Welcome to the July edition of Ask Dr. Emily! This month we celebrate the one year anniversary of our Ask Dr. Emily series! Thanks to Dr. Emily for her helpful advice and to our readers for sending questions we can all learn from. Here’s to another great year! 

We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights  in a question and answer format. We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month. Send your questions to theautismblog@seattlechildrens.org.

 

Q: My son always turns his stuffed animals to face the wall when he’s playing. I’m curious about whether other kids do this and, if so, why?

A: One of the diagnostic criteria for autism spectrum disorder is something called “ritualized patterns of non-verbal behavior.” Often, children with autism dislike when these rituals are disrupted. Your son’s insistence on turning his toys a certain way may be one of these rituals. We don’t know why children with autism choose the rituals they do. It might also be difficult for us adults to understand what purpose these rituals may serve. We might guess that these behaviors bring order to an otherwise chaotic world, and thus, may serve to soothe an underlying unsettledness.

Q: My son was diagnosed with Autism Spectrum Disorder in August of 2015. He is almost four years old. He rubs his head across the floor when he is upset or even just randomly sometimes. Why does he do that? Is there a term for that? Also, he can be aggressive when upset. Are there ways to slow his aggression?

A: Often, repetitive behaviors (like the rubbing you described) can be the result of what is called “sensory seeking.” Sensory seeking is one of the diagnostic criteria for autism spectrum disorder. Children who are under-sensitive to tactile (skin) sensations, may seek it out for the purpose of calming, or simply for pleasure. It’s a little like the pleasure we might get from a back scratch or a foot rub; but their bodies want more of it more of the time.

With regard to your question about aggression, it is not uncommon for children, autism or not, to hit, kick, throw, and/or push, when upset. First, the reasoning part of the brain (frontal lobe) that helps us humans think through consequences and resist the urge to lash out (and we all feel it sometimes, right?) is very under-developed in young children. In fact, the frontal lobe is not fully developed in typically developing individuals until they reach 25 years old! In addition, when upset, stress hormones in the brain cause the frontal lobe to stop working as well. Children with autism spectrum disorder commonly have frontal lobes that are even less developed than their same-age peers. They also tend to feel things (like emotions) more intensely than their typically developing peers (or feel things equally, but understand them less, making the experience overwhelming and confusing). Time for brain development to occur, in addition to behavioral interventions (like applied behavioral analysis) can promote the development of self control in children with autism.