Expert: James Michael Roan - 7/18/2008

Question
Hi Dr. Roan:

I emailed you some months ago about my then 17 month old son who was clearly displaying characterics of autism.  I have an older son, 14, with classic autism.  Anyway, this child who turns two in August has been very different than my older child in that he will make eye contact, he will initiate for things like books, dvds, etc and various sorts of roughhousing and sensory play.  He will occasionally point and vocalize and make eye contact.  He seems fairly flexible and he's definately intelligent.  While my older son had NO receptive or expressive language or ability to imitate at 2, I've managed in the last 5 months to teach this little guy to talk some ( he's got an expressive vocabulary of about ten words that he uses now), he can follow simple directions, he's got great receptive language and can identify all sorts of objects and pictures, he can match colors, etc.  He has no functional or pretend play but will imitate actions with objects if I ask him to.  He's got alot of good skills and alot to work with.  But . . . he engages in worrisome stereotypies:  he likes to look at corners and baseboards, he likes to sort of smack his fingers together, and occasionally I see him picking at his eyelids.  It's been my experience that these behaviors worsen overtime.  I fear that I'm not teaching him replacement behaviors quickly enough.  The function of this behavior does not appear to be for attention or escape.  It is clearly sensory so I've had him on the richest sensory diet I can manage, and yet . . . he still engages in the behavior.  he's starting this fall at a first class ABA/VB center based program and what I want to know is, what can I do right now to perhaps diminish the stereotypy?  Do I interrupt it? I've tried differentially reinforcing appropriate behavior, but I don't think he's made that connection yet.  I'm at my wits end,my gut tells me he should not be practicing this behavior.  Can you please advise?  Thanks a ton,

Teri

Answer
Hi Teri;

Picking at scabs, eyelids, etc. is common in children with Asperger's syndrome. Of course, I'm not saying I think your son has Asperger's syndrome, however I think some behaviors are rooted deeper in genetics and may never fully disappear. It may be better to have a "rule" that he can only pick at his eyelash at home, in the car, etc. It's my experience that most folks are unable to eliminate these behaviors. In the field of neuropsychology, stereotypies occur due to delayed development of the prefrontal cortex on a subcortical (involuntary) level. This area is associated with a set of interrelated functions governing attention, working memory, and sequencing called the "executive functions." I'm not sure how well conventional behavior management techniques will work.

Kind regards,
James