this unfair unbalance for your daughter or yourself.

By Maureen Connolly Medically reviewed by Sharon Saline, Psy.D.Updated on June 1, 2022

ADHD in Girls: Recognizing Key Symptoms

ADHD in girls — particularly if it’s the inattentive type of ADHD formerly called ADD — can look like this:

• daydreaming quietly in class

• feeling anxious or sad

• exhibiting silliness or apparent ditziness

• acting shy or inattentive

• trouble maintaining friendships

• picking at cuticles or skin

• being a perfectionist

ADHD in Girls is Often Missed

Twenty-year-old Andrea Burns fits the description of ADHD in girls perfectly. She wasn’t officially diagnosed with attention deficit hyperactivity disorder (ADHD or ADD) until her freshman year at Indiana University, even though she showed obvious signs of ADHD in middle school.

After Burns nearly failed out of school, an academic advisor had her undergo a LASSI (Learning and Studies Strategy Inventory) screening to evaluate learning behaviors and academic achievement. The results indicated what she and her family had long suspected: ADHD.

“In high school, I had a tutor to help me with different subjects, but once I got to college, I was expected to do it all by myself. I was studying all of the time, but doing poorly on tests because I’d freeze up,” says Burns. “And I’d try to listen in class, but I had a hard time concentrating and focusing on what the teacher was saying. I’d take lots of notes, but when I reviewed them, I couldn’t make sense of what I wrote,” says the communications major, now entering her junior year.

After a diagnosis of ADHD – Primarily Inattentive Type, Burns was prescribed ADHD medication. She saw almost immediate results: “I was finally able to focus during a lecture and take good notes, which helped improve my grades. For the first time I felt in control in the classroom.”

Burns is relieved to have identified the cause of her poor school performance, and happy she’s able to treat it. But it’s unfair that she, like so many other girls, suffered a decade or more with an untreated condition that can negatively impact life in so many ways. Why are girls being diagnosed so much later than boys, if at all? And what do teachers, pediatricians, and parents need to do to bring about a change?

Symptoms of ADHD in Girls

One of the key reasons girls are so often overlooked is that they exhibit hyperactivity differently than boys, according to Patricia Quinn, M.D., director of the National Center for Gender Issues and ADHD in Washington, D.C. “In a classroom setting, a boy might continually blurt out answers or repeatedly tap his foot, whereas a girl might demonstrate hyperactivity by talking incessantly,” she says. A girl who talks all the time is often viewed by the teacher as chatty, not hyper or problematic — and thus is less likely to be recommended for an evaluation.

Another reason that ADHD is often missed in girls is that they’re more likely than boys to suffer from inattentive ADHD. The symptoms of this sub-type (which include poor attention to detail, limited attention span, forgetfulness, distractibility, and failure to finish assigned activities) tend to be less disruptive and obvious than those of hyperactive ADHD. Put simply, a (hyperactive) boy who repeatedly bangs on his desk will be noticed before the (inattentive) girl who twirls her hair while staring out the window. “I believe I was overlooked for so long because I didn’t show hyperactivity the way my two brothers with ADHD have,” says Burns.

Why ADHD in Girls Goes Undiagnosed

It comes as no surprise that a recent national online Harris Interactive poll reaffirms that, with respect to ADHD, girls have gone largely unnoticed. Dr. Quinn and Sharon Wigal, Ph.D., associate clinical professor of pediatrics at the University of California at Irvine, surveyed 3,234 people, including members of the general public (adults without ADHD whose children don’t have the condition), parents of children with the condition, teachers, and children with ADHD, ages 12 to 17. Among those polled, 85 percent of the teachers and more than half of the parents and the general public believe that girls with ADHD are more likely to go undiagnosed. They said that girls are more likely to “suffer silently” or show fewer symptoms. And four out of 10 teachers report more difficulty in recognizing ADHD symptoms in girls than in boys.

Polled parents and teachers also said that, among children with ADHD, boys are more likely than girls to exhibit behavioral problems, while girls are more often inattentive or struggling with a mood disorder. Drs. Quinn and Wigal said these differences cause some girls with ADHD to slip through the cracks. “The failure to recognize ADHD symptoms in girls probably results in significant undertreatment,” they wrote. “…it is not a trivial disorder for them, and they are equally in need of professional care.”

Girls with ADHD Face Serious Risks

Another revelation from the Harris poll: Females may suffer more negative effects from their ADHD than their male counterparts. The survey showed that girls are more likely than boys to be asked to repeat a grade due to poor school performance. When a boy struggles, he’s more likely to be evaluated for ADHD or LD (and then diagnosed) than held back. But a teacher who observes a disorganized female student — one who can’t plan ahead, meet project deadlines, and so on — believes that she’ll benefit by being held back a year. “A year later, the girl is no better off because she still hasn’t figured out the source of her problems,” says Dr. Quinn.

The self-esteem of girls with ADHD also appears to be more impaired than that of boys with ADHD (which may explain why the survey found that girls were three times more likely to report taking antidepressants prior to being diagnosed). It’s not surprising, then, that the condition can take a toll on a female’s emotional health and general well-being. According to Dr. Quinn, girls with ADHD tend to have more mood disorders, anxiety, and self-esteem problems than non-ADHD girls. “They might get an A on a report, but because they had to work three times as hard to get it, they see themselves as not being as smart as other people,” she says.

Another reason that girls go undetected for so long has to do with how differently each gender approaches school. Dr. Quinn offers this example: “A male and female student with ADHD are assigned a long-term project. They each put off the work for weeks. Then, the night before the project is due, each remembers the deadline. Rather than attempt to get the work done, the boy decides to watch back-to-back episodes of SpongeBob. Meanwhile, the girl freaks out and tries to make a perfect project overnight. (Perfectionism is another common behavior in ADHD girls.) She demands that her mother help her while she stays up until 1 a.m. to finish her work. When she hands in the assignment the next day, the teacher has no clue that it was done at the last minute.”

Girls seem compelled to get their schoolwork done because our culture encourages them to be more socially conscious. They want to please more than boys, and they’re expected to do well in school.

Because grades K through six aren’t as challenging as higher grades, a girl with undiagnosed ADHD might do fine in elementary school — and then falter. “In middle and high school, the attentional demands are greater for a student, so she can’t get by working at 50 percent efficiency,” says Andrew Adesman, M.D., director of the division of behavioral and developmental disorders at Schneider’s Children’s Hospital in New Hyde Park, New York, and member of the national board of directors for CHADD. “And because the kids in junior high and high school more often change classes, teachers don’t have the time to get to know the kids and spot problems.”

Some girls also compensate by developing strategies that mask their ADHD. As mentioned earlier, it might be perfectionism. For instance, a girl might spend hours taking notes on each chapter she’s being tested on in order to assure a good grade. Or she might become obsessive-compulsive, checking and rechecking her backpack to make sure she has everything.

ADHD gender differences also show up outside the classroom. Research shows that girls with ADHD may be rejected more often by their peers than boys. The main reason is that, compared to boys’, girls’ friendships require greater sophistication and more maintenance. “Two boys can meet on the playground and start digging a hole to China with their shovels, and they’re instant friends. Friendship among girls is more complex, even at young ages. It requires picking up on social cues and bonding,” says Dr. Quinn.

With tendencies toward impulsivity, hyperactivity, and forgetfulness, it can be hard to keep your mouth closed, not to constantly interrupt, or to remember your best friend’s birthday. And when everyone in the group is admiring Jessica’s new earrings and the girl with ADHD blurts out something totally unrelated, the other girls look at her and wonder where she’s coming from. This kind of social awkwardness makes it difficult for a girl to feel good about herself and sustain relationships.

Unfortunately, these signs often aren’t enough to suggest ADHD. In the case of 14-year-old Danielle Cardali of Suffolk County, New York, it took two evaluations before her teacher and parents were able to pinpoint why her grades remained low. Being classified with ADHD in fourth grade, she was entitled to 45 minutes a day of one-on-one teacher time in a resource room. But real improvement didn’t come until seventh grade, when she was prescribed Strattera and Concerta. “After that first quarter on the medication, I got high C’s and low B’s,” says Cardali. “I seemed to have a better understanding of what was going on in class.”

In some cases, a parent will stumble upon ADHD after a learning disability is discovered. (They often co-exist, which is why it’s important when testing for one also to screen for the other.) That was the case with 7-year-old Allison Isidore of Montclair, New Jersey. Her mom, Liz Birge, had an opportunity to see her daughter at work in the classroom for 45 minutes once a week, when she volunteered to assist in a writing workshop. Liz discovered that her first-grader was having a great deal of trouble matching sounds to letters and that she showed no interest in trying to write. Testing revealed that Allison has both a learning disability and ADHD.

Helping Girls with ADHD

If parents suspect that their daughter has ADHD (or a learning disability), Drs. Quinn and Wigal urge them not to wait, even if teachers haven’t expressed concern. As mentioned earlier, teachers usually look for hyperactivity, disorganization, or forgetfulness as the signs of ADHD before recommending an evaluation. But the way ADHD often expresses itself in girls — excessive talking, poor self-esteem, worrying, perfectionism, risk-taking, and nosiness — is seldom read as such.

Your daughter’s pediatrician may be able to do an evaluation (if your daughter is an adolescent, find out first if the doctor is comfortable working with teens), but it’s best to work with an ADHD specialist. Make sure the evaluating clinician takes a thorough medical history (including family history, due to the high heritability of ADHD). The doctor should also work with your child’s school to obtain more information about her behaviors. “And since adolescents are a great source of information about their own experience, encourage a teen to talk directly with her doctor,” advises Dr. Wigal.

Ultimately, for a girl suffering from ADHD, an official diagnosis can be welcome news. “Everyone presumes that a diagnosis of ADHD is a stigma,” says Dr. Quinn. “In fact, 56 percent of the girls in our survey said that they felt better after finally having a name for what they felt. Only 15 percent said they felt worse. For most, it was a relief to find out they weren’t lazy, crazy, or stupid.”

More good news: Parents of girls diagnosed with ADHD are more likely to seek treatment than parents of boys diagnosed with ADHD, because only the more severe cases are diagnosed. “Girls may be at a slight advantage over boys in one sense,” wrote Quinn and Wigal in the Harris survey paper. “Once they are suspected of having ADHD, their parents tend to be more willing to seek medical advice.” And that bodes well for girls.

Source: ADHD in Girls: The Symptoms That Are Ignored in Females, by Maureen Connolly from https://www.additudemag.com/adhd-in-girls-women/ Accessed on June 4, 2022

Autism in Girls

Why Many Autistic Girls Are Overlooked

They often go undiagnosed because they don’t fit autism stereotypes and they mask symptoms better than boys do

Beth Arky

Many more boys than girls are diagnosed on the autism spectrum: more than four boys for every autistic girl, according to the latest numbers from the Centers for Disease Control. Researchers point togenetic differences. But clinicians and researchers have also come to realize that many “higher functioning” autistic girls are simply missed. They’ve been termed the “lost girls” or “hiding in plain sight” because they’re overlooked or diagnosed late. They don’t fit the stereotypes or their symptoms are misinterpreted as something else. And they may be better at hiding the signs, at least when they’re young.

Even when girls’ presentation is clearer, they can be overlooked. Take Melissa’s two children. Both have an autismdiagnosis. But while daughter Lisa’s symptoms were much more obvious than son Justin’s, the girl’s were waved off for three years by a variety of clinicians.

“On paper,” Melissa says, “she seemed to check all the boxes.” Lisa had a significant language delay — she didn’t speak in sentences until she was 4 — did no pretend play, and had several meltdowns each day. There were also other signs, like lining up her stuffed animals, spinning in circles, and constantly seeking sensory input. She was also unable to handle any change in routine.

Though Lisa’s challenges qualified her for Early Intervention at 18 months, it wasn’t until she was 6 that adevelopmental neurologist would diagnose her with autism.

Melissa’s son was also diagnosed at 6 — but by the first clinician who saw him,  despite the fact that his symptoms were far less obvious.

“The developmental pediatrician who saw Lisa didn’t believe autism was common in girls. He came up with excuses for her behavior and reasons why she couldn’t be on the spectrum,” Melissa says. “At one point, we were even told that my daughter just had low self-esteem and that’s why she didn’t speak. And, of course, that her issues were just a parenting problem. We were never told those things about our son.”

Autistic girls don’t fit the “model”

Autism is a developmental disorder that is marked by two unusual kinds of behaviors: deficits in communication and social skills, and restricted or repetitive behaviors. Children with autism also often have sensory processing issues. But here’s the hitch, according to Susan F. Epstein, PhD, a clinical neuropsychologist. “The model that we have for a classic autism diagnosis has really turned out to be a male model. That’s not to say that girls don’t ever fit it, but girls tend to have a quieter presentation, with not necessarily as much of the repetitive and restricted behavior, or it shows up in a different way.”

Stereotypes may get in the way of recognition. “So where the boys are looking at train schedules, girls might have excessive interest in horses or unicorns, which is not unexpected for girls,” Dr. Epstein notes. “But the level of the interest might be missed and the level of oddity can be a little more damped down. It’s not quite as obvious to an untrained eye.” She adds that as the spectrum has grown, it’s gotten harder to diagnose less-affected boys as well.

In fact, according to a 2005 study at Stanford University, autistic girls exhibit less repetitive and restricted behavior than boys do. The study also found brain differences between autistic boys and girls help explain this discrepancy.

Wendy Nash, MD, a child and adolescent psychiatrist, adds that girls are more likely to control their behavior in public, so teachers don’t catch differences. “A lot of autistic girls get ruled out because they may share a smile or may have a bit better eye contact or they’re more socially motivated. It can be a more subtle presentation,” Dr. Nash explains. If girls are socially interested but odd, which is the case with the majority of these girls, she adds, “I think people give them a pass.”

Another problem: misdiagnoses

Dr. Epstein says there’s another reason autistic girls are misdiagnosed, or diagnosed later than boys. Girls struggling with undiagnosed autism often develop depression, anxiety or poor self-esteem, and clinicians may not “really dig underneath to see the social dysfunction” caused by autism.

Dr. Nash adds that these girls can also be misdiagnosed with ADHD. “I see a lot of girls who are diagnosed withADHD when they’re young who actually meet the criteria for autism,” she says. “There’s hyperactivity without as much social impairment or a different kind of social impairment, so the autism is missed.”

Autistic girls “pass”… at least for a while

Another reason girls may not be diagnosed is because they’re able to “pass.”

“Girls tend to get by,” Dr. Epstein says. “They might not understand what’s going on but they’ll try to just go along and imitate what they see. And they may get away with it to third grade or fifth grade, but once they get to junior high and high school, it shows as a problem.”

This has been the case for Lisa, now 13. Melissa says of her daughter, “She is less mature than her typical peers, and girls are so intricate in how they behave socially. It’s very difficult for her to maintain friendships because of this and, let me tell you, 13-year-old girls are not very accepting of someone different.”

The cost of a missed diagnosis

Dr. Epstein says undiagnosed autistic girls end up wondering “what’s wrong” with them, which can lead to depression, anxiety and loss of self-esteem. They work so hard to fit in that it wears them out. “That’s the thing about imitating,” she says. “You don’t necessarily ‘get’ it so you’re just trying to do what people do. If you’re just trying to mimic and you don’t really understand, it makes it pretty rough.”

Dr. Nash says less severe autism in girls is often first flagged because of these social issues, or the depression they generate. “In people we call mildly autistic, there are adolescent social problems or they’re seeming hyperfocused on a topic and not participating in school to their potential or abilities,” she says. “Depression can be more common among high-functioning kids on the spectrum. So they’ll come in for something like depression or poor school performance. Then it becomes more clear to me that they have a restricted interest and social communication issues.”

Another cost of being overlooked is missing out on early support for skill-building. “We talk about early intervention,” Dr. Epstein says. “When the girls are identified late, they’ve missed out on a lot of social interventions that are much harder later. That’s the danger for anybody who gets a late diagnosis.”

Dr. Nash concurs, adding that they’ve missed opportunities to get the proper support in school as well as socially: “Academically, it’s harder for them to focus on topics that are not of interest. That’s true for people who have ADHD and even to a greater degree for kids who are on the autism spectrum.”

Safety risks for autistic girls 

Autistic girls may be bullied simply because they’re “different.” Also, Dr. Epstein says, because these girls miss social cues and want to be liked, their autism can leave them more naïve. This makes them easy prey for someone trying to take advantage of them, be it a bully or a sexual predator. “The girls may be wanting the interaction but not understanding what it’s about, what the cues are,” Dr. Epstein says. “It can be very easy for them to follow their hormones without an understanding of what the dangers are. And sometimes even if they have been taught, they need ongoing support to be able to maintain safety.”

Melissa says this has been true with Lisa. “I’ve had to think about female issues at a much earlier age than I expected,” she says. “We’ve already had an incident of her being inappropriately touched by a boy, for whom the excuse was made that because he’s also disabled, he ‘didn’t understand what he was doing was wrong.’”

One of her daughter’s greatest strengths is how accepting she is of others, Melissa adds. “She always finds the good in people, even when they are mean to her,” she says. “But because she is so accepting and kind, others can easily take advantage of her, or bully her, and she won’t say anything.”

Dr. Nash notes that there’s an area of study that’s rethinking how to help girls on the spectrum: “There’s expanding research on how boys and girls present differently and how our treatments may need to be specified a bit more for a girl’s presentation vs. a boy’s presentation.”

But first the girls need to be identified — and accepted. This will require more awareness and sensitivity on the part of parents, teachers and clinicians.

Source: Why Many Autistic Girls Are Overlooked, by Beth Arky from https://childmind.org/article/autistic-girls-overlooked-undiagnosed-autism/ Accessed on June 4, 2022

What Is Shavuot (Shavuos)? And How Is Shavuot Celebrated?

The holiday of Shavuot is a two-day holiday, beginning at sundown following the 5th of Sivan and lasting until nightfall of the 7th of Sivan (June 4-6, 2022). In Israel it is a one-day holiday, ending at nightfall of the 6th of Sivan.

The word Shavuot (or Shavuos) means “weeks.” It celebrates the completion of the seven-week Omer counting period between Passover and Shavuot.

The Torah was given by G‑d to the Jewish people on Mount Sinai on Shavuot more than 3,300 years ago. Every year on the holiday of Shavuot we renew our acceptance of G‑d’s gift, and G‑d “re-gives” the Torah.

The giving of the Torah was a far-reaching spiritual event—one that touched the essence of the Jewish soul for all times. Our sages have compared it to a wedding between G‑d and the Jewish people. Shavuot also means “oaths,” for on this day G‑d swore eternal devotion to us, and we in turn pledged everlasting loyalty to Him.

In ancient times, two wheat loaves would be offered in the Holy Temple on Shavuot. It was also at this time that people would begin to bring bikkurim, their first and choicest fruits, to thank G‑d for Israel’s bounty.

How Is Shavuot Celebrated?
Women and girls light holiday candles to usher in the holiday, on both the first and second evenings of the holidays.

It is customary to stay up all night learning Torah on the first night of Shavuot.

All men, women and children should go to the synagogue to hear the reading of the Ten Commandments on the first day of Shavuot.

As on other holidays, special meals are eaten, and no “work” may be performed.

It is customary to eat dairy foods on Shavuot. Menus range from traditional cheese blintzes to quiches, casseroles and more.

On the second day of Shavuot, the Yizkor memorial service is recited.

Some communities read the Book of Ruth during morning services, as King David—whose passing occurred on this day—was a descendant of Ruth the Moabite.

Some have the custom to decorate their homes (and synagogues) with flowers and sweet-smelling plants in advance of Shavuot.


Source: What Is Shavuot (Shavuos)? And How Is Shavuot Celebrated? from https://www.chabad.org/library/article_cdo/aid/609663/jewish/What-Is-Shavuot-Shavuos.htm Accessed June 4, 2022