Welcome to the June 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 here, on the last Friday of each month, 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 [email protected].


Q: I have a 4 year old grandson, who is diagnosed with autism. He comes to stay with me every other week, and I am learning a lot about him. Ever since he learned to walk, he has a fighting fit when his diaper or pants are taken off him. I’m worried about the diaper rash that he gets as a result. He doesn’t like when anyone tries to wash or wipe him. What is going on?

A: Because you mentioned a rash, the first thing to do is to have your pediatrician assess the area and give treatment recommendations. While I can’t say specifically what might be happening in your case, I can speak to one thing that could be playing a part. Specifically, it is not uncommon for children with autism to present with sensitivities to certain sensory input. In fact, one of the diagnostic criteria for autism spectrum disorder (ASD) is what we call “sensory sensitivities.” We call the sensitivities having to do with touch, “tactile sensitivities.” Children with tactile sensitivities could be sensitive to certain types or textures of clothing, may not like water on their skin or heads, might resist clothes being put on or taken off, may dislike haircuts or teeth brushing, and/or may dislike certain textures of food in the mouth. We can think of sensory sensitivities as the “senses on steroids;” everything feels stronger and more intense than you or I might feel it. Occupational therapy can be one way of helping children with ASD learn to tolerate sensory input more effectively. Like I mentioned earlier, the first step when there is a medical concern (like a rash) is to visit your pediatrician, who can make a referrals or recommendations based on their assessment of the issue.


Q: My 3-year-old daughter has autism, and I’m learning more and more about her every day. I’m curious as to why she walks around objects in certain ways. For example, she will walk around a table that is pushed up against a wall or will sometimes even walk around her younger brother’s toys that are on the floor. Sometimes I try to move things so that she doesn’t have to walk around them, but then she gets upset. What’s going on here?

A: One of the diagnostic criteria for autism spectrum disorder (ASD) is what is called “ritualized behavior.” This means repetitive patterns of behavior that may or may not appear to serve a purpose. A lot of the time these patterns of behavior don’t make a lot sense to us, but they make complete sense to our kids with ASD. Other examples of rituals might include stacking papers before bedtime, eating foods or doing tasks in one order (and one order only), requiring that parents take the same route home each day, or requiring that others say things in a certain order or certain way. It’s not uncommon for kids to become upset if they are not able to complete the ritual in the way they think it should be performed. The good news is that many times, these rituals are fairly benign. However, if you are finding that rituals are taking a great deal of time and interfering significantly with daily life, talk to your pediatrician about a possible treatment options and/or referrals.