Expert: Trey McGowan - 8/20/2009

Question
QUESTION: Hi, I read one of your answers and was impressed by your detailed response. Our 3 yr old son has a diagnosis of PDD and displays many features you would expect of a child on the ASD spectrum. He does something interesting and I wondered what you would make of it. When he calll our names (mum,mum,mum,mum,mum) he will not respond until you say "yes". Even if you are sitting nose to nose and raising your eyebrows and tilting your head to one side and nodding he doesn't respond until he hears "yes". Is this a classic case of him not reading visual cues?

ANSWER: Hi there, Jo!

The answer to this one is fairly simple: yes. This is definitely a case of either not reading, or not being able to read (there is a slight difference between those two things; one implies he can't learn how to) the visual cues. 'Nodding' is one gesture that many children will learn to get, mostly because it is such a gross and unmistakable gesture of movement. Very likely, it's one your son will pick up in the future. The raise of eyebrows, on the other hand, and the tilt of a head, are ambiguous gestures. What you might see as a very visible 'inquiry', he may not even notice at all, let alone recognize as 'language'.

In addition, the autistic mind learns to associate strongly. Therefore, even if he learns that the nodding of a head indicates 'yes', he probably doesn't recognize that the nod is directed toward his question. He has learned that to get your attention, he asks 'mum mum mum' (or whichever), and your acknowledging him is 'Yes?'. Not a nod, not just quietly looking over, not standing on a chair and dancing the samba (although there would be a sight!), but saying 'Yes?'. That is 'the proper answer' to him, and therefore the one he keeps looking for.

I hope my answers made sense to you! As per usual, questions, comments, feedback, follow-ups, can always be sent here!

Trey

---------- FOLLOW-UP ----------

QUESTION: Thanks for your answer, it has made me want to ask you more, I want to ask you about non compliance and refusal. Our son will often not comply or follow instructions even though he can easily perform the tasks, he seems not to care whether we are happy or frustrated by his behavior,he seems not to listen.Do you know why this might be? Also, he has speech issues and sees a therapist but why, when he can count to 100 and knows every sound of every letter of the alphabet, can he not perform some other very simple tasks? Why is toileting such an issue? Why does he show no interest in dressing himself?Why does he request things with a question, for example if he wants a shower he will say "want shower?" or milk "want some milk?" it's definitely a question not a statement and it mimics me, infact he mimics me and his father a lot in his speech, even down to the tone it was originally said in. Do you know of any good first hand accounts of how a high functioning autistic child sees the world which I could read? (No accounts of bullying or any trauma thought as I am still too new to all this to be able to deal with some people's experiences) Most importantly, will he make friends?

Answer
Hi there, Jo!

Glad that I could help you with your first question. :) As for your others, let's see how many of them can be answered.

Part of the issue with the non-compliance is what is often termed as 'No sense of self'. Essentially, the autistic child has a very simplistic way of looking at the world: it all thinks the same way. It often seems like selfishness, but more accurately, it's that the autistic child is not registering that an individual isn't thinking the way they are. If they know something, they assume that you would know it. Often, the compliance issues are a matter of the child not understanding why they shouldn't do it. They want to. So why shouldn't they do it? Or, as the case may be, they *don't* want to, so why should they do it?

Emotions are one of those big 'Sense Of Self' things. He understands that he feels 'good' and 'bad'. Emotions beyond that might not be something that he can give words to. Likewise, because *you* are feeling it, he doesn't understand it since *he's* not. He's not deliberately trying to hurt you. He simply doesn't understand what 'hurt you' is at the moment. It's difficult to explain in words, unfortunately, but I'm trying my best. ;)

Toileting and dressing can be an issue for a few different reasons. With dressing, it's likely because he dislikes the way the clothing feels on his body, or the annoying way he has to do this up or pull that on. Certain materials might feel like steel wool rubbed across his skin. Being sensitive to various clothes and other sensations is very common among autistic individuals. Maybe trying some other clothing might be a help. Try looser or tighter clothes, if that seems to be a problem. Give him some materials that are a different texture to the usual. For instance, forego scratchy wool (a very common unpleasant sensation) and try something smoother, like soft cotton, smooth nylon, et cetera. You probably won't even need to buy expensive materials. Just find a similar 'sensation' to one the child doesn't mind touching and wearing for long periods of time. Also, try clothing that is easier to wear. Avoid buttons, snaps, zips, laces, et cetera if possible. Velcro for shoes (or slip-ons for the warmer weather), simple elastic waists and pullover sweaters and shirts. Things that he might be able to tug on himself. It won't be a miracle, probably, but it might help with some of the dressing issues. And if he simply won't dress himself, you may need to put your foot down and simply tell him that he has to get dressed for such-and-such place. If he doesn't, then you simply can't go because naked children are not allowed. Obviously choose a 'positive' place for this; it wouldn't do to try and teach him that if he refuses to dress, he can't go to school or the doctor, after all.

Toileting, on the other hand, can be quite difficult. There can be a number of reasons for problem toileting. Some of them are physical, with the child simply not recognizing in time that they need to go *now*, or in having physical problems with bowels or bladder. Obviously, a doctor's visit should be done to rule this sort of issue out. If there is nothing physical, then most likely the toileting is an issue of the child simply getting too caught up in something he is doing, and not realizing that 'it's time to go'. Two good ways to help deal with this are to essentially schedule 'breaks' for the child, and make them regimented, and to deal with the child's accidents by showing them the responsibility involved in cleaning it up, taking a bath, or whatever else is needed to get the mess clean. In this way, it will start being obvious that it impacts him. And unfortunately, as some autistic children do not have an instinctive recognition that their own waste is 'dirty' and 'could make them sick', you may need to appeal to them in that fashion.

The speaking of a question in the way you describe is a communication issue known as 'echolalia'. It's just as you say: it's mimicking the ones that he's speaking to in order to, essentially, attempt to get the message across. This is often characteristic of ASDs and is not at all uncommon. Many children will grow out of it, particularly if they are under speech therapy. It is not stupidity on the part of the child, but simply a difficulty with using words in the way they should be. In effect, he's just having problems understanding how sentences are put together, and by mimicking you, he is able to get at least one sentence right and try to get the thought across.

One thing you can do to help the echolalia is to answer the child's question: "Do you want to go to bed?" "Yes. I think you do want to go to bed." Or, "Want some milk?" "Yes, please. I would like some milk." Again, demonstrating the appropriate pattern of words, and the child should hopefully start to mimic the 'right' ones once he understands.

Finally, a lot of accounts on how they see the world are life stories. While I understand your dislike for the unpleasantness, a lot of these life stories are filled with both the good and the bad. However, I can make a few suggestions that are as positive as possible:

http://tinyurl.com/lcmzyy
Thinking in Pictures, Expanded Edition: My Life with Autism
Temple Grandin
Dr. Grandin is an individual with autism who has moved above and beyond it. However, this book is an expanded view into her world, and how she sees it.

http://tinyurl.com/m9g5k3
The Unwritten Rules Of Social Situations
Temple Grandin
The viewpoint of the world from two autistic individuals: Temple Grandin and Sean. Understand that this may cause some tears, but at the same time, the tears are not from trauma, but from the strength of emotion that the book can bring.

As my library contains a lot of Temple Grandin books, they are the first ones I thought of to point out to you. If they are unhelpful, or if you need something different, feel free to give me a shout and I'll see if I can't suggest some more!

As usual, further questions, comments, feedback, and follow-ups are welcome!

Trey

EDIT: Forgive my earlier 'swearing', as the word 'ASDs' was apparently caught and changed by the spellchecker into a certain portion of rear anatomy. I wasn't deliberately calling your son an ass. ;)

SECOND EDIT: As I was researching for another questioner, I happened to come across this website that I thought would be interesting in an 'account on how they see the world'. It's not from the literal autistic viewpoint, but it is *very* well explained, as well as some examples to show how that portion of the thought process works
http://www.jonathanschild.com/explaining_mild_autism