“Nothing was getting better,” she says. “I just gave up; I’d had enough of life.”
A short while after taking the pills, Maya panicked that she was still awake, and that she might begin to vomit, something she dreads. She woke her parents and, within a half hour of arriving at the emergency room, fell into a coma.
* * *
Social isolation, bullying and depression are not exclusive to girls with autism—boys experience them too. But for older girls with autism, the intricacies of their social world add layers of complexity.
In early childhood, boys and girls with autism are about the same. If anything, girls appear to be more social—whether because they actually are or are just perceived to be. As they edge closer to adolescence, however, girls with autism lose this early social advantage, becoming less and less likely to have friends, and more likely to be isolated. “It can be very, very tough for them,” says Pelphrey.
For some girls, that may be a result of having mostly been in classes with boys who have autism. But even for girls who are placed in mainstream schools, the rituals of female adolescence can be boring or bewildering.
Adolescent boys tend to socialize in loosely organized groups focused on sports or video games, allowing a boy with minimal social skills to slide by, says Kathy Koenig, an associate research scientist at the Yale Child Study Center. “For girls, socialization is all about communication, all about social-emotional relationships—discussions about friendship, who likes who and who doesn’t like who and who is feuding with who,” Koenig says. “Girls on the spectrum don’t get it.”
Adolescence can be a confusing time for any young girl, but for a girl with autism, “trying to make friends and not understanding why the friendships aren’t lasting, or why you’re not being included when people are making plans” can be incredibly isolating, says Baron-Cohen. “You’re aware enough to know that you’re failing, basically.”
Ostracized and aware of it, adolescent girls with autism become highly anxious and depressed, and many develop eating disorders.This trend remains constant until late middle age, when clinicians suspect that, as they are known to do in the general population, the differences in mood disorders between men and women with autism may even out.
There are any number of programs for people with autism that teach specific behavioral skills—improving eye contact or turning your body toward the person you’re speaking to, for example. But there is almost nothing to give adolescent girls the kind of emotional support that only comes from true companionship.
In the U.S., there seem to be just three such programs—one at Yale, one at the University of Kansas, and a new center in New York City.
The Yale program, which Koenig launched more than three years ago, brings girls with autism together for yoga, or to make jewelry or to watch the blockbuster movie Frozen—the same kinds of activities typical girls might do. There are different groups for young girls, teenagers and young women, with about 102 families registered in total. Some groups are purely social, but others offer training for interviews, or provide support for women in college.