The Autism Blog

Ask Dr. Emily – Understanding Behaviors and Communicating Concerns with Loved Ones

Welcome to the December edition of Ask Dr. Emily!

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: I have a second cousin who is 19-years-old and has been diagnosed with autism. He is verbal, and his IQ is 92. What I can’t understand is that he is very manipulative. Is it possible that he could be misdiagnosed? He has anger issues and screams and acts like a “child” when he does not get his way. He can cook, wash clothes, and make his bed, but he only does these things when he wants to. My 73-year-old cousin, who he lives with, has had enough. He doesn’t want to move out or go to a group home, and even if he wanted to, I’m not sure he’d be accepted due to his anger issues and outbursts. What can be done for him?

A: Thank you for writing in. It sounds like there are two questions to answer here. First, you’re wondering if the diagnosis of autism spectrum disorder (ASD) is appropriate for your cousin because you observe his behavior as “manipulative” in some ways, correct?

Rather than think about behavior as purposeful or “manipulative,” it might be helpful to think about behavior in terms of its function. Behavior for all humans always serves one (or more) of the four purposes: Get something, get attention, avoid something, or is automatically reinforced.

Behavior therapy, like applied behavior analysis (ABA), works to determine the function of behavior and can help an individual learn to get their needs met with new, more effective behaviors.

The second question I hear you asking relates to housing resources for adults with ASD. It is possible that with behavior services, your cousin will be better able to control his outbursts and function more independently in his current living situation. However, given the age of your 73-year-old cousin he lives with, it might be a good idea to look into options for the future. Each state is different in how it handles housing for those with developmental disabilities, but keep in mind that many clients have behavioral challenges so this wouldn’t necessarily keep your cousin from being served. In Washington State, the Developmental Disabilities Administration (DDA), which is part of the Department of Social and Health Services (DSHS), is the housing authority for persons with developmental disabilities.

Q: Hello. I’ve been following this site for a while now, and I have a major concern. I’m in a relationship with my girlfriend and she has a 7 yr. old daughter. We’ve been together for four years. I strongly believe that her daughter has some type of ASD. I have a son the same age as her daughter and the stress level for him when we’re all together is very high due to her abnormal behavior. Of course my son has his moments being a 7 yr. old, but it’s easily handled. Here are some of the things that are challenging: Transitions, sleeping, public meltdowns, interrupting, attention seeking, safety issues (like darting into the street without looking and talking to strangers), noncompliance, difficulty playing alone, and hyperactivity and fidgeting. It’s like she’s being driven by a motor that doesn’t shut off. I apologize for such a long list of issues. I need help in trying to talk to her mom about it. When the issues have been brought up (by her daughter’s father), my girlfriend has shut the idea down. I really love this woman, but I would not be able to move in with her if things stayed as they are now. Please help. Thank you so much.

A: Thank you for reading our blog, and I’m glad you wrote in. This sounds like a really hard situation for you, as you’re torn between a loved one and setting boundaries for yourself and your children. I can completely understand your hesitation to take that next step (moving in), especially given the stress your 7-year-old may experience. I also understand your hesitation to speak with your girlfriend about your concerns, as it sounds like her reaction to others bringing this up in the past has been (perhaps understandably) less-than-collaborative. However, as is the case in any important relationship, communication with absolute transparency, especially about the hard stuff, is key. You might start with talking about your feelings and about how hard this is for you to talk with her about. You might also share how this issue is impacting your ability to move forward in the relationship (a hard dose of reality, but reality nonetheless). Finally, you might consider approaching this as a “let’s partner on this” issue, so that your girlfriend feels supported (rather than defensive). Best of luck to you as you work to align with your partner on this tough issue.

Happy Holidays from The Autism Blog

Ready or not, the holidays are here. And with them, comes a wide range of emotions and experiences as expectation meets reality. If you live with autism, there is an additional layer superimposed on this already hectic time of year. To help, we offer a social story for the kids and some insights and tips for the adults. Check it out and share your tips for making the holidays less stressful and more enjoyable.

Anticipating the Holiday Blues

Holiday Resources- A Social Story

Happy Unconventional Holiday to you and yours!

Happy Holidays from The Autism Blog

Abuse in the Form of a Hamburger

My 19-year-old daughter is profoundly deaf and severely impacted by autism and developmental delay. She’s been in supported living for the past three years – a single home that whole time, with one housemate in the other bedroom, run by an agency licensed by the state for her care. This past summer we experienced one of those incidents that I live in fear of at most times – fear kept tamped down to levels that don’t interfere with my everyday life, but still always calling out “present” when I check to see if it’s maybe taken some time off for a bit.

I had her out on her favorite Sunday lunch outing, a fast-food spot where she eats “cheese grilled sandwich french fries” as she invariably types into her iPad TouchChat app. It was just the two of us that day, and she was in one of her best moods, wide grins and lots of interactive communication about her new swim lessons on Thursdays and tomorrow’s planned outing with her grandparents.

While we were sitting and waiting for our order, a young woman came out from behind the grill – I recalled her from the cash register at previous visits, and she obviously recognized the far more memorable us. We’d never spoken before, though, and she started by asking if I was “her mom,” pointing to my daughter. “She was here last week,” the young woman told me, “with another girl who was, you know, disabled like her, and two older women with them.” She added descriptions that were clearly of my daughter’s housemate and some staff members. “I wasn’t happy with how the girls were being treated,” she then said, and paused, uncomfortable I think with saying more than I might want to hear. “Could you tell me more?” I asked, through the haze already rising up in my brain, hot and choking.

Pushing, shoving, impatience, food gone uneaten and taken away from the girls. “And you know how sometimes she” – pointing to my beloved girl – “kind of shrieks and flaps her hands really fast?” she asked. In fact, she had started doing it now, in happy anticipation of our meal. “Well, one of the staff people hit her up the side of the head when she did that

Always, always, my first focus in any situation is on my daughter and what she needs in that moment. Even though what I needed was to Get. My. Hands. On. Those. #%$!&$, what she needed was to unwrap her soggy white bread grilled cheese sandwich and gleefully peel away the crusts to eat first. She needed to carefully fill a cup with as many french fries from our shared order that she could, and place it out of my reach for her later attention. And yes, she needed to whip her head back and forth, flap her hands and let out a few shrieks as the meal progressed, just to express her excitement.

By the time these immediate needs of hers had been met, I’d honed my response down to the phone calls I needed to make right then, to figure out the next 24 hours and how to keep my daughter safe. This process was complicated by the chronic management upheaval at her home – there was currently no house manager in place, and the new “program director” (who oversees two or three houses run by the same agency) was literally starting in this position the next day, Monday. I had only met her and been given her phone number the week before.

The bare bones story of the weeks that followed include these scenes: my daughter “sleeping” (ha!) at my home Sunday night, because (I was told) there was insufficient proof to remove the staff in question from her home. Me waiting at the police station to file a report on Monday morning, and explaining to the officer in reply to his question that no, there was no possible scenario where physical restraint or coercion would be appropriate in caring for my daughter, even if she is developmentally disabled. It being safe for her to return home when the staff in question were finally suspended. The phone call where I learned that the hoped-for video confirmed the group’s presence at the restaurant on the reported date, but that the camera turned to their table was broken and there was no footage to “prove” what had happened.

What we ended with was two people’s word (two staff at the restaurant) against two others – the house staff who insisted that the whole story was a lie. Unless my daughter or her housemate could describe, themselves, what had happened that day, the case was closed

The supported living agency had conducted its own “investigation” and we met with them to hear their findings. “She didn’t want to eat her hamburger,” began the bigwig regional supervisor whom I’d never met before but who emerges in full defensive mode to run these conversations.

(“Why did they get her a hamburger??” was my younger daughter’s first question when I caught her up on what I’d learned, later that day. “Exactly,” I said.)

“Why did they get her a hamburger?” I asked the bigwig supervisor. “My daughter would never order a hamburger there.” Bigwig said there had been “miscommunication” and “misunderstanding” but “everyone meant well” and “there was no wrongdoing.”

I called bull!*@#, in so many words.

Here’s what I know. I know that if staff ordered a hamburger for my daughter, it means they hadn’t asked her what she wanted or given her the chance to say for herself what her choice would be. If ANY opportunity had been offered her, she would have typed “cheese grilled sandwich french fries” which is clear communication to anyone with even basic English, and difficult I believe to misunderstand.

I also know that she would have been agitated and unhappy about this. Not only does she not even LIKE hamburgers – but also, she has autism. People with autism don’t like changes to their routines. Not having a grilled cheese sandwich is a big deal change to that restaurant’s routine. My girl was entitled to be unhappy about all this, and to show it.

I don’t know – strictly speaking – whether staff pushed her around and hit her up the side of the head. But I don’t need to know that to know that she was abused that day.

And I don’t know when our society will learn to understand this – that people who have more difficulty communicating their needs have the same rights as anyone to having those needs heard and understood and met.

For my daughter, having a hamburger handed to her that day was just a different version of a slap up the side of her head.

The bigwig supervisor certainly doesn’t see things this way. She has stuck fast to her “misunderstanding” story and added for good measure, “staff in our homes across the state face accusations on a weekly basis, that are almost always unfounded.” Her definition of “unfounded” clearly doesn’t match mine – nor very likely that of the clients or families who bring the other accusations she brushes off so dismissively.

This “miscommunication” versus “mistreatment” description is not just a question of semantics, though I think that’s what the residential agency wanted to imply. I need those caring for my daughter to understand that without appropriate communication, they are not providing her with adequate care. I need them to acknowledge this and be accountable to it. This is something I will watch carefully for in the future, as she continues to rely on others to meet many of her most fundamental needs. 

Ask Dr. Emily – Driving and Singing

Welcome to the November edition of Ask Dr. Emily!

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 is 23, currently lives at home and has been aware of his diagnosis of Asperger’s for many years. He is a pretty accomplished guy, but struggles constantly with anxiety, confidence, and independence. Nevertheless, he chose to spend a year away from home in a residential living skills vocation program, which he really enjoyed. He has nearly completed his Bachelor of Commerce degree, and has also, albeit reluctantly, obtained his driver’s license.

My question revolves around driving. He’s got his license, but it’s been like pulling teeth to persuade him to keep practicing the skills he’s learned. His great reluctance to drive by himself has led me to try following or leading him in our extra car while he learns to drive longer and longer distances. My hope was to have him feel confident enough to drive himself to places he can’t get to by walking or by bus. He grows in skill but negates any progress he makes. I am at my wit’s end and wonder if this is a losing battle. Any thoughts?

A: A losing battle? No. However, it does sound like, despite your son’s driving skills improving, anxiety is playing a large part in his resistance to driving independently. In general, skills can take longer and require more repetition for the autism brain to master (and let’s face it, driving is a VERY complex skill with a lot of variables to learn). If you are worried about anxiety impacting this and other parts of your son’s life, your son’s primary care provider may be able to make a recommendation for a mental health evaluation, which will provide you with diagnostic clarification and a treatment plan. It is also important to think about the stick with which we measure success. In the end, not everyone is a driver. More and more folks these days choose to walk and take public transportation, which may be what your son opts to do. Ultimately, I hear you saying that independence is the goal, and this can likely be achieved, driving or not.

Q: I recently read that kids with Autism convert sensory input into picture or video memory. Is this true? If so, is singing to my child a good thing or should I be having my child watch videos instead? Do videos harm him? What kind of limits should I place on singing songs or watching videos?

A: Thank you for writing in. Generally speaking, given the “autism brain’s” varying challenges with language (which is an abstract process), the use of pictures (which are more concrete than the spoken word) can aid in understanding and communication. That doesn’t mean, however, that singing to your child or listening to songs is harmful or not worth doing. Speaking to and singing to (any) child increases the vocabulary that they are exposed to, which is good for any child’s language development. One could argue that increased language exposure for a child with language challenges is especially important. You might add to the singing experience by showing your child pictures, using hand gestures, or using puppets or props that coincide with the song lyrics. Reading and simply talking to your child can also be helpful.

Videos are another way of providing visuals to your child, and children with ASD tend to focus more heavily on video content than even the same actions happening live in front of them. Unlike reading, talking or singing though, there is a guideline that limits screen time; the American Academy of Pediatrics has historically recommended limiting screen time for children ages 2-18 to two hours or less per day. If you think about it, less time spent on screens means more time for learning, observing, exploring, interacting, and playing—all things that help promote development in any child.

In sum, sing and read and talk to your child to your heart’s content; do modify how much you use screens. Happy playing!

The Seattle Children’s Autism Center Research Team is Hosting a Research Pirate Party!

We would love to have you come join the fun and participate in autism genetics research!  The SPARK and PANGEA studies are exploring genetic differences related to autism.  Families who attend the family fun day will be able to complete study participation for one or both studies in a single day!  

 

There will be food, games, prizes, parking, and childcare available!  Pirate costumes are encouraged!

 To reserve one of the limited registration spots, please RSVP by November 24th by calling (206) 987-7917 or by emailing SCACstudies@seattlechildrens.org.

***We will call to confirm your RSVP/sign-up time***

 When: Saturday, December 2 from 9am to 5pm

Where: Seattle Children’s Autism Center, 4909 25th Ave NE, Seattle, WA 98105