Caring For Someone With ASD

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• QWhy does my autistic child want to spend so much time with animals?

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  A William Stillman , Health Education, answered

  Individuals with autism can be acutely sensitive, vibrating with a frequency that supersedes those who are “neuro-typical,” especially as it relates to all the senses. It is not uncommon for children and adults with autism to have unique, unspoken bonds with all kinds of animals. Remember St. Francis? He could communicate with animals of all species, even fish; and I’ve documented similar instances of conjoining between people with autism and domestic and wild animals. In her book, Animals in Translation, renown autistic author Temple Grandin compares her picture-thinking aptitude (how I also think) with that of animals. It is through the exchange of mental imagery that some children and adults with autism communicate with animals. If you’re familiar with how animal communicators or animal “psychics” work, you’ll know that the premise of image-swapping is similar.
  
  I hope that helps explain things a bit. Pay careful attention to the manner in which other animals are drawn to your child -- house pets, birds, butterflies, and squirrels for example. I’ll bet, if you hadn’t noticed it before, that you’ll see an interaction occurring during those times.
• QHow can having a passionate interest benefit people with autism?

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  A William Stillman , Health Education, answered

  For the person with autism, passions may be a bridge to enhancing relationships, decoding mystifying educational curriculum, or developing a viable vocation. Such individuals oftentimes possess encyclopedic knowledge pertaining to their special interests, or can lend insights unique to the autistic way of thinking when it comes time to problem-solve. For those fortunate to hold dear a passion that is not mislabeled as an “obsession,” social acceptance may by acknowledged by virtue of their place in the community and the manner in which they are revered for what it is they have to offer.
• QHow can I better understand what my autistic child is experiencing?

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  A William Stillman , Health Education, answered

  We all experience neurological blips, misfires and disconnects not unlike the person with cerebral palsy, Parkinson’s, or Hodgkin’s. On a grander scale, the person with autism experiences such anomalies to the extent that it precludes speech and facile movement. You’ve experienced an “autism” moment if you’ve:
  

  • Driven from Point A to Point B, but upon arriving at Point B you have no recollection of the drive
  • Been driving along and hear a song you like with the intention of listening all the way through, but soon realize your mind has wandered and you haven’t heard a word of it
  • Happened upon someone familiar while out shopping, but seeing them out of the context in which you know them disables you from recollecting their name on the spot and in the moment
  • Had to physically retrace your steps in order to remember something, or you’ve misplaced something you suddenly realize you’ve been holding the whole time you’ve been searching for it (a pair of scissors or your eyeglasses)
  • Lost track of time or self-awareness (no need to eat or use the bathroom) while immersed in an activity for which you hold great passion (painting, dancing, gardening, etc.)
  • Had a case of the giggles so severe that you could not regain your composure until the experience ran its course
  • Been so angry or afraid that words escaped you in the moment
  • Absolutely had to scratch an itch and could not focus on anything else until you were so relieved
  • Calmed your anxiety by biting your nails, tapping a pen, shaking your leg, rocking yourself, twirling strands of your hair or toying with a piece of jewelry, or talking or humming to yourself
  • Experienced uncontrollable shivers so intensely that your teeth chattered involuntarily
  • Struggled to decipher the meaning of certain words in the appropriate context, such as “she shed a tear over the tear in her new dress”
  • Organized your items in your kitchen cupboards, bathroom, work space, or clothes closet in alphabetical order (canned good with labels facing out), by color-coordination, or at right angles
  • Had a song in your head that absolutely will not go away! You may have even been awakened in the middle of the night hearing the song you cannot seem to banish. Imagine if that experience of being “stuck” with the song in your head (which precludes your thought processes) transferred throughout your body, or lodged in your throat and hindered your vocalizations?
• QHow can I cope with my nonverbal autistic child's extreme behavior?

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  A William Stillman , Health Education, answered

  Strive to address the issues as separate from, or adjunct to, your child’s autism instead of believing these behaviors are a function of autism. That is, your child’s behaviors are really communications. He has good reasons for doing what he’s doing, and he’s doing the best that he knows how to in the moment.
  
  Whenever I am faced with supporting someone with autism who is challenging to serve, I use the following paradigm in an attempt to deconstruct and decode the true issues. Are the child’s “behaviors” a function of one or a combination of the following three contentions:
  

  • The inability to communicate in ways that are effective, reliable and universally understandable
  • The inability to communicate physical pain and discomfort in ways that are effective, reliable and universally understandable
  • The inability to communicate mental health symptoms in ways that are effective, reliable and universally understandable

  I suggest pursuing these points simultaneously. First, we already know your child is limited in what he can communicate because he doesn’t talk. Pictures and some signs are good for laying a basic foundation of communication, but these modes are limiting and ultimately not boundless. Has he been assessed for a communication device, speech therapy, music therapy, and/or computer keyboarding?
  
  Second, can you attest that your child is not experiencing any kind of physical ailment that has gone undetected, undiagnosed, and untreated? Common culprits of pain in people with autism are gastrointestinal issues and allergies of all kinds --research these, please, as related to your child. Can you detect any such symptoms that have perhaps become chronic?
  
  Third, many autistic individuals are vulnerable to mental health issues due to their exquisitely sensitive nature. If depression, alcoholism and other addictions, suicide attempts and other related issues prevail in family history on either side, your child may be predisposed to such mental health concerns. In my experience and in my opinion, the most common mental health experiences in people with autism are anxiety, depression, bipolar disorder (depression cycling with mania), and post-traumatic stress disorder. Begin by researching the symptoms for each; gather information about symptoms, not behaviors; and discuss your findings with your child’s pediatrician.
• QWhy doesn't my child with autism tell me when he is hurt?

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  A William Stillman , Health Education, answered

  The issue of pain, and pain that goes undetected, undiagnosed and untreated properly is an important one for us all; but, perhaps, it becomes even more complicated when discussing autism because of all the variables that may come to bear upon any single child’s pain experience.Your child may not have reported his pain because:
  

  • He either isn’t neurologically wired for speech, or -- even if he
         does speak -- he may not have a way to describe or put
         language to what he’s experiencing in the moment.
  • He may have a flat affect -- that is, an expressionless facial
         appearance that doesn’t seem to register much of any
         emotion, making him tough to “read.”
  • His brain may not be properly registering the pain signals his body
         is sending it because of neurological crossed wires, so to
         speak; or there may be a higher pain threshold or a delay in
         processing pain.
  • He may not know there’s a parental expectation that he tells
         someone if he’s in pain (you may have to teach this concept
         to him).
  • He may not know how much pain he should feel before telling
         someone.
  • He may have an extreme fear of doctors, especially if he’s been
         treated roughly or insensitively in ways that were not
         respecting of his personhood. This makes allowing the pain to
         go unreported the lesser of the two evils.
  • Similarly, he may have had an adverse reaction when previously
         given pain medication, so he chooses to say nothing to avoid
         repeat circumstances.
  • He may not realize that what he’s experiencing is anything
         different from anyone else (like the boy with autism who only
         got relief from mild asthma at age eight and exclaimed, “I 
         didn’t know it wasn’t supposed to hurt when I breathe!”).
  • He’s trying to manage the pain independently but it’s looking like
         self-injurious activity (such as head-banging); he’s creating
         another pain as a diversion to the initial pain felt.
• QHow can I teach my autistic daughter how to deal with changes?

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  A Dr. Charles J. Sophy, MD , Adolescent Medicine, answered

  One of the hardest aspects of growing up was transitions: transitions from one place to another, one task to another, one person to another and other types of changes due to their sensory processing challenges.

  Behavior therapy can help to control a child's behaviors during difficult transition moments. One way to teach your child about transitions is to prepare them by having schedules and social stories about what is going to happen next. Having a visual as well as an auditory explanation is helpful as they have different learning styles (visual, auditory, kinesthetic). Eventually over time, the child will learn to understand what, for example, "going to the store" entails and he will be more prepared for the transition. Even if your child is non-verbal, and you do not know how much she understands, take the time to do this. Over time she will understand.

   

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• QHow can we teach our autistic son to brush his teeth?

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  A Dr. Tena A. Andrews-Phillips, DDS , Dentist, answered

  Teaching an autistic patient to do anything depends upon the level of function of the child.  

  High-functioning autistic children have no problem learning to brush their teeth and learn at about the same rate as any other grooming habit you might teach them. Lower functioning autistic children may need your help 2 to 3 times per day to brush their teeth.

  I am not an expert on autism; however, I have had a number of autistic patients, one of whom is in his teens whose mother still brushes his teeth for him.  He cannot vocalize clearly, and is moderate to low functioning.  I provided his mother with a mouth prop to insure her safety while brushing and flossing his teeth.  She sits on the couch and he reclines with his head in her lap with a table lamp shining light into the mouth.  She brings him to my office as often as possible for regular cleanings and check ups.  She is extremely dedicated and has prevented him from getting dental decay except for one filling which I perfomed with her assistance in my office.   

  If there is any question that your son might hurt himself while attempting to brush or that he may not cleanse the teeth properly, you need to assist him and brush and floss for him.  If there is a threat of getting bitten, only floss with a long, "Y"-shaped floss threader and/or use a metal covered in rubber mouth prop (purchased thru a dental supply house).

  Remember that nutrition plays a huge role in oral health.  Limit liquid and solid sweets.  Make sure the diet is rich in fruits and vegetables and a source of calcium and vitamin D, such as milk and cheese.  

  You would be surprised how much special needs persons can learn with a little effort from their caretakers.  I would certainly give it a try.  I also recommend finding a dentist who works well with special needs patients and make an appointment for a check-up.  

  Update, check out this site for more information:  http://www.nidcr.nih.gov/OralHealth/Topics/DevelopmentalDisabilities/DentalCareEveryDay.htm

• QHow do I potty train my autistic child?

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  A Dr. Sara Wiemer , Pediatrics, answered on behalf of NorthShore University HealthSystem

  Potty training can be a huge challenge for autistic children. In general it is important not to push or force potty training on an autistic child -- as you know they do not respond well to changes, uncomfortable situations, or anger. Have specific times of day when you try to have the child sit on the potty for several minutes -- the best times are usually shortly after meals because that's when the body naturally "needs to go." When they are on the potty, let them do something they enjoy -- play with a toy, look at a book, sing a song, etc. If they don't go after the allotted time, don't make a big deal; just try again later. If they do go, there should be some positive reinforcement (this is one time I advocate bribery!). Autistic children often have issues with constipation due to their medications or restricted diets, and that makes it very hard to potty train them. Do your best to have them stay well hydrated, eat high-fiber foods, and take any medications that are prescribed.