Within an hour of arriving at her new school, 14-year-old Beth Mitchell made her objections shockingly clear. The headteacher, Sarah Wild, recalls a member of staff calling frantically: “There’s a girl here covered in blood.”  Over the next month at Limpsfield Grange in Oxted, Surrey, Beth cut herself three times a day; she sabotaged lessons and shunned the other girls whom, she says, “seemed very weird”. Beth is autistic and has been diagnosed with pathological demand avoidance, meaning she would go to great lengths to avoid situations that filled her with anxiety – one of the prominent symptoms of girls on the autistic spectrum. Her small mainstream school had said they could no longer cope with her.  Finding a strategy to tackle Beth’s behaviour was just one of the daily challenges that Wild and her staff confront at Limpsfield Grange, the country’s only state-funded residential school for girls with special needs. It was Wild, whose past experience was working with children who have communication difficulties – a key feature of autism – who realised, when she became headteacher three years ago, that a high percentage of the girls were exhibiting behaviour on the autistic spectrum. “My question was: why aren’t we recognising this and doing something about it?”  The National Autistic Society talks of five times as many males to females with autism, but nobody has firm statistics  They set about getting those who needed it statements (56% of Limpsfield Grange’s 70 pupils now have statements on the autistic spectrum), as a first step towards devising a 24-hour pastoral and educational programme.  Wild, known by students as “Mummy of the school”, tempers the relaxed, jokey atmosphere with a “tough love” approach. If a girl finds a very visible place to sit and cry, nobody takes any notice; if the same girl concentrates hard in class, she gets lots of praise.  Wild says: “Autism in girls is massively under-diagnosed and as a result many are expected to cope in mainstream school. They often struggle, are bullied and isolated and become very unhappy.”  The National Autistic Society (NAS) talks of a perceived ratio of five times as many males to females with autism, but nobody has firm statistics. And, according to its 2012 survey, just 20% of girls with Autism who responded had been diagnosed by the age of 11, as compared to 50% of males. The survey also suggests that 42% of females have been misdiagnosed, as compared with 30% of males.  Dr Judith Gould of the NAS is working on an innovative way of using the data to help those working with girls to ask the right questions, and recognise how girls mask their symptoms and need help specific to them.  “Autism is seen as a male thing, and boys are often physical in expressing themselves when unhappy, whereas girls implode emotionally,” says Wild. “Boys tend not to be interested in contact and friendship, whereas girls desperately want friendship, they become obsessed very easily if they focus on someone as ‘theirs’ – whether a girl or a boy – and they yearn for boyfriends.”  Wild gives the example of one girl who texted a boy “60 times in an hour” and had 1,160 photos of him.  Girls with autism are likely to worry about body image and get very involved with TV series and celebrities, says Carol Povey, director of the NAS’s centre for autism. And there is a clear association between autism and eating disorders, as a report by Cambridge University’s autism research centre, led by Professor Simon Baron-Cohen, notes.  “Autism in girls is massively under-diagnosed and as a result they often struggle, are bullied, isolated and unhappy”  While boys tend to be diagnosed as young as three, late diagnosis can be a problem for girls, whose behaviour can be dismissed as “teenage hormones”. “They are full of emotion and implode into isolation and depression if things go wrong,” says Wild. Things seem to start going really wrong at about age 13, she says, when many become school phobic.  The school has taken part in a documentary filmed over six months in the hope it will help autistic girls’ behaviour to be more widely recognised.  When I visited, I meet Beth, who nowadays is articulate, sociable and academically high-achieving. She knows she is “different” but believes her autism won’t stop her fulfilling her dream of becoming a children’s nurse.  Her breakthrough came in year 9, she says. “Mrs Chips, my year 9 teacher, was the first person I bonded with. She helped me with schoolwork, but also I had one-to-one sessions every day to talk my worries and anxieties out. I had never been able to concentrate before because things kept worrying me.”  Her mother, Emma, says Beth arrived at Limpsfield with a spelling age of six, but now has taken GCSEs aged 15. “We have watched Beth set herself up to succeed, and she is determined to go on to college and possibly university. This from a girl who cut herself every time things looked too worrying.”  The school has a fairly traditional academic curriculum, but with only 10 girls to a class. Wild says she has high expectations for everything the girls do, explaining to them that, after school, they will need to get a job – and then they cannot “go into meltdown if somebody uses their coffee mug”.  Another feature of the curriculum here is thorough sex and relationships education, in recognition of these girls’ vulnerability. “They believe what people say and don’t read context,” says Wild. “Yet many are eager to have boyfriends and they need all the help managing that we can give.”  The girls all have daily one-to-one pastoral sessions to help manage their emotions. Wild describes a seven-year-old who talked of having “a tummy like a washing machine” before each emotional crisis. The school created an “emotions ruler” for her with green, amber and red. “Green is I feel fine,” explains Wild. “Amber is I feel wobbly. Red is like ooooh. On the back we have some strategies. So for this young person getting out of a troubling situation, moving around, going somewhere else in a structured way and coming back really helps.”  Abigail now comes over to join us. Wild explains how staff nearly gave up on her: “Abigail wouldn’t talk to anyone for six months. She wouldn’t follow adult instructions. It got to the point we felt we couldn’t do more.” Then the deputy headteacher “chose silliness as the way to reach Abi”. They played with her dog, Bella, and Abi thought the dog’s antics hilarious. Abigail explains: “The dog is Woofalot. I like nicknames.” And when Wild asks if she likes lessons now she replies: “Yes, because the grown-ups make me happy.”  Creative writing tutor, Vicky Martin, has helped some of the students to write a book, M is For Autism, about how it feels to live in a “tipsy-turvey, wobbly world” as a girl with autism.  The NAS is full of praise for the work at Limpsfield, which takes any girl they feel they can help (the local authority usually pays if the girl is statemented). Povey believes more such schools for girls are badly needed. The NAS has six co-ed dedicated autism schools; in addition, two new free schools, in Thames Valley and Cheshire, have devised ways of being responsive to girls, she says. The society is holding a conference on the subject in September.  Wild says she is encouraged to learn from papers she reads and conferences she attends, that more girls are being diagnosed. For now, her aim is to show the girls how valuable and talented they are. “I want all the girls to be encouraged to go into their local communities, to make a contribution. The things that they can do should be celebrated, because they’ve got amazing talents. They’re as valuable as anyone else. Just quirky.”  Girls With Autism will be broadcast on ITV on 15 July at 10.40pm  • This article was amended on 14 July 2015 to correct the number of NAS co-ed dedicated autism schools.
They may arrive self-harming, or unable to talk. Often their condition has been dismissed as ‘hormones’. We visit the only state school dedicated to girls with autism