Expert: James Michael Roan - 5/31/2006

Question
My five year old son was diagnosed with autism at the age of
three.  He has recently started to exhibit behaviors that we think
may fall into the OCD spectrum.  For example, he was riding his
bike up our slanted driveway and fell.  I rolled the bike so he
wouldn't slide into the street.  He screamed and begged to "try
again" for 45 minutes.  Unfortunately, through past experiences,
I know that he would have stayed in the driveway for hours
crying hysterically because he wouldn't be able to pedal up the
drive.  He will repeat sequences frequently if they didn't go as
planned.  For example, if his shoe falls off, he must put the shoe
on and walk back to his original position to begin his walk again.  
If he asks for help and you answer, he'll scream to do it again so
he can "pretend" that he knew all along.  Is this OCD? We are
trying to redirect without success.  He becomes so manic that
we can't get him to focus on anything.  Help is appreciated.

Answer
Hi LaDonna;

Actually, this is not OCD behavior. It comes under the heading of "repetitive, stereotyped behavior." There are a couple of things contributing to this behavior. First, children on the spectrum have concrete thinking styles versus abstract/flexible thinking styles. The result, is difficulty with transitions and dealing with circumstances where expectations do not meet up with outcomes. That does not mean they cannot learn some degree of flexibility, they can. You have to program it by slowly introducing different routes to school or Grandma's house. You can use advance verbal organizer's by asking them if they can consider multiple outcomes. Story time is good for this.

Also, children on the spectrum have difficulty with executive functioning or the ability to attend to social and contextual determinants of importance. In other words, children may not be able to shift attention from an activity of choice to the teacher when they walk into the room to teach class, or, they may be unable to attend to a call for dinner when engaging in an interesting activity. This difficulty is referred to as monotropism in the literature. This cognitive profile, though frustrating to parents and teachers, can in adulthood, lead to success in their chosen careers.

So, in conclusion, prepare your son for change (flexible thinking) with visual cues where and when possible. Get him used to change by varying his routines a little at a time. Discover subjects of high interest, so when he begins to break down you can distract him by asking him something about his interest area. I hope this helps.

Kind Regards,
James