Expert: Dr. Sharon A. Mitchell - 11/7/2008

Question
My 17 yr old foster son, a refugee from Myanmar, has been with me since Mar 08. There could be many reasons, totally unrelated to Autism, which may explain his behavior, but he does exhibit some autistic characteristics. For this reason the first foster parents felt they were not prepared to have this child in their home. Having spoken to them recently and shared some of his confusing behavior (no touching, happy one minute and the next shuts down. Will not respond to simple questions even after several repetitions, has anxiety over any new experiences), how does a parent show love to their child if they cannot be touched? I'm from a French family and we we do a lot of kissing and embracing and it can be frustrating to not be able to show him in this manner that we love him. Recently he was very disappointed that I would not accompany him to visit the city with my older married son, wife and their 4 yr old daughter. He had not met them before. I think he felt more comfortable with someone familiar being with him. He has a tremendous ability to be very gentle and patient with my grandaughters. When he shuts down and doesn't answer a question, should we say," It's OK we understand" and dismiss it? After a few hours of solitude, he seems to come out of it. During a heart to heart private meeting, I explained my concern about his behaviour and that we could find some help for him. He dismissed it almost jokingly and told me not to worry about it. I borrowed a friend's car. She is a nurse and left her stethoscope in the car. I put it to my ears and was about to place the pad on his back..He became very anxious and insisted...."please, please don't do that". When a Dr had used the scope, he had no objection. He does not, to my knowledge, shut down in school. All the teachers love him. Would appreciate any suggestions. There is no knowledge of past parental abuse. He did experience abuse by government authorities in Myanmar.

Thank you

Answer
Bless you for the care and concern you're showing for this young man.

You're quite right that there could be many reasons for the behaviors you see, many of them unrelated to an autism spectrum disorder. From what you describe, no, autism would not be the first thing that comes to my mind.

Although the symptoms of autism can be more pronounced in some situations and under stress, a person isn't just sometimes autistic. You say that the shutting down you observe only happens some times and not at all at school.

I think there are other factors that better explain what you're seeing.  If you're seeking labels, the two that may be possibilities are:
- Reactive Attachment Disorder
- Post Traumatic Stress Disorder

I'd make these guesses based on the fact that this boy is a refugee from an area that has seen much upheaval. Perhaps we'll never know all the horrors this child has seen or lived through. Such experiences can lead to Post Traumatic Stress Disorder. With this condition, the person lives in a state of high anxiety. The level of anxiety may come and go but it's always there, lurking in the background. It's hard to feel safe when bad things have happened to you and to those around you. Even when your head tells you that you're now in a safe place, your heart still remembers the state of hyper vigilance you had to maintain just to stay alive and whole.

Under such circumstances, predictability and routine can go a long way toward making this boy begin to feel safer or at least that he does not to be on high alert all the time. Learning that he can rely on certain people will greatly help him although that trust may not be easily won.

It's a compliment to you that he was disappointed when you did not accompany him on that with your older son. You must represent security to him.

When you're lived through great strife, the unknown is frightening. Just because he's been safe so far in your home and safe at school, how does he know he'll be safe with your son, whom he has never before met? How does he know they'll take him someplace safe? Will they bring him back? Will he run into authorities like those in Myanmar who did not treat him well?

When he shuts down he may be feeling overwhelmed by all he's experiencing in his new life. Think about operating in a new language, a new culture, new foods and expectations people have of you. And at the same time missing all that you knew in your earlier life.

As well as feeling overwhelmed, he may be mourning something from the life he used to know. Or even more likely, something has triggered a flashback and he's recalling some experience in his life before he came to your country.

Yes, I think you're quite right - give him space during these times. Rather that say "It's OK" and that you understand at such times, could you just say nothing and let him be for that space of time? As long as he knows you're nearby and are there for him, he might need these small amounts of time as a way of working through some of his past traumas.

Does he talk to anyone about his earlier experiences? If not, it may help, if he's willing. Does he like to write? Draw? Even if he does not see a counselor, sometimes drawing can be therapeutic, or writing, for some people. Encourage him to keep a scrapbook of his drawings and let him choose to keep them private or share his story with you or another person he trusts.

Here's some information on Post Traumatic Stress (PTSD):

- http://kidshealth.org/teen/your_mind/mental_health/ptsd.html

- http://www.canadianimmigrant.ca/health/psychology/article/798

- http://www.krisochtraumacentrum.se/pdf/HPS_diss.pdf

You mention that you're French and a family that welcomes touch. As you know, showing physical affection is a practice that varies among cultures. I'm unfamiliar with that aspect of Myanmar culture but it may not be an accepted practice in that country or only used with small children. At seventeen and especially given the experiences this young man has been through, he likely considers himself closer to adulthood than childhood.

Also kids who have experienced abuse and other physical traumas are typically wary of touch, even touch from those they know well. I'd suggest that while you're physically affectionate amongst your own family members, let this boy initiate any physical interaction between you. If you wish to put your hand on his shoulder, pat his arm, sling an arm  across his shoulders, approach him from the front so he can see what you're going to do. Announce any intention to shake his hand or give him a hug. He'll be more likely to welcome you embrace or your touch if he's not startled by it. And try to respect his reluctance. It is likely not a personal rebuff, just a factor of his culture and past experienced.

Another thing he could be experiencing is Reactive Attachment Disorder (RAD).

In order to develop normal social relationships and appropriate levels of emotional self-regulation, children need to have stable, reliable caregivers in their first few years of life. Without these loving adults to rely on, kids fail to learn to "attach" well to others. Such children do not trust easily. They manipulate their environment in an attempt to make others like(and therefore provide for them).

Sometimes parents are so wrapped in their own struggles that they're unable to provide a safe, caring, stable environment for their child. In war-torn countries where survival is at stake, the care parents would like to lavish on their child may just not be possible in the face of life and death situations.

Much of Myanmar has been embroiled in conflict for a long time. Refugees fleeing to Burma still live in uncertainty and hardship. It's hard to know just what your foster son has experienced or if he had the opportunity of even a few good years with his birth family. Even when he first went into foster care, he was not safe and stable - the other family felt they could not keep him, necessitating another move. Now, it must be very difficult for him to feel secure.

Kids with RAD

Again, as with PTSD, talking to a trained counselor would be helpful.

Here's some information on Reactive Attachment Disorder:

http://www.helpguide.org/mental/parenting_bonding_reactive_attachment_disorder.h...

http://members.tripod.com/~radclass/

http://www.mayoclinic.com/health/reactive-attachment-disorder/DS00988/DSECTION=s...

And this last one is full of suggestions for teachers:

http://www.brandonu.ca/academic/education/exceptional/Reactive%20Attachment%20Di...

This young man is very lucky to have ended up in your home.

I wish you and your family all the best,

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca