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I. BACKGROUND: STATISTICAL STATUS OF AUTISM

The Centers for Disease Control and Prevention (CDC) today released its biennial update of
autism’s estimated prevalence among the nation’s children, based on an analysis of 2014 medical records
and, where available, educational records of 8-year-old children from 11 monitoring sites across the
United States. The new estimate represents a 15 percent increase in prevalence nationally: to 1 in 59
children, from 1 in 68 two years previous.

However, prevalence estimates varied widely between monitoring sites, with significantly higher
numbers at sites where researchers had full access to school records. This suggests that the new national
numbers reflect a persistent undercount of autism’s true prevalence among the nation’s children. “These
findings demonstrate that while progress has been made on some fronts, there is still much work to do,”
says Autism Speaks President and Chief Executive Officer Angela Geiger. “They urgently warrant a
significant increase in life-enhancing research and access to high quality services for people with autism
across the spectrum and throughout their lifespan.”

Autism Speaks calls on legislators, public health agencies and the National Institutes of Health to
advance research that helps us better understand the increased prevalence and the complex medical needs
that often accompany autism. In doing so, policy makers should follow the U.S. Interagency Autism
Coordinating Committee’s recommendation to double the autism research budget. Autism Speaks also
urges government leaders to advance policies that better provide individualized support and services in
areas including education, transition to adulthood, residential options and employment.

Key findings of the new report include:

Nationally, 1 in 59 children had a diagnosis of autism spectrum disorder (ASD) by age 8 in 2014,
a 15 percent increase over 2012. But estimated rates varied, with a high of 1 in 34 in New Jersey (a 20
percent increase), where researchers had better access to education records. On the low side, autism’s
estimated prevalence in Arkansas was just 1 in 77. “This suggests that the new national prevalence
estimate of 1 in 59 still reflects a significant undercount of autism’s true prevalence among our children,”
says Autism Speaks Chief Science Officer Thomas Frazier. “And without more and better research, we
can’t know how much higher it really is.”

The gender gap in autism has decreased. While boys were 4 times more likely to be diagnosed than girls
(1 in 37 versus 1 in 151) in 2014, the difference was narrower than in 2012, when boys were 4.5 times
more frequently diagnosed than girls. This appears to reflect improved identification of autism in girls –
many of whom do not fit the stereotypical picture of autism seen in boys. White children were still more
likely to be diagnosed with autism than were minority children. However, the ethnic gap had narrowed
since 2012, particularly between black and white children. This appears to reflect increased awareness
and screening in minority communities. However, the diagnosis of autism among Hispanic children still
lagged significantly behind that of non-Hispanic children. Disappointingly, the report found no overall
decrease in the age of diagnosis. In 2014, most children were still being diagnosed after age 4, though
autism can be reliably diagnosed as early as age 2. Earlier diagnosis is crucial because early intervention
affords the best opportunity to support healthy development and deliver benefits across the lifespan.

“It’s encouraging to see evidence of improved identification of autism in girls and minority groups,” Dr.
Frazier says. “We must continue to narrow this gap while greatly speeding up the time from first concerns
about a child’s development to screening, diagnosis and intervention. If most children aren’t being
diagnosed until after age 4, we’re losing months if not years of intervention that can deliver benefits
throughout their lives.”

II. CHARACTERESTICS OF AUTISM

Two studies published in the past month lend support to the notion that autism looks different in
girls than it does in boys, making it harder to recognize and diagnose in girls. The studies reflect growing
suspicion in the research community that the underlying biology and the experiences of girls with autism
may both be distinct.

The first study, published in the March issue of the Journal of the American Academy of Child
and Adolescent Psychiatry, is the largest yet to try to parse the differences between boys and girls with
the disorder1. The researchers report that autism characteristics in girls depend on their level of
intelligence. “On the lower end, they tend to have more social communication impairment and lower
cognitive ability” than boys who have the disorder, says study leader Thomas Frazier, director of the
Center for Autism at the Cleveland Clinic in Ohio. “On the higher end, they have fewer restricted
interests.” These differences may make it tricky for parents, teachers and doctors to recognize the signs of
autism in girls. This is especially true because autism has traditionally been thought of as a boy problem:
Four times as many boys as girls are diagnosed with the disorder.

“For a long time the gender disparity has been talked about as if it’s a fact,” says Jane
McGillivray, associate professor of psychology at Deakin University in Victoria, Australia. McGillivray
led the second study, a pilot effort to investigate friendship skills in girls and boys with high-functioning
autism, published 28 February in Molecular Autism2.

Researchers are now beginning to question the degree to which this gender disparity is real.
Some studies have found that girls may be genetically protected from developing autism. Others suggest
that autism is underdiagnosed in girls — that is, clinicians often fail to recognize the disorder, especially
in girls with normal intelligence. Defining gender differences in the symptoms of autism may help
researchers nail down how much each of these possibilities contributes to the skewed diagnostic ratio.
Highandlow:
The first study draws on information from 304 girls and 2,114 boys with autism enrolled in the
Simons Simplex Collection (SSC), a database of individuals with autism and their unaffected parents and
siblings. (The SSC is funded by the Simons Foundation, SFARI.org’s parent organization.) Some of the
findings echo those of previous studies of gender differences in autism, but this study is substantially
larger, adding heft to the results.

Among individuals with autism who have an intelligence quotient (IQ) lower than 70, girls have
greater social communication impairments than do boys, the researchers found. Girls in this group also
have lower IQs on average than the boys do. Those findings are consistent with previous studies showing
that females diagnosed with autism tend to be more severely affected than males. They are also in line
with the hypothesis that more mutations are required to produce autism in females. “Females may require
extra hits, but once they get those extra hits they become severely affected,” Frazier says. Curiously, the
researchers also found that regardless of IQ, girls with autism show more irritability and externalizing
behaviors than boys who have the disorder. That’s a surprise rbecause externalizing behavior — that is,
acting out — is typically thought of as a boy-like behavior.

Finally, for individuals with IQs above 70, the most striking difference between girls and boys
with autism is a lower prevalence of restricted interests among girls. Some researchers say this last
finding doesn’t jibe with clinical experience. “They do have restricted interests, but their restricted
interests are more socially appropriate,” says David Skuse, professor of behavioral and brain sciences at
University College London, who was not involved in either study. For example, a 10-year-old girl with
autism might bombard a listener with facts about her favorite pop star whereas a boy might rattle off train
timetables, and a teen girl with the disorder might obsessively collect makeup rather than old coins.
Clinicians may be more alert to certain stereotypical restricted interests, such as trains, than they are to
female topics.

“The problem is that the way we have defined autism, conventionally, is a male stereotype,” Skuse says.
Frazier says that because the analysis found a large difference in the level of restricted interests between
boys and girls, this gender difference is probably real. In addition, he notes that highly trained clinicians
evaluated individuals enrolled in the SSC and would have picked up on restricted interests even in the
girls. Still, it’s possible that the clinicians missed some subtle symptoms, Frazier says. The girls’
“restricted interests may just be more female-specific presentations that we’re not picking up in the data.”

III. HOW TO CONDITION AUTISM (BOYS AND GIRLS

UNDERSTANDING AUTISM IN GIRLS

Doctors can overlook or misdiagnose autism in girls because it is more common in boys. Older
girls with milder forms of autism may hide their symptoms or work harder to "fit in" with their peers.
Early diagnosis can help autistic girls access support, so it is important to recognize the symptoms.
Doctors may be likely to underdiagnose autism in girls because they may not fit the traditional view of an
autistic person, or because they hide their symptoms. (Some symptoms of autism include repetitive
behaviors, difficulty with impulse control, and a tendency to avoid eye contact.) The symptoms of autism
tend to be the same for boys and girls, but people are more likely to overlook them in girls. Every person
is different, and symptoms vary between them. Autism covers such a wide range of symptoms Trusted
Source that autism spectrum disorder (ASD) is now the most accepted term. Autism is a developmental
condition that can affect a person's ability to communicate and interact with others. However, symptoms
vary a lot between individuals.

Symptoms of autism in girls

Some symptoms of autism include repetitive behaviors, difficulty with impulse control, and a
tendency to avoid eye contact. The symptoms of autism tend to be the same for boys and girls, but people
are more likely to overlook them in girls. Every person is different, and symptoms vary between them.
Autism covers such a wide range of symptomsTrusted Source that autism spectrum disorder (ASD) is
now the most accepted term. Many autistic children have difficulty with social interaction and
communication. Some examples of common symptoms include:

 not responding to their name by the time they are 12 months old
 preferring not to be held or cuddled
 not following instructions
 not looking at something when another person points to it
 losing certain skills, such as no longer saying a word they could use before
 difficulty explaining what they want or need
 difficulty understanding how other people are feeling
 avoiding eye contact

Girls may have more self-awareness and be more conscious of "fitting in" socially. This can mean that
they are able to hide the symptoms of autism in childhood. As girls get older and social norms and
friendships become more complex, however, they may find it harder to relate to others. This can mean
that they may not receive a diagnosis of autism until their teenage years.

THE AUTISM SPECTRUM: A PREPONDERANCE OF MALES

In many ways, males appear to be more vulnerable to life's hazards than females. For a variety of
reasons, both biological and social, they are more prone to death or damage before birth, more likely to
suffer accidents or fall victim to violence, and have a shorter average lifespan than females. 1 2 They are
also more likely than females to have autism, pervasive developmental disorder not otherwise specified
(PDD-NOS), Asperger's syndrome, or any other type of ASD.
 In the first clinical account of autism in 1943, psychiatrist Leo Kanner noted that boys with the
condition outnumbered girls by a ratio of 4 to 1. 4 Similarly, in 1944, when Hans Asperger described the
syndrome that would come to bear his name, he initially found it only in boys. 5 The impression that there
are far more boys with autism than girls, and that this is even more striking in Asperger syndrome, has not
changed much in the years since. Recent studies continue to show that the ratio of boys to girls with
autism is about 4 or 5 to 1, 6 7 while the ratio of boys to girls with Asperger's syndrome is between 6 and
11 to 1. 8 9 What no one has been able to discover yet is why.

AUTISTIC TRAITS: MALE PLUS?

It is not just that there are more boys than girls with ASDs. Researchers have also noticed that
there is something "male and then some" about the way individuals with ASD think, act, and cope.
Asperger himself speculated that the characteristics he saw in his young patients could represent an
"extreme variant of male intelligence." 10 More recently, Simon Baron-Cohen, a prominent autism
researcher at Cambridge University, has proposed the extreme male brain theory of autism, which
attempts to explain the remarkable similarities between traits generally associated with human "maleness"
and traits associated with the autism spectrum. 11 It is not just that there are more boys than girls with
ASDs. Researchers have also noticed that there is something "male and then some" about the way
individuals with ASD think, act, and cope. Asperger himself speculated that the characteristics he saw in
his young patients could represent an "extreme variant of male intelligence." 10 More recently, Simon
Baron-Cohen, a prominent autism researcher at Cambridge University, has proposed the extreme male
brain theory of autism, which attempts to explain the remarkable similarities between traits generally
associated with human "maleness" and traits associated with the autism spectrum. What are these traits?
For one thing, typically developing males tend to show strengths in mathematical and spatial reasoning
and the ability to discriminate details from a complex whole. Compared with typically developing
females, however, males tend to be at higher risk for language impairment and at a disadvantage on
social-judgment tasks, measures of empathy and cooperation, and imaginary play during childhood. 12
Many of the traits associated with ASDs could be thought of as an extreme profile of "typical male"
strengths and challenges. Where, on average, typical men may be good at detail-oriented processing,
people with ASD may be incredibly good at perceiving detail...and impaired when it comes to seeing "the
big picture." Where typical men may be less able than women to make social judgments or empathize
with others, people with ASDs are literally disabled in these areas.

Stereotypes about typical male and female behaviors can cause some people to miss some
symptoms. Many people think of girls as naturally quieter or more content to play alone than boys.
However, speaking less and preferring to spend time alone can both be symptoms of autism.

IV. SAMPLE LEARNING AREA CONDUCTIVE FOR LEARNING

Effective teachers look for every available opportunity to increase student learning. The
classroom environment is a teaching resource that should not be ignored. Students and teachers spend the
majority of their day in school classrooms, and it’s your responsibility to foster an environment and
atmosphere that enhance learning. Developing a classroom environment conducive to learning is a
process that entails staging the physical space, getting the students to cooperate, creating a communal
environment, and finally maintaining a positive classroom climate and culture.

PHYSICAL SPACE
To create a classroom environment conducive to learning, you must first focus on the physical
space. Use every possible area of the room to create an atmosphere that encourages participation and
learning. The physical space includes the layout and arrangement of the desks or tables, the placement of
computers and equipment, and items on the bulletin boards and walls. In modern classrooms the tables
and desks are usually not fixed, allowing for various seating arrangements. Take time to draw up a seating
plan based on how you expect to conduct your lessons. If you’ll give a lot of instruction, it’s ideal to have
any students who have difficulties closer to you so that they have greater access to the lesson. If you’ll
require your students to take part in collaborative activities, you can arrange the classroom so that you
have maximum visibility of all groups, which may then be clustered around the classroom as appropriate.
You may be required to make individual seating changes based on disruptive behavior, keeping students
who are more likely to be disruptive closer to you and rewarding them by allowing them to move if they
learn to conduct themselves more appropriately. You could also allow students to be clustered around
focus areas for activities, moving back to a more traditional seating arrangement when they have
completed the activity. Always try to accommodate the physical size of students by procuring an
adequately sized desk for them.

Next, consider the furniture and equipment you must fit into your classroom. Where are the
electrical outlets? Which pieces of equipment may need to be plugged into them? Where is the
chalkboard or projector screen? Will students need a clear view of them? Where should you place your
desk to allow maximum observation and encourage good behavior? Finally, students with special needs
often require extra attention. For instance, a student with visual impairment or behavior problems may
need to be placed in the action zone, the area in the front and the middle of the class.

After arranging the room with the optimal furniture placement, you must assume responsibility
for the organization of the entire classroom. Where will the students keep their supplies? What resources
will you need daily access to? Supplies, bins, shelves, and cabinets should be carefully organized and
easily accessible. The wall space and interest centers will suit a well-organized and efficient classroom
and will optimize students’ learning potential. Find creative ways for students to explore and learn in their
environment, and set up learning centers throughout the class. Learning centers are creatively staged
learning areas that allow students to participate in activities related to the curriculum. Teachers will
prepare an activity at each center. Activities are typically hands-on and are fun for the students. Learning
centers may include a computer center, a science center, a reading corner, or an interactive bulletin board.
Another dimension of the physical classroom is the wall space. Wall space should be pleasing to the eye,
with special attention to student morale and learning. One way of accomplishing this is an organized
display of student work. Displaying student work not only boosts morale but also fosters ownership of the
classroom. Bulletin boards make the room look neat and attractive and are a source of learning by
highlighting key facts or by allowing student interaction. Interactive bulletin boards are bulletin boards
that allow students to participate in an activity that reinforces the class’s objectives. Bulletin boards can
also be electronic, which can easily be set up for any subject area. These may be used differently from
traditional “on-the-wall” bulletin boards, but allow multiple students to access any problems you post on
the board and discuss or propose answers among themselves before you intervene with the correct
answer. Establish ground rules to ensure the use of bulletin boards is effective.

GETTING STUDENTS TO COOPERATE