Autistic Behaviors and Management

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Today's post is especially dedicated to my online friend, Doc Kae, a mother of two-year-old twins, a boy and a girl, both under the Autism Spectrum.

Even as a baby, I knew Miggy was a little “special” from other babies. He never cried even if he was hungry or wet. He didn't need cuddling and the usual rock-a-bye-baby bedtime routines. He seemed very contented in his crib, kicking, sucking his fingers, and always moving. He seemed to be deaf because he never turned his head toward sounds; he had no eye contact; no coos or babbles.

At age 2, Miggy started manifesting the following behavioral concerns:
- walking on tiptoes
- running back and forth
- banging his head on walls
- not sensitive to pain; could not feel minor pains

- no fear of danger

- excessive scratching (to the point of bleeding) of bumps on his skin, such as old vaccines, old wounds, insect bites, the skin in contact with clothing labels or folds

- flapping his hands when excited (e.g., upon hearing certain sounds)
- spinning and running in circles
- his very few words disappeared (e.g., mama, dada, ate-ate)
- always jumping; stomping his feet; tapping hands on walls
- moving his head in circles
- staring at objects from the far side of his eyes with neck angled
- lining up of objects (cars facing the same direction)(His lines could not be disturbed for it may trigger an outburst.)
- filling and emptying boxes, baskets or cabinets
- very fascinated with the sight of water and its pouring sound
- preoccupation with objects being placed in his chosen location
- strong liking for round and rolling objects
- trying to eat all edibles and inedibles (papers, toys, or anything that could fit into his mouth)
- destructive; breaking all breakables (particularly glasses with water) and forcefully trying to break the unbreakables
- covering both ears when the place was too crowded and noisy
- could not stay seated even for 2 seconds
- very, very good with puzzles (It was really bizarre. I witnessed him accurately complete the back of a puzzle. It was done on a glass table. When I viewed it from under the table, it was perfect. He was four years old then.)

Miggy’s hyperactivity, compulsions, obsessions, and repetitive behaviors were managed through occupational therapies. He was diagnosed at 2yrs/9months in May 2005, and exactly six days after, he started his therapies (one-hour sessions, 2 - 3 times per week). To shape his behavior and calm him down, sensory integration techniques were applied, such as ball rocking, pancake (being rolled and squeezed in a mattress), jumping on trampoline, and deep pressures massages (with the use of lotion).

Teacher Joan Ongat, his first occupational therapist, miraculously taught Miggy to stay seated for 5 minutes at first, then 10, then 20, and so on until Miggy was able to sit for a full hour and was able to complete the tasks (sorting shapes and colors, beading, shading, connecting dots). They began every session with sensory integration.

In August 2005 (age 3), exactly after 3 months of occupational therapy, Miggy talked in one-word only, such as names of common objects, shapes, colors, parts of the body which he learned from BumbleBee Educational Videos playing non-stop during the day for more than two months.

He became echolalic. (Echolalia is the delayed or immediate echoing of meaningless words heard from TV commercials, radio, movie scripts, parental reprimands, etc.) He would repeat lines from his favorite educational videos over and over and over again.

By December 2005 (age 3years/4months), he could spell names of animals, shapes, colors, numbers, common objects. And then again, three months after, he learned to read from rote memory and he learned to count objects from 1 – 20 before he was 4 years old.

At home, I gave him daily deep pressure massages. Swinging in a hammock proved very effective too. Magic! While swinging, I would always ask him the names of each flashcard I showed him and volia! He would always give me correct answers. It was probably the dizzying effect of the swinging motion that made him very focused. Or sometimes, I would just count aloud 1 – 50, over and over again while he seemed to be listening.

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Miggy did hippotherapy with speech therapist, Justin Palou, for 2 months when he was 5yrs old. Hippotherapy is a therapeutic horseback riding. In children with autism, it helps in improving gross motor skills (sitting, standing and walking); strengthening speech and language skills; and improving behavioral and cognitive abilities.

Now, at age 7 years/11 months, Miggy outgrew almost all symptoms. What remained are: covering the ears and scratching.

Sometimes, he still stands and walks on tip toes. I always have to remind him: “Miggy, down on your heels.” And in rebellion because he probably didn’t like my tone of voice, he would stomp his feet hard on the floor.

He doesn’t like the sound of thunder and fireworks, and the sound of rain falling on the roof. He would cover his ears, hide under the pillow, or close the window and draw the curtains. He likes banging his knuckles or big toe on hard surfaces whenever he hears a particular music on Cartoon Network. He likes to stare at patterns (ex: stripes on a bedsheet). His present obsessive-compulsive behaviors are: (1) hoarding of his favorite snacks in a small transparent bag, perfectly arranged, he would know if I

touched them and would only eat them when a substitute is available; (2) watching the same video everyday for more than a month, memorizing all lines with the exact intonation; (3) obsession with cars, little furniture, stickers, crayons, markers, colored pencils, and empty boxes of cookies; (4) unable to sleep when a toy is missing or when he noticed that something is not placed in his preferred location. Last week, in the middle of the night, his older sister and I helped Miggy search for his little toy soap smaller than a rice crispy and a shampoo the size of a kernel corn. He said,

“The soap is missing. Where is the shampoo? Mommy, you find it.”

It was only last year (September 2009) when he became aware of danger. We were going home from school, waiting for a cab, there was a big truck approaching us, he backed off a few steps, exclaiming “Oh no, oh no, oh no!” There was this time also, he was seated at the front of our car. At a sharp curve, again there was a truck and he probably thought it was going to hit us. He pressed his right shoe hard on the floor, as if he was in charge of the brakes, crying out, “Daddy, oh no!”

Children with autism experience sensory dysfunction in all five senses: sight, sound, smell, taste and touch. They have trouble processing information they receive from all these senses, all the more confusing their already confused minds. Autistic minds do not interpret sensations just like we do. A gentle pat may feel like a forceful blow; a certain color may hurt their eyes; soft music may come to them as too deafening; or sweet fragrances may be too intense. They may not feel the floor, causing them to stomp their feet. Stares from strangers may be too overpowering, causing them to avoid eye contact. Sensory integration helps autistic children balance all sensory input they receive so that eventually they will become skilled to react to the stimuli.

Note: The above mentioned interpretations were only based from my personal observations of my son. All children under the spectrum may naturally behave differently.

For more info on Miggy’s intervention, please click on the topics on Intervention at the left side bar.

Meet Josh

Asperger Syndrome (AS) individuals are often called “Little Professors” because of their impressive photographic memory. While they may have good rote memory skills, they have difficulty with abstract concepts.AS individuals manifest excellence in the fields of art, music, mathematics, and computer science. Asperger Syndrome is rarely diagnosed and often mistaken as High-Functioning Autism (HFA). Having parallel and overlapping characteristics, both AS and HFA fall under Pervasive Developmental Disorders. Individuals belonging to any of these disorders possess average or above average intellect and standard or superior language skills. However, the distinction between Asperger Syndrome and High-Functioning Autism is detected in the person’s ability to communicate. AS individuals develop early, normal language and cognitive skills which are not apparent in individuals with autism.

There are some debates among health professionals as to whether AS is a unique disability with symptoms that are not present in any other disorder or merely an autism with superior intelligence quotient. Asperger Syndrome, according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), is not recorded as belonging to the autism spectrum. However, the fifth edition of American Psychiatric Association, which is to be published in May 2013, formally listed Asperger Syndrome as autism. This declaration infuriated some AS people because they do not want to be branded as autistic.

Majority of AS individuals are actually proud to be diagnosed with the disorder. It is assumed by psychologists and a group of commoners that AS is correlated with above average scholarly quotient that pop culture accounts label as genius. Moreover, It is strongly believed that famous highly intellectual people such as Michelangelo, Glenn Gould, Wolfang Amadeus Mozart, Albert Einstein and Thomas Edison belong to the AS group. Well, who does not want to be associated with these people?

Meet Josh

Josh, a 22-year-old New Zealander, third year architecture student in an Australian university, and president of the university’s student union, is here in our country as a vacationer. He will leave our country this first week of July with fond memories of “smiling, cheerful and friendly people” (that’s what he told me of the Filipinos), and of precious times shared with his newly found Pinoy “special family.”

Josh was strolling down the length of Session Road when he spotted the Fun Run Project of the Autism Society of the Philippines and Play and Say Therapy Center posted at Jet Book Store. The bookstore owner (an officer of ASP Baguio) became curious as to why this guy wanted to participate in the Fun Run and why he was wearing an “autism bracelet” on his left wrist. Surprisingly, this very perfect-looking guy, with no trepidations, no hesitance, with all guts, admitted he belongs to the spectrum. Kudos! How many people could be so willing to admit having a disability? Asked if he could give an impromptu talk to inspire parents with special children, he enthusiastically agreed. That night, word spread among parents of children with disabilities (including yours truly) and therapists, about the event to take place the following day.

The next day, excitedly early, we were all there at the West Burnham Place, awaiting the arrival of this controversial guy. What is he like? Is he normal? Is he just like any typical person, able to mingle with the crowd? Without a trace of the “label”? Queries are mounting in our heads. We are about to witness a first-hand information from a recovered autistic.

Only four years ago, Josh accidentally discovered he has Asperger Syndrome through an audio tape (with his name on it) he found safely camouflaged in a stack of tapes. It contained the conversation between a behavioral doctor and his parents, about the diagnosis of AS in their son. So that was why he was getting all the attention, he thought.

As a child, he remembered, he had trouble putting his shoes on, couldn’t look people in the eyes, had impaired eye/hand coordination and in fact, couldn’t even catch a ball. Moreover, just like any typical autistic, he liked lining up objects; had strong adherence for uniformity, and was hypersensitive to sound. There was one time when he was five that he ran away from school because the noise produced by everyone in the classroom was too overwhelming. He impulsively felt the need to escape. (As what I have researched, observed and written in my other posts: Autistics cannot filter sounds just like normal individuals do. They hear all sounds near or far, soft or loud, with the same deafening decibel. Impossible, yes! But Josh confirmed its veracity. Hearing it from someone who experienced it firsthand erased all doubts this issue may have raised.).

As he grew older, he knew and felt he was different. He was outside norms and was even labeled weird. However, despite some deficits in social interaction, motor movements, and comprehension, Josh manifested excellence in the fields of mathematics, art, music, sports (basketball, soccer, tennis) and mind games, such as chess. What’s more? He could process three or more things at the same time without getting distracted and still get excellent results and pleasant feedback.

The “label” got him a special treatment from everyone. His classmates wrote notes for him and in return, they copied his Math assignments.

Some other facts about Josh:

-He is very good in details; he likes facts and figures.

-He has no fixations.

-He developed social skills as he grew up.

-He had speech therapies at age 5 – 8.

-His parents pushed him to talk to people. His parents’ friends regularly take their children on a one-and-a-half-hour-drive to their house just so they can play.

-He is very honest and modest, and has strong Christian values.

- He believes that Asperger Syndrome is genetic.

-He likes telling not-funny jokes.

- He is very passionate about his chosen field: architecture. He believes that it is something that he really wants to do.

- Even now, he has difficulty mixing with people. He is more comfortable mingling with the younger crowd.

- Just like any regular human being, he always looks up in the sky when he is searching for answers.

- His desk is his familiar place and comfort zone. Sitting on his chair in front of his desk makes him more relaxed and focused on his work.

Some quotes from Josh:

“I want to change the ‘stereotype’.”

“After the discovery, I am more aware of my past.”

“Humming tones down the mind.”

“Tapping has a calming effect; makes it easier to concentrate. It’s like 20 – 80% revitalized.”

“I always wanted to wear the same shirt.”

“People with Aspergers and Autism have too many emotions which cause them to shut down.”

“I never liked reading books but I make my own books, my own characters.”

“In New Zealand, it is very expensive to get a diagnosis but once diagnosed, New Zealand government gives free money.”

Asperger Syndrome diagnosis is increasing. It may be due to its high prevalence or simply because medical professionals are now more aware of the disorder. We may not know it but the “bright” person next to us may be an aspie. Aspies may not even recognize they have it.

I read this somewhere, and it is by far the most interesting, catchy and controversial thought I have ever come across:

"Even God had some Autistic moments, which is why all planets spin."

~ Jerry Newport

What is .....?

Miggy at 7yrs/5mos. :
January 21, 2010: During one of his speech therapies at Play and Say Therapy Center, Teacher Justin playfully thought of asking Miggy some things that were not part of their lessons. Each question seemed incredibly easy but due to its extreme plainness, we as adults may find it difficult to answer.

Teacher (sipping her milk): Miggy, what is a girl?
Miggy (eyeing teacher's milk): "A girl is someone you use as a she."
T: What is a boy?
M: "A boy is someone you use as a he."
T: What is an animal?
M: "An animal is something you see in the zoo. Teacher Justine, why do you need to drink milk? Because you are thirsty." ... and with one quick swoop, grabbed teacher's milk and sipped!

The next day, I made a follow-up of what-questions with Miggy.
Mommy: Miggy, what is a milk?
Miggy: "A milk is something you drink."
Mom: What is a chicken?
Miggy: "A chicken is something you eat."
Mom: What is a...
Miggy: "Mommy, I don't like what-is. No more what-is."
Mom: What is no more?
Miggy: "No more is gone."
Mom: What is gone?
Miggy: "Gone is the-end. Mommy, the end! Stop talking! I don't like what-is!"
Laughing, I stopped.

First-Day-of-Classes Blues

"No school! Cannot go to school! Teacher is sick! The school is closed," he grunted when I tried to wake him up to get dressed for school. After a few minutes of coaxing, he agreed to go, in one condition:
"And then, we will go to the grocery store."

* Autistic people usually have impaired imagination. They lack the capacity of making up stories and excuses. However, at age 6 1/2, I noticed him making little excuses, such as:
"There's no power," he reasoned when I asked him to turn on the light.
"Because that's so funny!" he said when he was watching the Tom and Gerry Show and I asked him why he was laughing and shouting.

"P- I - Z - Z - A spells pizza"

"Mommy, you cook Bibbo cheese hotdog."
No, that's not your dinner. Your dinner starts with a letter P. You guess.
"Pancit?"
No.
"Papaya?"
No, you don't eat papaya and that's not for dinner.
"Pig?"
Hahaha! No, you guess again. It starts with a letter P, has a triangle shape and has cheese on top.
"Pizza! Mommy, you get the pizza."
Spell pizza first.
"P-I-Z-Z-A spells pizza. Mommy, you get the pizza."

*When asked a question, he answers. When told to do something, he obeys.
I always open a conversation with him. 5 years ago, I would always get no response. But now, look at him, he is conversational. And he looks at me when we are having a conversation. Fruits of labor and love evident.

"I don't want mommy to go."

"I do not want mommy to go to Korea."
I asked why.
"Because the airport is closed and the airplane is on fire."
I told him that I will buy his toys in Korea.
"No toys in Korea. Buy toys at Toy Kingdom, the amazing toy store."
"No more Korea!"
"No toys!"

*My sister's family, my eldest daughter, Clarisse, and I went on a four-day vacation in Korea. It was my first vacation since Miggy was born more than 7 years ago and was my most memorable and priceless bonding moment with Clarisse.

The trip was my first days-off away from autism and into the teenage world of my Clarisse. We had fun, we licked ice cream together, ate Korean street-foods, and shopped (mostly window-shopped). She laughed at my silly jokes. I was amazed at her simplicity and naivety. Amid all the wonders now in front of her, I was surprised to hear her say, "I missed Miggy." Who doesn't? I was always looking at my watch, thinking what he and his daddy had been doing, and where they spent the day.

"Let's go to the grocery store."

Just like any typical morning, Miggy comes up with his list of wanna-buys.

"Mommy, it's time to get dressed. Let's go to the grocery store. I want to buy Tiger energy cream cookie strawberry pop and Wildlife chocolates. Just two only." Miggy said.

How about for Ate? What are you going to buy for Ate?,
I asked.

"C2 green tea," he replied.

Teaching How to Answer What Questions

Children with autism are not skilled in answering questions because they do not really know how to socially interact. However, this can be explicitly taught through visual mediums and effective behavioral techniques. With Miggy, I used positive reinforcement along with the technique. Positive reinforcement can be in the form of praise ("Good job!", "Very Good"). Of course, facial exaggeration and vocal intensity are essential to attract his attention. Reinforcement can also be in the form of food, stickers, stamps, toys or it may be an event such as going to the park, eating out, or simply letting him play with his favorite toy.

Answering WHAT questions is the easiest. I used flash cards of common objects and watched educational videos with Miggy. Children with autism learn fast through visual aids.

Example 1: "What is this? This is a ball." (showing the child a picture of a ball and pointing to it). Do it over and over again. The child learns through constant repetition. If you are using a video, pause the video player every so often. It's okay if the video player gets broken, there are repair shops everywhere and dvd players are always on sale. I tell you, it's worth the education your child will be getting. Also, by modeling "pointing", you also teach your child how to point with his finger which is not inherent in children with autism.

Tip: Never mind if your child may seem inattentive. The truth is, he just doesn't know how to show you that he is interested in some way. He just has a different way of learning. Promise, this is from experience. He may not look interested but actually, he is absorbing everything he sees and hears. You will actually be surprised when he finally and miraculously blurts out what you have taught him minutes, hours, months, or even years ago with the precise words and intonation you used. Just be patient.

Start with simple objects, such as shapes, parts of the body and common foods. Later, when your child has mastered them, move on to animals, numbers, house things, vehicles, action words (with you acting out every action word).

Example 2: "What do you want?"
Teach your child to say "I want ______." (cookie, milk, ...). Then, "I want to_____." (to eat, to drink, to sleep, ....).

Example 3: "What is your name?", then progress on to other complex what questions.

Possibilities are endless. Patience...patience...patience. With autism, nothing is instant. Everything has to be mastered one step at a time.

Note: Every child is different. This may or may not be helpful. But it's worth trying. You know your child very well as much as I know mine. Discover ways to penetrate into his world. Break down those walls. As I have always said, "When the Lord closes the door, somehow, he opens the window."

***My sessions with Miggy are only supplemental to his occupational and speech therapies, academic tutorials and mainstreaming education.