Susan's Blog

Wednesday, June 20, 2007

Getting Closer to Fine

I went to the doctor, I went to the mountain
I looked to the children, I drank from the fountain
There’s more than one answer to these questions pointing me in a crooked line.
–Indigo Girls

There are three major components to understanding another human being: close observation of his behavior and drives; recognizing what is similar in ourselves; and then feeling what the truth is. I truly believe that if we understand what we ourselves do, our motivations, agendas, drives, and needs, then we can start to understand the people in our life, on the same meaningful level.

I’m still trying to understand why Nat has these disturbing fits. Often they are around the dinner hour; last night, for example, he worked himself up to terrifying screaming because he wanted Ned to use the chili powder, but Ned did not want to. We had to let him scream it out, pretending it wasn’t happening. Do not reward the negative behavior; reinforce and reward the desirable behavior. You think I like that? A behavioral solution? No, I don’t. But what else can others suggest? Particularly the ASD readers. Give me real advice I can use, if you can. I try keeping things very regulated and regimented; I tell him “first — then;” I talk him through the upsetting thing by repeating what he wants to hear. I hug him when he asks for a hug, which he often does. But I just found out today that these tantrums also have been occurring on the bus as he sits in the line waiting to be brought into school. He pinched his driver today, too. She told me how she responds to his screaming, and it sounded like what I do. We calmly and gently reassure him many, many times that the thing he is waiting for will happen in so many minutes. He likes the certainty of exact time, even though we are not sure that he can actually tell time by looking at a clock. He nevertheless has a real feel for the passage of minutes, hours, days, and weeks. And Denise, the driver, is now going to try to reduce the waiting time by arriving later in the afternoon and earlier in the morning.

With all that in the back of my mind, I discussed some of my own issues with my therapist today. How sometimes continual success and peace raise my anxiety levels, counterintuitive though that may seem. It’s like when things are going too well, I find myself thinking, “Wait, wasn’t there something that was bothering me, though?” And I feel the flicker of anxiety, worry without a name or shape. Then I search for that thing, plumbing the dimmer regions of my brain like a tongue hunting for a cold sore.

We talked about how this anxiety probably arose long ago, when there was some kind of disconnect between something I did and how it was received by my family. Such anxiety, I think, goes way back to childhood feelings of rage and impotence, the most primal fears of abandonment and death that we experience while very young. But we learn over time that we will survive this or that disappointment, betrayal, anguish. But I may not have learned it so well.

I flashed to Nat, suddenly, rather than any association with my own childhood. I thought of how much he is achieving in school lately; his last progress report had 17 goals achieved and only a few progressing. He is successfully employed by Meals on Wheels, he is mastering his community purchasing, his telephoning, his typing, his reading comprehension, his sports, his conversations, his interactive leisure time. All day long, from 8:30-3, he has teachers asking him to try this or do that, and when he does, they praise him. We see it here, too. So much great language, willingness to do his chores, his routines.

So then I wondered, does Nat, like me, feel a heightened anxiety that accompanies his own success, strengthened by his tiredness from all the hard work he does? Does he feel afraid of all the change he himself has wrought, through his determination during the school day? Does he feel, irrationally perhaps, that he will be cast into a scary, unknown, place if he allows change to occur? Because those are my feelings, so I wondered if this kind of anxiety for the next step — literally, the next phase, the transition — causes him to flip out.

Sure, we are not the same person, and perhaps he is actually blessed, like his father and brothers, with a stronger core. But I suspect he and I share a fragility that is shaped by our neurology and our childhoods, somehow. Anyway, I feel it, more than know it but sometimes that is closer to the truth than anything the data can show me.

11 comments

I wish I had some words of wisdom for you, but as I am only just starting to get my own feet wet on this whole ASD thing, the best I can do is send you hugs and positive thoughts.

— added by Kirsten on Wednesday, June 20, 2007 at 6:10 pm

I know there are a lot of deeper issues here that I am not qualified to get into, but for the simpler ones, I will tell you what we do.

With the dinner, I might be tempted to split the contents of the pot into two pots and put the seasoning into one and not the other. It may not work, but then again, maybe it might. Maybe Nat just likes it that way and he might go for that.

Charlie always needs background noise. I hit on something here that has nearly stopped our screaming. “If you are screaming, the TV (radio, whatever) goes off.” I have the remote and off it goes. He settles down. “Use your words.” I tell him all the time.

We are in that phase where when he actually verbalizes, we try to accommodate him as best we can, we can’t always, like if he wants to go to K-Mart and get a toy, but sometimes we can find a way to make things work for him based upon what we are willing to do. We love to reinforce the words.

If Nat had said to you, “Want chili powder” you might have gone ahead and done it, rather than having been bullied by screams. We really try use those situations of screaming to get him to verbalize anything.

Also, we have this cool timer that he might really enjoy. Here’s a link:

http://www.autismuk.com/index%20timer.htm

When the red goes away, the time is up. Charlie loves it.

— added by Mom on Wednesday, June 20, 2007 at 6:15 pm

Sorry, me again, here is an item number of one timer I found on ebay:

260127710181

good luck, hang in there!

— added by Mom on Wednesday, June 20, 2007 at 6:17 pm

the answer will find you one day. maybe there IS no answer-but if there is you will figure it out. I suggest you guys just make sure YOU are all able to handle it since you cannot change it at the moment. what else can you do? When my son screams like that I make him leave the table. he screams in another room and when he is done, he comes back. whatever you decide to do-stick with it(you already know that).

— added by Anonymous on Wednesday, June 20, 2007 at 9:40 pm

Oh Susan! I cried tears of joy when I read about Nat’s gold metal in backstroke, and saw the soft-focus picture that was so pregnant with “what-ifs”! We are also going through a terrible time with Max and trying to tease out what part of his “tizzies” constitute poor behavior/aggression as opposed to terror/anxiety. His “tizzies” are coming fast and furious these days, with not one 24 hour hiatus in the mix! I think you’ll agree with me that it is often the times that there are the greatest number of breakthroughs and positive developments for our guys that are — on the other hand — rife with intense negative behaviors. Like Gang Of Four sings: “2 steps forward; six steps back, six steps back… ” Hang in there! I emphatically empathize! – T Peacock

— added by Anonymous on Wednesday, June 20, 2007 at 10:50 pm

Oh Susan! I cried tears of joy when I read about Nat’s gold metal in backstroke, and saw the soft-focus picture that was so pregnant with “what-ifs”! We are also going through a terrible time with Max and trying to tease out what part of his “tizzies” constitute poor behavior/aggression as opposed to terror/anxiety. His “tizzies” are coming fast and furious these days, with not one 24 hour hiatus in the mix! I think you’ll agree with me that it is often the times that there are the greatest number of breakthroughs and positive developments for our guys that are — on the other hand — rife with intense negative behaviors. Like Gang Of Four sings: “2 steps forward; six steps back, six steps back, six steps back, six steps back… ” Hang in there! I emphatically empathize! – T Peacock

— added by Anonymous on Wednesday, June 20, 2007 at 10:53 pm

When my son is screaming (usually at the top of his lungs) I give him a verbal warning with a pecs card showing “time out in room.” He screams his head off in his room. It’s hard to balance. He has a brother who is a year older, his brother begs for me to send him to his room because the screaming is very upsetting to his brother. It’s tough but I know if I give in I’ll just be encouraging more screaming. I’ve tried waiting his screaming out in the past and it’s never worked and in fact got worse followed with headbangs on the floor and food bowls flying. I think the time in his room may help.

— added by KC's Blog on Thursday, June 21, 2007 at 12:49 am

About the only advice I’ve heard from people with ASD on screaming and tantrums is try to look for what causes it. If it’s overload (and you may know it isn’t, but I can’t tell by your post), a certain sensory stimulus, a lack of certain stimuli, or having too much pressure and work can set off a meltdown. Does he tend to react this way to certain situations? Certain sounds, or trying to do certain things? If there is something, it might help to look for a work-around.

Alternately, if this is him being angry, difficulty expressing himself, or not thinking that he gets heard could be contributing to the blow-ups. A lot of autistic adults who can talk choose not to use it as their only means of communication, precisely because many find the effort too tiring. Have you looked at alternate means of communication? Adding another means of communicating won’t necessary replace talking, but might supplement it. Or if Nat doesn’t think he gets listened to without tantrums, it might help to encourage people around the house, at school, or wherever, to make sure they acknowledge him.

This is all just speculation and ideas, though. It could just be the autistic version of ordinary adolescent temper, or something completely different.

— added by Anonymous on Thursday, June 21, 2007 at 3:02 am

My kids are too young for me to have any real advice. The only thing that stuck out is that maybe he needs more input into the making of meals? Sounds like for some reason that’s a really tough time for him. Have you asked him?

With Patrick being only 5 we’re still at a stage where we can’t always differentiate between autistic behaviours and 5 yr old behaviours.

— added by mumkeepingsane on Thursday, June 21, 2007 at 9:46 am

I have worked in residential services for over twenty years and anecdotally, we refer to dinner time the “cocktail hour”. Many people experience difficulty during the transition between afternoon and evening exacerbated during meal prep. for dinner. You are undoubtedly doing everything right up to the screaming and the suggestion others have made here of time out is the one thing I have seen that works. It is not okay to scream when one has other modalities, like words and pictures available to them. Time out is not used as punishment but used as an alternative place to go and “let it out” without disturbing others around you.

— added by Anonymous on Thursday, June 21, 2007 at 10:56 am

Dinner time has always been the witching hour at our house. As I’ve said, when Jared took Abilify, his meltdowns numbered 5-6/day, and were notably more frantic and anxious. We’ve had about 3 months of good results from Invega, a reformulation of Risperdal. Jared’s agitation has diminished significantly, and when he does get frustrated, he’s less likely to lash out.

A lot of autistic children I know seem to follow a lunar cycle, losing it right around the full moon. If Nat follows some such pattern, maybe making him aware of it could reduce it. “oh, Honey you’re upset, let’s go see if the moon is full” Maybe that distraction would be good, maybe it would just confuse the bejeebies out of him.

We also got Jared in the habit of responding to “Jared, are you all right?” with “I’m okay” and this rote response does a great job of ramping down the intensity. When we first started with this, we were trying to get Jared to answer questions with a yes or no, instead of just repeating the end of the phrase when he meant “yes”, and working on eye contact. So when he’s yelling in another part of the house, we can guage if he’s hurt or just mad that his toy stack fell over. Helping him calm himself from a remote location is a great luxury.

Like Jan said, removing a desired item or activity to get the negative behavior to cease is also effective at our house. Following that up with a hug, reinforces his attempts at self-control.

Lastly, if the screaming doesn’t end quickly or seems to increase, we would remove him from the room, although that can be tricky.

Good luck, at least we all know we’re are not alone in trying to crack this code.

— added by Lisa on Thursday, June 21, 2007 at 11:47 am