Autism's Solitude

Though Autism is predominantly characterized as a social disorder in the DSM, it’s really a mosaic of disorders that we find in childhood development, from communication disorders, anxiety, Attention Deficit Hyperactivity Disorder, Oppositional Defiance Disorder, Motor Skills Disorder, Stereotypic Movement Disorder, and Mental Retardation. With such a cornucopia of disorders thrown into the mix and psychologists and doctors alike flipping madly through the pages of the DSM to find an answer, it’s no wonder so many autistic kids are misdiagnosed and so many other children are misdiagnosed as autistic.

Communicative Impairments
There can be no denial that there are impairments in autism that prevent these children from effectively relaying their wants and needs to the world. Some are nonverbal; some are verbal with speech difficulties. Children cannot officially be diagnosed as autistic unless they had an absence of or a significant delay in speech development. If there was no speech delay present but other symptoms appear, they may qualify as having Aspergers.

Those who are nonverbal have, in one way or another found a way to communicate, either by pointing, grabbing your hand and gesturing, or vocalizing (whining, grunting, crying). As a parent, most know what a tiny nudge on the side or a pinch to the forearm means, like a mother or father who recognizes their new baby’s cries as distinctly different for hunger, wetness, fear, or pain. Given that you know what your child needs and wants, most parents find this sufficient for functioning, however how long would these gestures suffice in an outside environment, placed in a new classroom, with new friends, or new caregivers who haven’t spent several years with the child and haven’t the benefit of parent intuition?

Children who are verbal, however, are not necessarily more successful in communicating their desires than nonverbal. As mentioned in the previous blog, scripting is a frequent verbalization with these children. With limited vocabularies and a very limited ability to independently construct the words they do have into sentences, many children draw off of pre-made conversation; dialog from television and movies, songs, words from everyday exchanges they overhear, etc. One child I worked with would typically use scripts to answer various questions. For example, I could ask “Where do you want to go?” and he would respond “I need your help to find the park, can you see it?” in typical Dora the Explorer or Mickey Mouse Clubhouse fashion. “You want to go to the park?” I would ask. “Yes, let’s go! We can do it!” Another particularly bright patient would accurately pair the tone and words of the scripts to present her emotions: when happy, her scripts were songs and games. When upset, she scripted dialog from shows where the characters were distressed, yelling “We have to get out of here! Incoming! Ahhh!” However, for most autistic children, when reciting these lines, they are not often directed towards anyone in particular. As mentioned, these repetitions are usually to entertain themselves (perseveration) or to manage anxiety (obsessive-compulsion).

There are several techniques and technologies being used today to help autistic children communicate, whether verbal or nonverbal, from more simplistic tactics such as PECS, Icon boards, and letter boards to higher end technologies such as iPads and Go-Talks. Again, the pros and cons of these approaches will be discussed in detail in a later blog.

Stereotyped Behaviors and Interests
Most people recognize the most typical autistic behaviors, such as hand or arm flapping, pacing, twirling their fingers in front of their eyes, etc. These are behaviors autistic individuals can engage in for hours at a time if they’re permitted to, and while seemingly pointless to the outsider, these movements are meeting a need for these children. Most times, that need is “stimming”, short for stimulation. We all require stimulation of the various senses, and there are five for autistic children that are slightly different from the common ones we know: Auditory (hearing), Visual (sight), Tactile (touch), a combination of Olfactory and Gustation (smell and taste), and Kinesthetic (movement). Given that the autistic mind mirrors much of the ADHD mind, autistic individuals usually struggle with an overactive brain in an underwhelming environment, therefore they seek stimulation in various ways to appease their senses. What movements and activities satisfy which senses, how to determine your child’s dominant senses, and how to stop some stims and utilize others to help your child interact, grow, and learn academically will also be discussed in an upcoming blog.

Other children with Autism and Aspergers usually engage in obsessive and very select interests or topics. Some become obsessed with objects such as trucks or blocks. Others are obsessed with topics such as very specific events in history or how planes operate. These obsessions usually consume the individual’s daily life; they rarely can discuss other topics without somehow integrating their preference or completely redirecting the conversation back to their obsession. Like security blankets, most cannot function without frequent contact with the tangible object of their obsession, or the continuing thought of it. Obviously, with limited ability to discuss other topics or acknowledge the interests of others, this presents a considerably large obstacle with developing sustainable relationships. One patient I frequently spoke to had a particular obsession with middle eastern countries. Nearly every time he approached me, I could anticipate a question about Iraq or Afghanistan. At one point, I made the mistake of divulging that I had a friend from Palestine, and for the next two weeks, our conversations always began with “Does your friend in Palestine…”. We then we took a three week break for summer, and once he returned, the questions resumed, uninterrupted. Though at times I could redirect the conversation to his daily life, it never carried over to the next conversation we would inevitably have regarding the flag of Iran. It is very difficult to break these obsessive tendencies, typically through systematically reduced contact and discussion of these obsessions, but usually once one obsession is exhausted or is no longer made available, a new one is formed, and the cycle begins again.

Developmental Delays
Most parents don’t need to wait until their child is three to know there is something different about them. Developmental delays usually consist of delay in emotional expression (smiles, laughter), social development (eye contact), emotional contact such as a desire to be touched or a desire to be with one’s mother in the mother’s absence, delays in motor skill movement such as grabbing objects, picking things up, crawling and walking, and cognitive delays reflected by speech and academic abilities such as simple counting and recognizing basic colors and shapes.

As mentioned before, the symptoms of autism affect each child differently, some symptoms are more prevalent than others, some are not present at all. And if we’re not careful in not only diagnosing as professionals, but accepting diagnoses as parents, we may just end up like Jenny McCarthy, spending years treating an illness our child never had.