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• Speech Delay: Not as obvious in younger students, as girls tend to speak earlier than boys but more noticable as girls get older.
• Difficulty with Social Skills: Many girls with ASD tend to be passive, well-behaved and follow the rules, often being in the position of being manipulated by a more dominant peer. They may also present as overly confident and vocal in their expression towards the teacher and peers, appearing extreme and righteous as they always have something to say or correct about something, In both of these examples, girls struggle with what is considered to be socially appropriate.
• Sensitivity: Girls with ASD can be highly sensitive and emotional and easily overwhelmed by sensory overload (e.g. in situations like changing rooms between lessons with a high noise level, during snack when there are multiple smells in the room).
• Conflict and Stress: Self-regulation in situations of conflict can be impossible for children with ASD.
• Structure and Rules: Students with ASD often have a strong sense of order, and work best (or only) with set rules and structures. In addition, they may have their own rituals that may seem odd to others.
• Special Interests: In many cases, children with autism have strong special interests. More often than boys, girls’ interests may include music, arts, literature or animals. Boys with ASD may have interests that fit the sterotypes more (computers, video games, etc.).
• Anxiety: Many girls with ASD experience severe anxiety on a daily basis and may not be able to manage it well.

• Provide structure (classroom set-up and learning experiences).
• Let students with ASD sit somewhere where they can easily leave the classroom if they need to.
• Create a quiet area/space within the classroom that you encourage all students to use.
• Supply noise-cancelling headphones for students who request them.

Learning and Communication

• Provide students with multiple options to communicate and express themselves. These can include speech and writing and multiple forms of media. This also means honouring students’ requests to communicate one-on-one or in small groups rather than in a whole class discussion.
• Allow students to work in groups or independently.
• Have high expectations for all but be flexible as to how students meet or exceed them.
• Practice differentiation and provide challenging/ stimulating tasks to meet individual student needs.
• Communicate clearly and, if possible, literally, to prevent confusion. Follow through on what you say and be consistent and reliable.

Peer Relationships

• Encourage participation in extracurricular activities that engage students interests and connect with like-minded peers.
• Normalize the use of quiet spaces when needed. Students with ASD often feel overwhelmed during social interactions and may feel the need to take a break. By making it one of your classroom norms, you remove the stigma that students with ASD may feel when they need a break.
• Structure all activities clearly, providing activities and specific roles for students at break times.

Girls with ADHD might feel more ashamed about their condition, they have not been trained to be assertive, girls are taught to internalize their problems and girls tend to be willing to please others. All these factors lead to girls not asking for help when they need it and not expressing their needs to their teachers. Girls might feel insecure and anxious about what will happen if they share their needs.

So in order to find out about the needs of girls with ADHD and give these girls the opportunity to share their needs, you could try to implement the following ideas:

• Create a safe and secure classroom environment
• If a girl feels included and knows she will not be judged, she will feel less anxious about sharing her difficulties and more willing to ask for help
• Set up an interview with the student of concern
• Is the student 9 years old or younger? →  Set up an interview with the student and a parent. In this way, a student feels safe and can share important information about her needs. Furthermore, by inviting a parent a teacher gets an insight into the home-situation as well. This can be helpful by creating an holistic overview that can help to identifying the needs of a student
• Is the student 10 years or older? → Have the student fill in a self-report scale (Nadeau, Littman & Quinn, 2016). This can be useful for uncovering internal struggles girls with ADHD can experience.

What teachers should look for in order to spot ADHD in girls:

• Compulsive talking
• Not being able to answer a question, despite looking attentive
• Having difficulty following directions
• Frequently asking other students to repeat instructions
• Rarely finishing assignments, despite appearing to work and sitting quietly
• Messy desks and lockers
• Forgetting to turn in permission slips or homework
• Missing supplies that are needed to do work
• Seeming to have auditory processing problems
• Seeming to have expressive language problems
• A slow rate of working

Important factors to keep in mind when identifying ADHD in girls

• Girls will not show their struggles, they are more likely to tell you about them when/if you ask.
• Always provide space for girls to approach you whenever they might have the urge to share something with you
• Current ADHD guidelines are focused on behaviour in boys
• Try to always use an open, holistic view when reviewing the behaviour of girls.
• Beware of the possible ‘referral bias’.
• Teachers are likely to suffer from a phenomenon called the ‘referral bias’. Several studies (Abikoff et al., 2002; Groenewald et al., 2009)(Coles, Slavec, Bernstein & Baroni, 2010) have found that teachers are more likely to refer students with ADHD symptoms related to hyperactivity and impulsive behaviour to special needs education. Students with the inattentive type of ADHD are more often overlooked by the teacher. Since this type of ADHD is significantly more prevalent amongst girls, they are the ones that are being overlooked by the teacher. Therefore teachers: Be aware of your bias, you might unconsciously overlook girls with ADHD!

• By working in small groups, students with ADHD will be able to engage in a lot of interaction. This will help them both with developing their social skills and by improving their on-task behaviour. On-task behaviour results in a prolonged attention span.

Meditative practices

• For students with ADHD, practising meditation will benefit their executive functioning, especially by increasing their attentional awareness. By doing so, students are able to stay focused for a longer period of time. Part of using meditative practices could be emotional control and problem-solving training. By being able to regulate their emotional responses to problems, students with ADHD will develop a more relaxed state of mind and a positive approach to solving problems.

Personalised learning path and instruction

• Girls with ADHD may/can experience a relatively high amount of shame and fear due to a perfectionistic mind. This often results in a perfectionistic mindset. To work towards a more natural and beneficial mindset, teachers can create personalised learning paths together with the students. There are a few important things to keep in mind when creating these learning paths:

• • Use clear and small goals
  • Make use of clear and constructive feedback
  • Create an organizational routine → this benefits the organizational skills of the student
  • Allow for clear, personalised assignments that fit the adjusted learning
  • If possible, do not mark off for messiness. Often girls with ADHD struggle with this unwillingly due to underdeveloped organizational skills.

• Create a personal checklist for your student with ADHD. This increases ownership of learning and creates a clear overview of tasks
• Make use of a calendar within your classroom and online. This makes it possible to have an overview of work ready at all times, both at home as well as in the classroom.
• Minimize the need of taking home schoolwork. Forgetfulness in girls with ADHD could often cause unnecessary issues with forgetting homework or leaving work at school → A great way to solve this is to create an online platform where teachers could post activities and students can upload their results!

Being misdiagnosed or not diagnosed at all can have significant negative effects on girls and women with ADHD or ASD. Consequences can include social isolation and identity issues that may lead to severe mental health problems. Therefore, it is necessary to reform the history of a male-centred approach in diagnosis to one that benefits girls and women with ADHD and ASD.

This comes with challenges, especially for teachers that are often already overwhelmed with a variety of learning needs in their students. It is important to note that there is no perfect way of doing this and that it often takes time to recognise certain characteristics as symptoms of ADHD or ASD. This process involves a teacher connecting with each individual student and trying to understand them. Every student is different and so is every case of ADHD and ASD. Taking it one step at a time while making educated and empathetic choices for and with your student is a good start when your overwhelm gets the better of you.

Finally, it is imperative to be aware that a good relationship with your student builds the foundation to recognising their individual needs best. Only when that is a given, the ideal learning environment for a student can be provided.