Thursday, December 22, 2016
SELF-Regulation and the Autistic Child
Hypothetical Situation* (names not actual names)
“Joey”* participates in a self-contained classroom in his public school. He has done very well. Over the past 12 months his verbal skills have dramatically. He now speaks in full sentences and expresses his needs, thoughts and feelings. His echolalic speech has dramatically decreased. He is no longer speaking in cartoon conversations, etc.
Joey no longer needs to be in constant movement. He is following directions and can sit a table to complete a 3 step fine motor task for up to 30 minutes.
Concerns still remain when with spontaneous (non-task related) actions. Recently he was rehearsing a church program that was being led by older teenage boys and he was jumping around and could not “stay still” even though he was reminded by the leaders to do so and also by his mother.
There are other situations similar to this that are a concern to his mother and to some degree cause a level of embarrassment when these incidents occur.
The Immediate questions for the family is how to control him and how to limit these unusual behaviors. Questions also arise as to if these behaviors should be tolerated as “sensory based” or are they just “mis-behavior”?
What is sensory what is not
Almost everything we do as human beings is sensory: we feel, we speak, we smell, we touch and when we do we react to those experiences.
What makes the Autistic child different is that they do not have a filter through which to decide how to plan what to do when.
These children do not have the intuitive ability to follow a motor emotional cue to redirect their actions.
These reactions are sensory. Occupational Therapy teaches self-regulation as well as standard motor emotional response patterns that help meliorate and qualitatively enhance the child’s repertoire of socially acceptable behaviors.
However, in novel situations such as having to follow specific directions in a typical group of peers, these learned behaviors cannot easily be recruited because the situation is so different from those within the child’s familiar expectations.
For the Autistic child following verbal directions is difficult because they cannot visualize what is being asked of them. In larger unfamiliar groups, being given verbal directions, particularly “reprimands” is almost intolerable for the Autistic child. They do not have the emotional resources as to how to alter their behaviors to “do it right” and they do not completely comprehend what it is they are doing wrong.
These sensory inputs: everyone around the child (personal space), the sound of singing (noxious to a child with auditory sensitivities), visual spatial processing (where to stand), proprioception /body awareness (how to be still) become muddled for this impacted child. And the more he is told to stop, the more sensory agitated he becomes so he gets to the point where is cannot stop.
To the uneducated he looks like BUT IS NOT a misbehaving child. This is why it is important to explain to the “leaders” in these situations that Joey may need a little more “TLC” than the other children.
Things to do that may help
1. Instead of the (usual) putting the out of sync child in the back, place Joey in the front so that the stimuli of others around him is reduced.
2. Have him wear a weighted jacket so that he can feel him body more securely
3. Put on sound reducing head phones so he can “hear” but muted so that he is not over reacting to the extraneous noises
4. Rehearse the songs (or play or __) at home before he gets to the rehearsal and/or the program
5. Gently remove him from the situation and (in private) give him deep pressure massages to the neck and back for about 2 minutes.
6. Let him do jumping jacks if he is expressing the need to move.
Things to understand
1. Joey is doing his best
2. This is not about parenting
3. The “annoyance” of others is their problem not yours
4. Take self judgment out of the picture—you know your child and you are doing your best.
5. This is not intentional on the child’s part it is reactionary and in part sensory and learned behaviors: (the child learned in situation “A” to do “B” but in novel situations he is at a loss. It is the treatment of Occupational Therapy to diversify his reaction repertoire.