Differences between Tics, Compulsive Behavior, and Self Stimulation

Here is another post from "Autism Discussion Page". It's a nice explanation of different behaviors shown by kids with autism. -

Differences between Tics, Compulsive Behavior, and Self Stimulation

Are your child’s repetitive behaviors tics, compulsive behaviors, or self stimulation? The repetitive behaviors in all three conditions serve different functions. Tics are a neurologically driven, often involuntary. They can be very jerky, not a smooth rhythmic pattern, and often involuntary. They usually involve motor musclegroups (eye blinking, facial twitching, etc.) or vocal noises, sniffing, throat clearing, or snorting type patterns. Usually the child has multiple motor patterns, and at least one vocal tic. They seem to serve no functional purpose for the child. The child may feel the “urge” coming on, but have very difficult time stopping them. The child do not enjoy the tics, and often feels frustrated in not being able to control them.

A true “compulsive behavior” (as compared to a fixation) is driven by anxiety and often result from “obsessive thoughts”. The person feels driven to do it because of anxiety and will become more anxious if you block it's occurrence. They are aware of and have some control over the behavior, but feel “compelled” to do it, and feel very anxious if they don't do it. They often do not feel good, the child is driven to do it, because they feel anxious if they don’t. The disorder can consist of strong repetitive obsessive thought patterns (intense worries, exaggerated fears, etc.), compulsive behavior patterns (washing hands over and over, repeatedly opening and shutting doors, compulsive orderliness, etc.), or both.

Self stimulation is a more voluntary, controlled sensory seeking to calm and organize the nervous system. These repetitive behavior is used to sooth and calm the nervous system when over-aroused, alert the nervous system when under-aroused, and block out unwanted stimulation when overwhelmed. They usually consist of repetitive “rhythmic” movement, auditory, or visual patterns. Self stimulation is usually a voluntary pattern the child uses to help regulate their nervous system. Usually if the repetitive pattern, is rhythmic in nature, and feels good, it is not tics or OCD, but self stimulatory.

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Do you think I am having fun!

Such a nice post from "Autism Discussion Page". Reading this, I myself realize that how sometimes working with my son, I start to control him instead of supporting him. We all love our kids. We want them to learn all the skills, but sometimes we forget that they can not learn forcefully until unless they are interested in the activity. -

“Do you think I am having fun!” From the child’s perspective! 

“Do you think I am having fun when I scream, fall to the floor and slam my head repeatedly?”

“Do you think I am enjoying it when I meltdown in the middle of a classroom with my peers staring at me?”

“Do you think I am having fun when I cannot sit still, and am running around the room, bouncing off the walls, ignoring your assistance?”

“Do you think I am having fun when I am staring into space, with glassy eyes, and turning away to block you out because I am overwhelmed and shutting down?”

“Do you think I am having fun when I repeatedly hit my face with my fists until all the frustration is gone?”

“Do you think that I enjoy hitting, kicking, and biting you when I love you?”

When I hear people discussing my behavior, what is there that leads them to believe that I like to do this; that I find enjoyment in creating havoc, stress, and anxiety for myself and others? Do you think I would do this if I had more adaptive ways of dealing with the problem? When I am continually acting out to gain your attention, you say I am “seeking attention” (like I like it) and put me on extinction. Do you ever think about “why” am I needing constant attention in the first place. Why am I acting inappropriately to obtain attention? Instead of ignoring me, try and listen and understand why I “have the need” to act that way. Seeking attention may be the obvious observable function, but ask yourself (1) why am I needing so much attention, and (2) why am I using this behavior to get it. Don’t just “ignore” me. It doesn’t teach me anything, but makes me feel isolated and unwanted. It does not deal with why I need the attention, or teach me more appropriate ways of getting it.

When I act out when you place demands on me, yes I may be trying to “escape and avoid” these demands, so you force me to comply, so my acting out is not rewarded by allowing me to escape. You say I act out to “manipulate” you to avoid things I do not like. Have you asked yourself “why does he feel the need to escape or avoid?” If most children willfully comply, why am I resisting so adamantly. Don’t you think if I had the tools, and felt confident enough to do it successfully, that I would also “want” to do it?

When I become overwhelmed in events with overpowering sounds, sights, and smells, why would you think that forcing me through it is somehow helping me? If my brain becomes overloaded with stimulation, how can I be expected to “handle it?” What is that teaching me, if my brain doesn’t allow me to learn during those moments?

I wonder why you do not ask these questions. You call me a manipulator, lazy, disrespectful, oppositional, etc, like I somehow intentionally choose to act this way; assuming I know how to act differently. At your meeting, you sit at a table and discuss among yourselves how I must learn to act better, to not be spoiled, learn to respect others, and comply with your demands; like I am so how having “fun”, intentionally choosing to act this way. You don’t first look at what you might need to change, but try to force change on me. You scold, force, punish, and restrain me, like I purposely want to be this way. Are you that DUMB to think that if I knew how to do it right, and I felt confident doing so, I wouldn’t have more “fun” being cooperative and receiving the positive attention and rewards like all the other children. Look at my face! Look at my actions! Look at my emotions! How do you assume that this is fun!

Please let me tell you, if I felt good about myself, confident in what I am doing, and safe and accepted by you, I would not be acting this way. Either the demands of the situation are greater than I can handle, the way you are supporting (or not supporting) me is overwhelming me, or I do not feel “safe” in doing it. I do not mean to “piss you off!” I do not find joy is making you angry and lashing out at me in frustration. I am not having fun in watching everyone stare, scold, and ridicule me into submission. How do you think that timing me out, taking away privileges, and restraining me helps me to feel safe, accepted, and competent in your presence!

Please, when you look at me struggling, assume that I am feeling anxious, insecure, and most importantly “inadequate” at the moment. The stronger the opposition the more insecure and inadequate I am feeling. Then, ask yourself how can you (1) change the expectations and demands, (2) how can you provide greater assistance to support me, and (3) teach better skills for meeting these expectations. And most importantly, in the heat of a meltdown, think “how can I help him feel safe”, not “how can I control him.” And when it is over with, ask yourself how you can change the conditions next time to avoid setting me into “fight or flight”, rather than how can you punish my behavior into submission. You are the one placing me in these conditions, you are the one who has to learn to change! Yes, like for all children, I need realistic boundaries and consequences to learn to be successful, but meet me where I can realistically succeed, be a supportive mentor, and please do not assume that I am having “fun” and “prefer” to act this way!

Thanks you for listening to me. Please do it more often!

“Learning” through “relating!”

Here is one more post from "Autism Discussion Page" series. Really, I like all the posts on the page.

“Learning” through “relating!” Activate the right side brain!

Children on the spectrum have weak neurological connections between the different brain centers, rendering the processing of multiple information simultaneously, very difficult. It makes it difficult to integrate the various brain centers to maximize brain functioning. One of these integrative functions is integrating the left brain (logical, analytical, detail/factual) with the right brain (intuitive, creative, social/emotional relating). For people with autism, it is well known that they are weak in the area of social referencing, perspective taking, reading nonverbal communication, and emotion sharing; all which are important in social relating. Not only is social relating compromised, but much of our early learning is through “social learning”; learning by referencing others for information, imitating, and following the lead of others. Most early learning occurs through this relating with others. For children on the spectrum, they do not learn by taking the perspective of others, and learn by following their lead. They have to learn by individual exploration; missing out on all the “learning through others” that most child thrive on.

The recent brain research in the area of “brain plasticity”, has shown that the brain is constantly rewiring itself through experience. With each new experience, and repetition of experiences, the brain creates new neurological pathways. The brain can develop stronger neurological connections though repeated experiences that pave the way. Given this, it is important that we provide the child numerous exposure, through normal daily activities, to “experience sharing” with others, especially the primary caregiver (parents). This does not mean more rote social skills training (teaching discrete social scripts), or throwing the child into social groups and overloading them with trying to regulate with multiple peers. This is too confusing and overwhelming to them. Teaching the child “relating skills” occurs through the one on one, daily interactions with the primary caregiver (parents). These social, relating, pathways develop by but doing things together, sharing the experiences together, which sets the stage for children to (1) reference you for information, (2) sharing emotion together, (3) referencing your perspective, and (4) co-regulating, staying coordinate, in activity together. This joint attention and experience sharing with another can occur through “shared” engagement” in normal daily activities.

By “doing it together” in We-Do activities (see photo presentation on We-Do activities at Autism Discussion Page); we incorporate this essential learning into all daily activity. By “doing together” and learning through relating, we bring into play the parts of brain responsible for “relating” and develop stronger neurological pathways to those regions. We bring into play the right side of the brain, that needs further strengthening. Also, by changing from “praising” performance to “celebrating” doing it together (see three step social reward) we are developing social reciprocity (the social dance of sharing an experience). This learning through “sharing” an experience with others, provides constant exposure and activation of these neurological pathways, creating stronger social/emotional relating. While we are teaching essential life skills, by doing it together, we are also teaching social referencing, emotion sharing, and relating skills. The child is learning “through” doing with you, referencing your guidance, feeling competent learning through you. It builds stronger emotional attachment, greater relating skills, and stronger social learning skills.

So, build “relating” into your normal daily routine activities with your child, by doing them together, helping each other out, and becoming an essential element in their activity. In addition, move from praising task performance to “celebrating” doing it together, with three step social reward (physical contact, gesture, and declarative statements). By doing so, you are bringing the “social areas” of the brain into play, and developing greater neurological pathways through these experiences. For specific guidance in building these experiences and skills, please see the photo presentations on “Emotion Sharing”, “Reciprocal Interaction”, “Co-regulating interaction”, “Experience sharing” and “We-Do activity.” at Autism Discussion Page. Start developing these right brain functions by strengthening the neurological pathways in these areas.

The Challenges of Tooth brushing!

I like the Facebook page "Autism Discussion Page" and want to share it with my blog friends. I will keep posting few of them.

The Challenges of Tooth brushing!

Tooth brushing is very intrusive. When training staff we used to have them brush each other's teeth so they see could feel how intrusive it is. We don't realize that we know exactly how hard to brush, where we feel sensitivity, how to miss the gums, and how fast to brush, when we are brushing our own teeth. To have someone shove a toothbrush into your month, and brush your teeth, without you controlling it can be really discomforting. In addition, many of these children have strong sensory sensitivities. Kids that tend to be tactile defensive (touch) are often orally sensitive. There are a variety of things to try, but again, I would start by validating that you (1) recognize that brushing causes discomfort for him and (2) that it is understandable. Then from there I would try.

1. Work slowly and talk him through it, telling him what side is next.
2. It often helps to have a set number of strokes you use for each side (top, bottom, side, front, etc.). Like five back and forth strokes. Count out each stroke. Counting gives the child a definite end, allows them to judge “how much longer”, allows them to hold out a little longer, and gives them something to mentally distract them.
3. It is best to give the child as much control over the brushing as possible. Brush five strokes on one surface, then pause, and wait for child to let you know when ready for next.
4. Let the child do as much of it as they can. Even if they do poorly you can go over it.
5. Throw away your toothbrush, it may be too hard of bristles. Use a sponge toothbrush call a toothette. It is a sponge that is soft and delicate to the gums.
6. Experiment with different toothpastes to find what the child likes the best. Or, don’t use toothpaste at all. Simply use water. If you child will use a mouth rinse, this also can be added. 
7. Work slowly, and pause whenever the child shows discomfort. Continually show the child you are working with them, pausing when discomfort occurs, and letting them control the pace of brushing.
8. Many children with oral sensitivity like to use a battery operated, vibrating tooth brush. The vibration tends to dull their oral sensitivity.
9. Have fun with it. You brush his teeth, and let him brush yours...lol.
10. Reinforce the child with a strong reward once the brushing is complete.
11. Put up a chart, and let the child get a star for each time they brush. After they fill up the chart (five squares, one for each star) then they get a special reward.
12. If child doesn't like the taste of toothpaste, start off with just water, no toothpaste. Then slowly put a little on. There are liquid washes that you can substitute for those who do not like paste.
13. For some kids we actually use a soft washcloth over our finger to rub the teeth and gums, instead of a toothbrush.

When in doubt, stay supportive and try not to force. I know it takes time, but having someone force a toothbrush around your mouth can be very intrusive.

Happy New Year

Wish You All A Very Very Happy New Year :)