Monday, May 7, 2007

Behavioral Issues

I am visiting a nearby clinic, having lunch with a friend and colleague who works there. A student clinician is having some trouble with her new autistic client today. It seems that he throws things when he's frustrated, and he frequently is. He's well behaved as long as his mom's in the room, but goes ballistic as soon as she leaves. He kicks the clinician and refuses to play nice with toys. She's come to my friend's office to ask what she should do.

We talk about what might be making him unhappy. He is four years old and is being asked to answer what color is this, what color is that, work on his ABC's and on sharing. They are trying to use a reward system. I throw out a couple of ideas about using his interests, not so much as external rewards but to make the lessons rewarding in themselves. I suspect this kid knows all about colors and ABCs and isn't too interested in performing this show that's being asked of him.

I end up offering to make some more interesting materials for the clinician to use. I try my best to make my point about not talking to people (and this includes 4 year old people) as if they were none too bright. Right now, this is all I can do.

What I want to do is go down the hall to where the boy is and try to find out what it is that he wants to work on. Maybe he wants to go outside; it's a beautiful sunny day and there are plenty of rocks and cracks in the pavement to be seen and bricks to be touched, blades of grass to be shredded. But those are my ideas of fun. I don't assume this is true for everybody any more than saying what color the sky is or what comes after "C". I do know that the letter "D" is easier to talk about when I am shredding grass. Or drawing squares.

I wonder if anyone has ever listened to this boy, really listened to whatever form of talk or alternate ways of saying things he uses. I wonder if he is bored with blue and wants to talk about turquoise, aqua, cornflower, periwinkle. Or if the existence of all those shades might make "blue" an intimidating concept. I wonder mostly if I've made a really bad choice, deciding to work in this field. I feel discouraged before I've even started, doubting my ability to make a difference in a world that seems already to have made up its mind.

My main interest is in working with autistic adults around employment issues, where the right to self determination will only need to be defended against disability based bias, without the additional concerns inherent in working with minors. To be more honest and precise, I want to work with the employers and co-workers of these adults, to help them understand how the different thinking styles and behaviors of their autistic compatriots can benefit their organizations. Sometimes it's a good thing to have someone around who doesn't think "blue" is a good enough answer.

But right now, I want to go and sit with an autistic kid and stim. And look at the sky and not think about the words for sky because words put limits on things that are so much bigger than that and really mean so much more.


  1. First, I hope you will reflect on the discouragement that you experience when learning about someone with autism getting therapy--but not give up learning about current approaches and giving feedback to professionals and families about it. We all need reminding about using interests to make tasks fun and meaningful--especially students who haven't been inducted into the culture of autism yet. Hopefully in the future, this clinician will remember that incorporating this child's interests worked and will use it and suggest it for other children she contacts--very good.

    Second, most children go through teaching and learning experiences when they're growing up that can be a bit challenging for them. So some resistance to tasks and adult requests can be age appropriate.

    And when we try things with children, we learn about how to teach them. For example, the clinician's "what color is this?" approach would have been acceptable to some children with autism; she would have assessed their color knowledge, and kept moving forward to other learning activities. In this case, we learned that it didn't work and she had to find an alternate way to find out if he could identify colors and say their names. We don't want to give up teaching, so we have to try various approaches to see what the child can do. And if a child can respond to a more typical approach, so be it--their life may be simpler that way. If a child doesn't respond to typical approaches, then we try again until we find a way to help them learn that is meaningful and understandable to the child.

    Now I don't mean to suggest that stimming or totally self-directed experiences don't have their place--they do--for all children. But young children learn a lot from their interaction with objects and people, so if a child's self-directed behavior is very repetitive, they can benefit from being shown how to try some other object uses and some new concepts as well. Very young children don't have as much internal self-talk as older humans do--children talk to themselves out loud, in fact, until they're about 8 years old. So, flipping a string may just be comforting and relaxing (as opposed to the child mentally creating a new conceptual theory of object permanence while flipping).

  2. As the student clinician, I am grateful for these first introductions I have had into the autism culture. Until recently, I, like many others in this country, was totally ignorant. Now, I'd say I'm just mostly ignornant. But, as indication that you should continue on with your career plans, I firmly believe that education takes place person to person. If I am to learn a better way interact with my young client, I think my education is best coming from adults with autism and aspergers who can educate me on how to bridge the way I think and how he does so we can communicate best. If that means we sit outside on a goregous day, then that is where we will start and return. I appreciated the guidance of your suggestion and look forward to seeing it.

    My goal is not to ask this young man to give up his interests or warp them by squeezing them into the expectations of society, but to give him any tools I have in my toolbox to help him as he navigates that very society as he ages. I see it as he and I have things to learn from one another. In that way, I hope to be a life-long 'student' clinician.

  3. Anonymous 1: Certainly, I didn't mean to say that children don't need to be taught anything. That's crazy talk! And since I haven't met the boy in question, I have zero knowledge about his abilities, these are only my imaginings of what could be going on. I am very much influenced by the writings of a number of autistic adults who use alternate communication methods. I have seen that a lot of anger and frustration can result from being asked to do tasks for which there is no clear and logical purpose, for being assumed to have lesser intelligence because of the way one communicates, etc. A lot of these behaviors result from the frustration of wanting to be left the hell alone or to tell the therapist the lessons are stupid and not being able to get that across.

    My personal experience confirms this and is how I know that these concepts apply to autistic people with a huge spectrum of verbal styles and abilities. Until about the age of 30, I was utterly unable to tell people that their questions were misguided or didn't apply or that they were treating me like an idiot. My response was to stare at them and say nothing. That didn't mean there was nothing to say, and if I had had a laptop computer in those days, they would have been able to grasp my thoughts perfectly.

    So no, I don't think there is anything whatsoever wrong with colors and ABCs. I think that we are in fact very much in agreement that trying multiple approaches is the way to go. I think it is also important that the clinicians not get frustrated when the child doesn't respond to a certain approach. I would take actions such as spitting, biting, throwing things as their best current way of saying NO. That's why my question to the clinician was (poorly stated for NT communication, I know) "what is your goal here, what are you trying to accomplish?"

    Because that matters a lot. If the goal is to assess what letters and colors a person knows, there are many creative ways to go about it. If the goal is to teach how to say NO without hurting people, well, that can be harder. Anyway, I think that there does have to be a primary goal, and whoever is working with the child has to keep the goal in mind and keep switching approaches until something clicks.

    I don't at all believe that we are at cross purposes. We just have a different focus.
    Helping people to fit into society is a valid approach (especially regarding expressions of anger that don’t harm others). So is trying to change the attitudes of a society that is too restrictive in what it deems acceptable expressions of human behaviors.

    Anonymous 2: I appreciate your receptiveness to my comments and your understanding of learning as a two-way street. I especially like the attitude you express in defining yourself as a lifelong "student"/clinician. I could use more of that philosophy myself, as too often I become convinced that I know more than I do. Your willingness to incorporate the ideas and experiences of autistic adults into your practice is a valuable (and unfortunately still somewhat rare) quality. Thank you for engaging in this dialogue.

  4. I remember when I was quite young, and an adult was quizzing me on my colors. What happened in my head was doubtless far from what they were even thinking of:

  5. Andrea, Thanks for the link to your post; I hadn't read that one.
    I have experienced that "positive yoin" when reading your posts in the past. This was another one. I remember vividly the exact revelation you described about the subjectivity of words and the sense of alienation that goes with that. I have always been drawn to Theatre of the Absurd, which often references this failure of language

    Kristine Chew also has a post today on words and colors, and blue in particular, which brings up some interesting points about language and perception.


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